Noma Bolani has a clear memory of her abusive father stopping the car in the middle of the highway in Durban, South Africa and asking her mother to get out. 

She was just six years old, but Bolani followed her mother out of the car, and together they sought help from a passing motorist. 

Bolani is now 38, and has anxiety stemming from early childhood experiences related to growing up with an abusive father and witnessing her mother being at the receiving end of emotional and financial violence.  

Ayesha*, 34, from New Delhi, India, grew up watching her mother being subjected to physical, emotional and financial violence from her father. He would sometimes also resort to silent treatment that would last weeks, refuse to pay school fees for Ayesha and her sister and resort to physical violence using belts, shoes and, at times, utensils.  

Ayesha suffers from Polycystic Ovary Disease (PCOD) that affects the regularity of her periods and causes hormonal changes. Her doctor believes the stress she was subjected to as a child played a significant role in worsening her PCOD.

Like Bolani, Ayesha also carries mental health scars from watching violence directed at her mother.

When mothers are at the receiving end of violence, it can make their children physically ill, according to a growing body of research. 

Impact on children’s health

Health data from 37 countries in sub-Saharan Africa found that children under the age of five whose mothers experienced intimate partner violence (IPV) were more likely to develop diarrhoeal disease and symptoms of acute respiratory infections, according to a study published in The Lancet last year.

It called for tailored interventions to address childhood morbidity and mortality attributed to IPV in “priority countries” – Burkina Faso, Burundi, Chad, Comoros, Gabon, Liberia, Nigeria, Sierra Leone, South Africa, and Uganda.

“The most important thing is actually the cumulative effect,” said Abel Dadi, lead author and a social epidemiologist at the Menzies School of Health Research at the Charles Darwin University in Australia.

His study looked at exposure to three kinds of violence – physical, sexual and emotional. “When they come together, their effect increases,” he said.

Dadi’s team also found a strong link between IPV and stunting in Burundi, and IPV and children being underweight in Burkina Faso, although the results were not consistent across all countries. 

What is not yet clear is the exact pathway of how IPV directed towards the mother affects a child’s physical health.

Pervasive violence

The World Health Organization (WHO) recognizes that violence against women is a major public health issue. Globally, one third (27%) of women experience IPV in their lifetime, according to WHO figures. In sub-Saharan Africa, these rates are even higher, with 45·6% of women experiencing IPV in their lifetime.

Young women aged 15 to 19 are the most affected by IPV. By the time they are 19 years old, almost a quarter of adolescent girls (24%) who have been in a relationship have already been physically, sexually, or psychologically abused by a partner, according to WHO data.

However, while it is widely accepted that intimate partner violence affects a woman’s mental, physical and sexual health at risk, its impact on children has not received the same attention. 

But a child’s health and well-being are completely dependent on their mother during pregnancy, and heavily dependent in the early years, so a mother’s health and well-being directly affects her child’s health.

The WHO, which developed a toolkit with UN Women to prevent violence against women in 2019, acknowledges that violence against women and against children often occurs in the same household. 

Psychiatrists like Bessel van der Kolk, who wrote ‘The Body Keeps the Score’, and Gabor Mate, author of ‘The Myth of Normal’, have also brought the lifelong impact of childhood trauma into the public domain, particularly of growing up with abusive parents.  

But IPV has long been seen as a criminal issue rather than a health issue. In India, for example, hospitals have only recently started to offer health workers training to see it as a public health problem.

“I don’t think it is a well-understood field of work in terms of a response from the courts or from the state’s response to children’s rights,” said Julie Thekkudan, South Asia consultant at Equality Now, a global non-profit that advocates for women’s and girls’ rights. 

There has been progress, with signs that IPV is reducing in some low- and middle-income countries due to progress in women’s empowerment.  

The reason women find it hard to leave abusive relationships, especially in the Global South, is that they have been socialized to tolerate violence, according to Thekkudan.

In societies that favour sons and devalue daughters, girls are socialized into believing that their “purpose in life is to get married”, she explained. Staying in a marriage, even if it is abusive, and seen as part of “making sure that your family honor is maintained”, Thekkudan added. 

That, in addition to the fact that women don’t always have the financial ability to leave, makes it a harder choice. 

Dadi said that any intervention design on maternal health should consider intimate partner violence as well as the mental health of the mother. Currently, most of these kinds of interventions are concentrated in high-income countries, according to research.

On average, countries that do better on gender equity indexes usually also experienc lower levels of violence against women, according to takeaways published in The Lancet.

But a woman’s higher economic status can also make her vulnerable. One study from sub-Saharan Africa showed that women’s employment, especially if they were the sole earners or if they earned more than their male partner, was linked to a higher level of intimate partner violence.

Any solution “has to be a multi-pronged, multi-level”,  said Thekkudan. “I don’t think there is one solution that will change the entire system or the structure.”

*Name changed to protect identity

Image Credits: Photo by Alex Pasarelu on Unsplash, BMGF, World Bank.