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Social Science & Medicine 72 (2011) 1534e1554

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Social Science & Medicine


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Impacts of domestic violence on child growth and nutrition: A conceptual review of the pathways of inuence
Kathryn M. Yount a, *, Ann M. DiGirolamo b, Usha Ramakrishnan a
a b

Hubert Department of Global Health, Department of Sociology, Emory University, 1518 Clifton Rd. NE, Room 7029, Atlanta, GA 30322, United States Care U.S.A., United States

a r t i c l e i n f o
Article history: Available online 12 April 2011 Keywords: Domestic violence Early childhood growth Early childhood malnutrition Review

a b s t r a c t
Domestic violence against women is a global problem, and young children are disproportionate witnesses. Childrens exposure to domestic violence (CEDV) predicts poorer health and development, but its effects on nutrition and growth are understudied. We propose a conceptual framework for the pathways by which domestic violence against mothers may impair child growth and nutrition, prenatally and during the rst 36 months of life. We synthesize literatures from multiple disciplines and critically review the evidence for each pathway. Our review exposes gaps in knowledge and opportunities for research. The framework also identies interim strategies to mitigate the effects of CEDV on child growth and nutrition. Given the global burden of child malnutrition and its long-term effects on human-capital formation, improving child growth and nutrition may be another reason to prevent domestic violence and its cascading after-effects. 2011 Elsevier Ltd. All rights reserved.

Introduction Domestic violence against women is a global problem. In North America and Europe, as well as Africa, Asia, Latin America, and the Middle East, 11%e71% of women have reported prior physical domestic violence (ICF Macro, 2010; Johnson et al., 2008; Tjaden & Thoennes, 1998), and sexual and psychological forms often cooccur (Kishor & Johnson, 2004). Domestic violence against women is more likely in early marriage and pregnancy (Kishor & Johnson, 2004), and young children, who rely on their mothers as primary caretakers, are likely to be exposed. Global estimates of childrens exposure to domestic violence (CEDV) are lacking; however, some 15.5 million American children are exposed annually (McDonald, Jouriles, Ramisetty-Mikler, Caetano, & Green, 2006), and those under ve years are disproportionate witnesses (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997). CEDV predicts poorer health and development in early childhood (Bair-Merritt, Blackstone, & Feudtner, 2006; Kitzmann, Gaylord, Holt, & Kenney, 2003; Wolfe, Crooks, McIntyre-Smith, & Jaffe, 2003), but its effects on nutrition and growth prenatally and through the toddler years (to 36 months) are understudied. This gap is surprising, given the global burden and consequences of malnutrition in these periods (Bhutta et al. 2008; Black et al., 2008; Underwood, 2001).
* Corresponding author. Tel.: 1 404 727 8511; fax: 1 404 727 4590. E-mail address: kyount@sph.emory.edu (K.M. Yount). 0277-9536/$ e see front matter 2011 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2011.02.042

In poor countries, about 112 million children less than 5 years are underweight (weight-for-age z-score or waz <-2 SD from reference median), 178 million are stunted (height-for-age z-score or haz <-2 SD from reference median), and levels of stunting are 8%e50% (Black et al., 2008). Vitamin-mineral deciencies, especially of iron and zinc, are widespread and predict higher risks of child morbidity and mortality (Black et al., 2008). Anemia, a low blood-hemoglobin [Hb] concentration often resulting from iron deciency, affects roughly two billion people globally and especially pregnant women (w50%) and young children (w48% in 0e2 year-olds and 25% in 3e5 year-olds) (Allen & Casterline-Sabel, 2001). Malnutrition prenatally and the rst years of life has adverse effects across the life course, including low birth weight (LBW), infant morbidity and mortality, impaired early childhood growth and development, and various human-capital outcomes into adulthood (Martorell, 1995, 1997; Ramakrishnan, 2001). Despite what is known separately about domestic violence and early malnutrition, their inter-relationships are understudied. We propose an evidence-based conceptual framework of the pathways by which CEDV may impair growth and nutrition prenatally through the toddler years. Our conceptual review integrates literatures from multiple disciplines, providing a synthesis of theory and research. We critically review the evidence for each pathway, identifying gaps in knowledge and opportunities for research. The framework helps to identify interim strategies, short of eliminating domestic violence, to mitigate the effects of CEDV on child growth and nutrition during these critical periods for subsequent human-capital formation.

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The rest of the paper is organized as follows. We rst describe denitions of domestic violence and childrens exposure to it. We then discuss prior research on the effects of CEDV, noting its focus on developmental outcomes in school-aged children in North America (and its oversight of nutritional outcomes among younger children in poor regions). To motivate further our path framework, we review (limited) research in children generally under six years of the total effects of CEDV on growth and nutrition. We then describe our conceptual framework and review evidence for each pathway linking CEDV to poorer growth and nutrition in the prenatal, infant (0e11 months), and toddler (1e3 years) periods. We conclude with discussions of the ndings, gaps in knowledge, and opportunities for research and intervention. Dening domestic violence and childrens exposure Domestic violence refers to assaultive and coercive behaviors that adults use against their intimate partners (Holden, 2003, p. 155). The aspects of domestic violence with potential implications for children include its type (psychological, physical, sexual), specic acts (threating, hitting, using weapons), severity, injurious effects (bruises, hospital visits, death), and timing, frequency, duration, and age at exposure (Holden, 2003). Other dimensions with possible implications for children include its escalation, type of perpetrator, perpetrators relationship to the child, victims behavior during the assault, and outcome of the assault, such as apology, submission, or continuation (Holden, 2003). Childrens exposure to domestic violence (CEDV) includes direct prenatal exposure and direct or indirect involvement (Holden, 2003). Direct prenatal exposure refers to physical trauma or exposure to an altered uterine environment as a result of a pregnant mothers experience of domestic violence. Direct involvement includes participation in an assault, intervention on the victims behalf, victimization from verbal or physical abuse during an assault, observation (or over-hearing) of an assault, and the initial or longterm effects of an assault, including residential displacement, incarceration of the perpetrator, altered parenting, and/or maternal psychological challenges. Indirect involvement includes being told of or hearing about the assault or being ostensibly unaware of it. Despite these standard denitions, their use in research is limited (Edleson et al., 2007). Prior research on CEDV Prior research on domestic violence and children has focused on its co-occurrence with child maltreatment (Jouriles, McDonald, Smith, Heyman, & Garrido, 2008), or acts of commission or omission by a parent or.caregiver resulting in potential or actual harm to a child (Leeb, Paulozzi, Melanson, Simon, & Arias, 2007, p. 11). Prior research also has stressed the effects of CEDV on childrens behavior, social competence, and emotional and psychological status (Evans, Davies, & DiLillo, 2008; Kitzmann, Gaylord, Holt, & Kenny, 2003; Holt, Buckley, & Whelan, 2008; Ribeiro, Andreoli, Ferri, Prince, & Mari, 2009; Wolfe et al., 2003) mostly (e.g., Wolfe et al., 2003), but not entirely (e.g., Ellsberg et al., 2000; Ribeiro et al., 2009) in selective U.S. samples. In several metaanalyses (Evans et al., 2008; Kitzmann et al., 2003; Wolfe et al., 2003), CEDV has adversely affected emotional and behavioral development in children three years and older; yet, the included studies were of varying quality and limited mainly to U.S. samples. Other limitations of prior research on CEDV are notable. In one review (Edleson, 1999), only 31 studies separated physical from other forms of marital conict, measured other co-occurring violence, claried the sample and measurement procedures, assessed the socio-demographic attributes of children, or applied

rigorous qualitative methods. The 31 studies that met these criteria had other drawbacks, including case-control designs, purposive samples from selective populations, small samples (n < 250 for 20 studies), the grouping of 3e6 year-olds (when studied) with older children, maternal report of psychosocial and behavioral outcomes, an inability because of study design to assess the moderating effects of community context, and poor representation of non-U.S. populations, with only two studies being non-U.S. based and none conducted in populations with prevalent child undernutrition. Thus, the effects of CEDV on growth and nutrition prenatally through 36 months (a critical period for growth and development) are understudied, especially in poor, malnourished populations. Total effects of CEDV on malnutrition in childhood To clarify this gap and motivate our path framework, Table 1 describes the 13 studies we identied that assessed the total effects of CEDV on growth and nutrition in various periods of childhood. Six of these studies were conducted in the last 10 years, conrming the newness of this topic. A majority were conducted in North America (5) and Western Europe (3), exposing the gap in knowledge for poorer regions. Almost half were based on case-control (4) or crosssectional (2) designs, and only one was based on national samples, limiting the capacity to make broader inferences. A majority (8) included samples of fewer than 500 children, and only four focused on children under three years. Moreover, the types of domestic violence assessed, and tools for assessment, differed widely (Table 1). Finally, the studies controlled variously for other confounders, such as co-occurring violence (e.g., Karp, Scholl, Decker, & Ebert, 1989; Olivan, 2003). Thus, cross-study comparisons and generalizations beyond most samples warrant caution. In this context, the ndings from case-control studies were mixed. Two found no difference in Hb concentration or anthropometry in infants and 2e6 year-olds by maternal exposure to physical domestic violence (Arcos, Uarac, & Molina, 2003; Attala & McSweeney, 1997); yet, matched case-control studies found associations between the number of violent parental disagreements and non-organic failure-to-thrive (Bithoney & Newberger, 1987) as well as severe physical violence and the adjusted odds of wasting (weight-for-height z-score or whz <-2 SD from reference median) in children 1e24 months (Hasselman & Reichenheim, 2006). The ndings from cross-sectional studies were similarly mixed. In three villages in Karnataka, India, children 3 e 14 years of everbeaten mothers consumed 294e394 fewer (kilo)calories than those of never-beaten mothers (Rao, 1998). Yet, in ve national samples of children 6e59 months, the adjusted odds of stunting and severe stunting were higher only in those of Kenyan mothers exposed to any or only physical domestic violence (Rico, Fenn, Abramsky, & Watts, 2010). The ndings from prospective cohort studies in diverse settings were persuasive, however. A follow-up of 121 newborns of exposed women in the U.S. showed greater increases in weight from 6e12 months among those whose mothers reported an end to violence at 6 months than among those whose mothers reported continued violence (McFarlane & Soeken, 1999). A follow-up of pregnant women in U.S. cities showed higher adjusted risks of obesity at age ve years among the children of mothers with chronic domestic violence (Boynton-Jarrett, Fargnoli, Suglia, Zuckerman, & Wright, 2010). A longitudinal nutrition experiment with pregnant women in rural Bangladesh showed lower weight and length at birth, smaller changes in waz and haz from 0 to 24 months, and lower waz and haz at 24 months with exposure to any domestic violence (sling-Monemi, Naved, & Persson, 2009). Finally, in national follow-ups of a British birth cohort and a Swedish cohort of adults, exposure to family conict or dissention predicted higher adjusted

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Table 1 Summary of studies of the total effects of domestic violence on child nutrition and growth (n 13 studies). n Year of Publication 1985e89 1990e99 2000e09 2010 N America Europe South Asia Latin America Africa Case-Control (CC) Cross-Sectional (CS) Longitudinal-CC Longitudinal-Cohort Sample Size 1e99 100e499 500e1499 1500 Response Rate < 50 50e74 75e100 Not stated  3 years 5 years  6 years 7 years Mixed, not stated Post-neonatal period 12 mo post-partum 24 mo post-partum 60 mo post-partum Other Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual Other, Not Stated Yes 2 5 4 2 5 3 2 3 1 4 2 1 6 2 6 0 5 3 0 7 3 4 3 2 2 2 1 1 1 2 2 4 2 1 3 3 11 % 15.4 38.5 30.8 15.4 35.7 21.4 14.3 21.4 7.1 30.8 15.4 7.7 46.2 15.4 46.2 0.0 38.5 23.1 0.0 53.8 23.1 30.8 23.1 15.4 15.4 15.4 14.3 14.3 14.3 28.6 28.6 30.8 15.4 7.7 23.1 23.1 84.62 Studies (author, date) Bithoney and Newberger (1987), Karp et al. (1989) Attala and McSweeney (1997), Mcfarland and Soeken (1999), Montgomery et al. (1997), Peck and Lundberg (1995), Rao (1998) Arcos et al. (2003), sling-Monemi, Naved, & Persson, 2009, Hasselman and Reichenheim (2006), Olivan (2003) Rico et al. (2010), Boynton-Jarrett et al. (2010) Attala and McSweeney (1997), Bithoney and Newberger (1987), Boynton-Jarrett et al. (2010), Karp et al. (1989), Mcfarlane and Soeken (1999), Montgomery et al. (1997), Olivan (2003), Peck and Lundberg (1995) sling-Monemi, Naved, & Persson, 2009, Rao (1998) Arcos et al. (2003), Hasselman and Reichenheim (2006), Rico et al. (2010) Rico et al. (2010) Attala and McSweeney (1997), Bithoney and Newberger (1987), Hasselman and Reichenheim (2006), Karp et al. (1989) Rao (1998), Rico et al. (2010) Arcos et al. (2003) sling-Monemi, Naved, & Persson, 2009, Boynton-Jarrett et al. (2010), McFarlane and Soeken (1999), Montgomery et al. (1997),Peck & Lundberg (1995) Bithoney and Newberger (1987), Olivan (2003), Olivan (2003), Attala and McSweeney (1997), Hasselman and Reichenheim (2006), Karp et al. (1989), Rao (1998), Arcos et al. (2003), McFarlane and Soeken (1999) sling-Monemi, Naved, & Persson, 2009, Boynton-Jarrett et al. (2010), Montgomery et al. (1997), Peck & Lundberg (1995), Rico et al. (2010) Boynton-Jarrett et al. (2010), Montgomery et al. (1997), Olivan (2003) Arcos et al. (2003), sling-Monemi et al., 2009, Hasselman and Reichenheim (2006), Mcfarlane and Soeken (1999), Peck & Lundberg (1995), Rao (1998), Rico et al. (2010) Attala and McSweeney (1997), Bithoney and Newberger (1987), Karp et al. (1989) Arcos et al. (2003), sling-Monemi et al., 2009, Hasselman and Reichenheim (2006), Mcfarlane and Soeken (1999) Boynton-Jarrett et al. (2010), Rico et al. (2010), Olivan (2003) Attala and McSweeney (1997), Karp et al. (1989) Montgomery et al. (1997), Peck & Lundberg (1995) Bithoney and Newberger (1987), Rao (1998) Arcos et al. (2003) Mcfarlane and Soeken (1999) sling-Monemi et al., 2009 Boynton-Jarrett et al. (2010), Montgomery et al. (1997) Olivan (2003), Peck & Lundberg (1995) Attala and McSweeney (1997), Karp et al. (1989) of child, Rao (1998), Arcos et al. (2003) Hasselman and Reichenheim (2006), Olivan (2003) Rico et al. (2010) sling-Monemi et al., 2009, Boynton-Jarrett et al. (2010), Mcfarlane and Soeken (1999) Bithoney and Newberger (1987), Montgomery et al. (1997), Peck & Lundberg (1995) Asling-Monemi et al. (2009), Attala and McSweeney (1997), Bithoney and Newberger (1987), Boynton-Jarrett et al. (2010), Hasselman and Reichenheim (2006), Karp et al. (1989), Fernald and Grantham-McGregor (2002), Montgomery et al. (1997), Peck & Lundberg (1995), Rao (1998), Rico et al. (2010) Arcos et al. (2003), Olivan (2003)

Region

Study Design

Age of Children

Length of Followup

Domestic Violence Type

Control for Confounders

No Other, Not Stated

2 0

15.38 0

odds of short stature at age 7 years (Montgomery, Partley, & Wilkinson, 1997) and as adults (Peck & Lundberg, 1995). Thus, studies of the total effects of CEDV on child growth and nutrition are of mixed quality and limited geographic scope; still, longitudinal studies in four countries show negative effects of domestic violence against mothers on childrens growth in their rst two years and their risks of stunting at two years and short stature at seven years and adulthood. The operative pathways of these relationships are understudied, however (Troxel & Matthews, 2004). Pathways linking CEDV to growth and nutrition in utero and early childhood Our framework adapts general process models (Jaffe, Wolfe, & Wilson, 1990; Repetti, Taylor, & Seeman, 2002) to articulate the plausible direct and indirect pathways by which domestic violence against mothers may affect a childs nutrition and growth prenatally and during the infant and toddler periods (Fig. 1).

According to the risky family environment model (Repetti et al., 2002), exposure in utero or during infancy to overt family conict, or recurrent episodes of anger and aggression (p. 330), may disturb a childs stress-responsive biological regulatory systems, which are central for maintaining physical and mental health (Path A, Fig. 1). Early exposure to these stressors may cause cascading, potentially irreversible interactions (p. 336) of these stressors with genetic predispositions. Cumulatively, these interactions can augment susceptibility to stress, biological and behavioral markers of chronic stress, and stress-related physical and mental conditions (e.g., Lanius, Vermetten, & Pain, 2010). Prospectively, such exposures have directly impaired childrens intellectual functioning, behavior, health, and stature (e.g., Huth-Bocks, Levendosky, & Semel, 2001; Koverola et al., 2005; Repetti et al., 2002; Lanius et al., 2010). According to the family disruption model, domestic violence may affect children indirectly, through spillover effects on other family processes (Jaffe et al., 1990; Margolin, 2005; Troxel & Matthews,

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A B
Family Socioeconomic Context Maternal Mental, Physical, & Nutritional Symptoms

{Childs stress-responsive biological regulatory systems}

C D E

Prenatal Risk Behavior & Prenatal & Delivery Care


a b

Domestic Violence

Fetal Growth & Pregnancy Outcomes


c f

Early Childhood Growth & Nutrition

Post-natal Risk Behavior & Maternal Infant & Toddler Care

Child Attributes

Community Context

Fig. 1. Conceptual Framework.

2004). A mothers experience of domestic violence may initiate behavioral risks (smoking, alcohol, drug use) as well as psychological (anxiety, depression), physical (injury, disability, fatigue), and nutritional (anemia, poor weight gain) symptoms (e.g., Campbell, 2002; Dutton et al., 2006; Golding, 1999; Jordan, Campbell, & Follingstad, 2010), which may mediate the effects of domestic violence on a childs stress-responsive regulatory systems (Path B, Fig. 1). Also, because mothers often are young childrens primary caregivers, maternal impairments for the above reasons may adversely affect the immediate causes of early growth impairment and malnutrition. These include maternal prenatal and delivery care such as prenatal preventive care or hospitalization for complications, fetal growth and pregnancy outcomes, such as LBW and size for gestational age, and maternal infant and toddler care, such as feeding practices, exposure to infection, and psychosocial care (Paths C e E, respectively, Figure 1). The strength of these pathways may vary or be confounded by community, family, and child attributes (Figure 1), including but not limited to community poverty and violence, household poverty and co-occurring family violence, maternal autonomy and obstetric history, and the childs age, gender, and genetic predispositions. Below, we review the evidence for pathways A e E, according to the timing of these mediators around parturition. Domestic violence / childs stress-responsive biological regulatory systems According to Repetti et al. (2002, p. 336), the bulk of damage done to [childrens] physical health in risky families may come from the initiation of biologically dysregulated responses to stress. Recurrent exposure to overt family conict may alter several stressresponsive biological regulatory systems that are critical to maintain good physical and mental health (Mead, Beauchaine, & Shannon, 2010). Pregnancy and infancy are critical periods for the development of these systems and are likely periods for CEDV because they involve heavy dependence on maternal care (Huth-Bocks et al., 2001). Dysregulation of these systems may cause decits or delays in energy release and metabolic activity, immune activity, mental activity and cognitive functioning, sexual maturation, reproductive

function, and physical growth (Mead et al., 2010). Dysregulation of these systems also may predict decits in emotion processing, social competence, and behavioral self-regulation (Mead et al., 2010; Repetti et al., 2002). Thus, CEDV in utero or during infancy may dysregulate a childs stress-responsive systems, thereby impairing growth and nutrition through the toddler years (Path A, Figure 1). Table 2 presents eight studies of the association of family conict or domestic violence against mothers with various biomarkers of stress in children. Most of these studies were case-control (4) or cross-sectional (3). All included fewer than 250 children, who were purposively selected mostly from U.S. locations. Response rates typically were not reported, domestic violence was variously measured, and all but two studies were conducted among children 4 years and older, with uncertain applicability to younger children. Despite these drawbacks, the results were remarkably consistent. Children exposed to domestic violence or marital conict typically had higher heart rates (El-Sheikh, 1994; Saltzman, Holden, & Holahan, 2005), salivary cortisol levels (Davies, Sturge-Apple, Cicchetti, & Cummings, 2008; Davies, Sturge-Apple, Cicchetti, Manning, & Zale, 2009; Saltzman et al., 2005; Zhang et al., 2008), levels of plasma amino acids (Zhang et al., 2008), parasympathetic nervous-system activity (Davies et al., 2009), urinary dopamine levels (Gottman & Katz, 1989), and more reported symptoms of distress (Suglia, Ryan, Bellinger, Enlow, & Wright, 2010). Exposed children also had lower sympathetic nervous-system activity (Davies et al., 2009) and lower vagal tone (or ring of the nerve originating from the brainstem and regulating heart rate) (Gottman & Katz, 1989; Rigterink, Katz, & Hessler, 2010). In school-aged children, biomarkers of stress or resilience have mediated the effects of exposure to marital conict on general health problems (El-Sheikh, Harger, & Whitson, 2001; Katz & Gottman, 1997) and have predicted physical growth (Fernald & Grantham-McGregor, 2002). Domestic violence / maternal mental, physical, and nutritional health Compounding the direct effects of CEDV, such violence may harm early child growth and nutrition through impairments of maternal mental, physical, and nutritional health, prenatally and in

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Table 2 Summary of Studies of the Effects of Domestic Violence on Childrens Stress-Responsive Biological Regulatory Systems and Effects of Stress on Growth (n 11 studies). n Year of Publication 1985e89 1990e99 2000e09 1 2 7 % 8.3 16.7 58.3 Studies (author, date) Gottman and Katz (1989) El-Sheikh (1994), Katz and Gottman (1997) Davies et al. (2008), Davies et al. (2009), El-Sheikh et al. (2001), Fernald and Grantham-McGregor (2002), Nakata et al. (2009), Saltzman et al. (2005), Zhang et al. (2008) Rigterink et al. (2010), Suglia et al. (2010) Davies et al. (2008), Davies et al. (2009), El-Sheikh (1994), El Sheikh et al. (2001), Gottman and Katz (1989), Katz and Gottman (1997), Rigterink et al. (2010), Saltzman et al. (2005), Suglia et al. (2010) Nakata et al. (2009), Zhang et al. (2008) Fernald and Grantham-McGregor (2002) El-Sheikh (1994), Fernald and Grantham-McGregor (2002), Gottman & Katz (1989), Saltzman et al. (2005), Zhang et al. (2008) Davies et al. (2008), Davies et al. (2009), El-Sheikh et al. (2001), Suglia et al. (2010) Katz and Gottman (1997), Rigterink et al. (2010) Nakata et al. (2009) El-Sheikh (1994), El-Sheikh et al. (2001), Fernald and Grantham-McGregor (2002), Gottman & Katz (1989), Katz & Gottman (1997), Rigterink et al. (2010), Saltzman et al. (2005) Davies et al. (2008), Davies et al. (2009), Suglia et al. (2010), Zhang et al. (2008) Nakata et al. (2009) Rigterink et al. (2010) Davies et al. (2008), Saltzman et al. (2005) Davies et al. (2009), El-Sheikh (1994), El Sheikh et al. (2001), Fernald and Grantham-McGregor (2002), Gottman & Katz (1989), Katz & Gottman (1997), Nakata et al. (2009), Suglia et al. (2010), Zhang et al. (2008) Davies et al. (2009), Zhang et al. (2008) El-Sheikh (1994), Gottman & Katz (1989) Rigterink et al. (2010) Davies et al. (2008), Saltzman et al. (2005), Suglia et al. (2010) El-Sheikh et al. (2001), Fernald and Grantham-McGregor (2002), Katz & Gottman (1997) Nakata et al. (2009)

Region

2010 N America

2 9

16.7 75.0

Study Design

Europe South Asia Latin America Africa Case-Control (CC) Cross-Sectional (CS) Longitudinal-CC Longitudinal-Cohort Experimental (EX) 1e99

0 2 1 0 5 4 0 2 1 7

0.0 16.7 8.3 0.0 41.7 33.3 0.0 16.7 8.3 58.3

Sample Size

Response Rate

100e499 500 or more Unknown 0e49 50e74 75e100 Not stated

4 0 1 0 1 2 9

33.3 0.0 8.3 0.0 8.3 16.7 75.0

Age of Children

 3 years 5 years  6 years 7 years Mixed, not stated Other Post-neonatal period 12 mo post-partum 24 mo post-partum 60 mo post-partum Other Physical Type Physical, Psychological Physical, Sexual Physical, Psych, Sexual Other, Not Stated Yes

2 2 1 3 3 1 0 0 0 0 2 2 2 0 2 6 7

16.7 16.7 8.3 25.0 25.0 8.3 0.0 0.0 0.0 0.0 100.0 16.7 16.7 0.0 16.7 50.0 58.3

Length of Followup

Domestic Violence

Katz & Gottman (1997), Rigterink et al. (2010) Davies et al. (2009), Rigterink et al. (2010) El-Sheikh (1994), El-Sheikh et al. (2001) Saltzman et al. (2005), Zhang et al. (2008) Davies et al. (2008), Fernald and Grantham-McGregor (2002), Gottman & Katz (1989), Katz & Gottman (1997), Nakata et al. (2009), Suglia et al. (2010) Davies et al. (2008), El-Sheikh et al. (2001), Katz & Gottman (1997), Fernald and Grantham-McGregor (2002), Rigterink et al. (2010), Saltzman et al. (2005), Suglia et al. (2010) Davies et al. (2009), El-Sheikh (1994), Gottman & Katz (1989), Nakata et al. (2009) Zhang et al. (2008)

Control for Confounders

No Other, Not Stated

4 1

33.3 8.333

the infant and toddler periods (Fig. 1). These impairments may then operate through biological or behavioral mechanisms to compromise early child growth and nutrition. Biologically, impaired prenatal maternal health may harm fetal growth through alterations in the uterine environment (e.g., Path D, Fig. 1). For example, malnourished and distressed pregnant women more often have LBW newborns (Valladares, Pen, Ellsberg, Persson, & Hogberg, 2009; WHO, 1995), who may remain underweight as children (Saigal & Doyle, 2008). Impaired postnatal maternal health may dysregulate a childs stress-response, thereby compromising the childs nutrition and growth (Path B, Fig. 1). Behaviorally, a woman who is underweight, micronutrient (iron) decient, or injured from violence may be fatigued and cognitively impaired (Huth-Bocks et al., 2002). Such mental, physical, and nutritional impairments prenatally may induce risk behaviors and alter prenatal and delivery care, thereby contributing

to poor pregnancy outcomes (e.g, Path C to Path b, Fig. 1; Rahman, Harrington, & Bunn, 2002). Post-natallly, such impairments may keep a mother from offering adequate infant and toddler care (e.g., Path E to Path f, Figure 1; Rahman et al., 2002). In the rest of this section, we review evidence of the inuences of domestic violence on maternal mental, physical, and nutritional health, and of subsequent effects on early childhood growth and nutrition. In later sections, we review evidence of the effects of domestic violence on maternal risk behaviors, prenatal and delivery care, pregnancy outcome, and postnatal infant and toddler care, and of subsequent effects on early childhood growth and nutrition. Domestic violence / maternal mental health / fetal/young child growth Various forms of domestic violence against women predict impairments to their mental health (Jordan et al., 2010), including

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in the prenatal and postnatal periods (Table 3). Of the 18 studies reviewed here, 8 were longitudinal, and 10 involved samples of more than 500 pregnant or postpartum women. Ten were conducted in Asia and Latin America, and response rates typically were reported and reasonably high. The types of domestic violence and methods of assessment differed. Cross-sectionally, diverse forms of domestic violence before or in pregnancy have predicted higher perceived emotional distress in pregnancy (Valladares, Pena, Persson, & Hogberg, 2005), higher scores for prenatal depressive, somatic, and post-traumatic stress symptoms (Varma, Chandra, & Thomas, 2007; Zareen, Majid, Naqvi, Saboohi, & Fatima, 2009), higher odds of perinatal mental disorders (Fisher et al., 2010), and higher odds or scores for post-natal depression (Bacchus, Mezey, & Bewley, 2004; Beydoun, Al-Sahab, Beydoun, & Tamim, 2010; Gomez-Beloz, Williams, Sanchez, & Lam, 2009; Gross, Wells, Radigan-Garcia, & Dietz, 2002). Prospective ndings are consistent, with various forms of domestic violence before or in pregnancy predicting higher residual evening prenatal cortisol levels (Valladares et al., 2009) as well as higher odds of: prenatal depression or anxiety (Karmaliani et al., 2009; Melville, Gavin, Guo, & Fan, 2010; Nunes et al., 2010), more postnatal depressive symptoms (Leung, Kung, Lam, Leung, & Ho, 2002; Ludermir, Lewis, Valongueiro, Arajo, & Araya, 2010; Romito, Pomicino, Lucchetta, Scrimin, & Turan, 2009; Tiwari et al., 2008), and postnatal thoughts of self-harm (Tiwari et al., 2008). Regarding the associations of maternal mental health with child growth, animal models have shown that post-partum maternal stress inhibits the secretion of growth hormone in offspring, causing persistent growth impairment (Nakata et al., 2009). A review of research on humans in mainly Western settings has linked maternal psychosocial stress in early pregnancy with LBW (Hobel, Goldstein, & Barrett, 2008), a strong predictor of subsequent growth (Saigal & Doyle, 2008). Research in poorer settings is more limited (Rahman et al., 2002), and ndings from case-control studies in several countries are mixed (Anoop, Saravanan, Joseph, Cherian, & Jacob, 2004; Baker-Henningham, Powell, Walker, & Grantham-McGregor, 2003; Carvalhaes & Benicio, 2002; Rahman, Lovel, Bunn, Iqbal, & Harrington, 2004). Yet, cross-sectionally among mother-child (6e18 months) dyads in India and Vietnam, maternal mental disorders have directly predicted childrens odds of stunting and underweight (Harpham, Huttly, De Silva, & Abramsky, 2005). Prospectively in rural Pakistan, a comparison of 160 newborns each of depressed and non-depressed mothers showed that those of depressed mothers had more growth retardation in infancy (Rahman, Iqbal, Bunn, Lovel, & Harrington, 2004). In a few studies, poor maternal mental health has mediated the link between domestic violence and birth weight. Cross-sectionally, mothers in the U.S. reporting stress associated with prior domestic violence also had newborns with lower mean birth weight and higher adjusted odds of LBW (Altarac & Strobino, 2002; Rosen, Seng, Tolman, & Mallinger, 2007). In a pregnancy cohort in Leon, Nicaragua, biomarkers of stress mediated the association of violence in pregnancy with newborn birth weight (Valladares et al., 2009). Domestic violence / maternal physical health/nutrition / fetal/ young child growth Domestic violence also predicts poor physical health and nutrition in women (e.g., Ackerson & Subramanian, 2008; Yount, & Li, 2010; Dutton et al., 2006). Table 3 highlights the 11 studies we reviewed of the links between domestic violence and prenatal and postpartum health and nutrition in women. Most (7) occurred in the U.S. or Europe and so may not apply to poor settings. Response rates often were not reported or varied widely, and the types of violence assessed and methods of assessment differed. Still, over

one third (4) of studies were longitudinal, and most (8) were based on large samples of more than 500 women. In case-control and cross-sectional studies, physical and sexual (with or without psychological) domestic violence have predicted lower maternal prenatal weight gain (Kearney et al., 2004; Moraes, Amorim, & Reichenheim, 2006; Yang, Ho, Chou, Chang, & Ko, 2006), higher adjusted odds of greater (> 20 kg) weight gain (Stckl et al., 2010), high blood pressure (Kearney et al., 2003; Stckl et al., 2010), higher cardiac response to orthostatic challenge (Rice & Records, 2010), sexually transmitted infections (Johnson & Hellerstedt, 2002), and thyroid disease (Stckl et al., 2010). Prospectively in the U.S., Uganda, and Brazil, any prenatal domestic violence has predicted low maternal weight gain, infections, and anemia (Kaye, Mirembe, Bantebya, Johansson, & Ekstrom, 2006; McFarlane et al., 1996; Nunes et al., 2010; Parker et al., 1994) as well as higher odds of hypertension (Kaye et al., 2006). A prior systematic review corroborates that poor prenatal weight gain is more likely in mothers exposed to domestic violence (Boy & Salihu, 2004), and in the U.S., poor weight gain has mediated the relation of prenatal domestic violence and a childs birth weight (e.g., Campbell et al., 1999; Kearney et al., 2004). Domestic violence / maternal risk behavior / fetal/young child growth In general, women who experience domestic violence are more likely to practice risky behaviors and to abandon healthy behaviors (e.g., Dutton et al., 2006). Of interest are violence-induced behaviors occurring pre- or post-natally that expose a fetus to the risks of preterm labor or LBW or a young child to inadequate care. Our review identied 15 recent studies, mainly in the U.S., Canada, or Western Europe (12), often of large samples with more than 500 women (12), and more than one third (6) having longitudinal designs. Response rates and assessments of domestic violence varied across studies (Table 4). Across all study designs, exposure to various forms of domestic violence predicted prenatal smoking and/or alcohol or drug use (Amaro, Fried, Cabral, & Zuckerman, 1990; Bailey & Daugherty, 2007; Heaman, 2005; Fanslow, Silva, Robinson, & Whitehead, 2008; Goedhart, van der Wal, Cujipers, & Bonsel, 2009; HuthBocks, Levendosky, & Bogat, 2002; Kearney, Haggerty, Munro, & Kawkins, 2003; Kearney, Munro, Kelly, & Kawkins, 2004; McFarlane, Parker, & Soeken, 1996; Nunes et al., 2010; Parker, McFarlane, & Soeken, 1994; Quelopana & Champion, 2008; Stckl, Hertlein, Friese, & Stckl, 2010). Cross-sectionally and longitudinally in Australia, Norway, and the U.S., smoking and substance abuse partly or fully mediated the link between any form of prenatal domestic violence and LBW (e.g., Campbell et al., 1999; Kearney et al., 2004; McFarlane et al., 1996; Schei, Samuelsen, & Bakkerteig, 1991). Domestic violence /prenatal and delivery care / fetal/young child growth Domestic violence may have at least two effects on prenatal and delivery care. A pregnant woman who is mentally, physically, or nutritionally impaired by domestic violence may be less able to seek prenatal care, missing chances to prevent, detect, and treat poor health and nutrition. Such a woman also may require more injury-related care. Except for selected studies in the U.S. and Brazil (Huth-Bocks et al., 2002; Nunes et al., 2010; Pagnini & Reichman, 2000), the evidence reviewed supports both outcomes (Table 5). Most of the 18 studies reviewed were recent (2000 or later, 13) and based in the U.S. (13). They typically had cross-sectional (12) or longitudinal (5) designs and large samples of at least 1500 women

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Table 3 Summary of Studies of the Effects of Domestic Violence on Maternal Mental, Physical, and Nutritional Health. n % Studies (author, date) Altarac and Strobino (2002), Bacchus et al. (2004), Gomez-Beloz et al. (2009), Gross et al. (2002), Karmaliani et al. (2009), Leung et al. (2002), Romito et al. (2009), Rosen et al. (2007), Tiwari et al. (2008), Valladares et al. (2005), Valladares et al. (2009), Varma et al. (2007), Zareen et al. (2009) Beydoun et al. (2010), Fisher et al. (2010), Ludermir et al. (2010), Melville et al. (2010), Nunes et al. (2010) Altarac and Strobino (2002), Beydoun et al. (2010), Gross et al. (2002), Melville et al. (2010), Rosen et al. (2007) Bacchus et al. (2004), Romito et al. (2009) Fisher et al. (2010), Karmaliani et al. (2009), Leung et al. (2002), Tiwari et al. (2008), Varma et al. (2007), Zareen et al. (2009) Gomez-Beloz et al. (2009), Ludermir et al. (2010), Nunes et al. (2010), Valladares et al. (2005), Valladares et al. (2009)

Mental Health Conditions-Prenatal and Postnatal (n [ 18 studies) Year of Publication 2000e09 13 72.2

2010 Region N America Europe South Asia Latin America Africa Case-Control (CC) Cross-Sectional (CS)

5 5 2 6 5 0 0 10

27.8 27.8 11.1 33.3 27.8 0.0 0.0 55.6

Study Design

Altarac & Strobino (2002), Bacchus et al. (2004), Beydoun et al. (2010), Fisher et al. (2010), Gomez-Beloz et al. (2009), Gross et al. (2002), (2003), Rosen et al. (2007), Valladares et al. (2005), Varma et al. (2007), Zareen et al. (2009) Karmaliani et al. (2009), Leung et al. (2002), Ludermir et al. (2010), Melville et al. (2010), Nunes et al. (2010), Romito et al. (2009), Tiwari et al. (2008), Valladares et al. (2009) Bacchus et al. (2004), Fisher et al. (2010), Romito et al. (2009), Rosen et al. (2007), Valladares et al. (2005), Valladares et al. (2009), Varma et al. (2007), Zareen et al. (2009) Altarac & Strobino (2002), Karmaliani et al. (2009), Leung et al. (2002), Ludermir et al. (2010), Nunes et al. (2010) Beydoun et al. (2010), Gomez-Beloz et al. (2009), Gross et al. (2002), Melville et al. (2010), Tiwari et al. (2008) Melville et al. (2010) Altarac & Strobino (2002), Beydoun et al. (2010), Fisher et al. (2010), Gomez-Beloz et al. (2009), Gross et al. (2002), Karmaliani et al. (2009), Leung et al. (2002), Ludermir et al. (2010), Nunes et al. (2010), Romito et al. (2009), Tiwari et al. (2008), Valladares et al. (2005), Valladares et al. (2009) Bacchus et al. (2004), Rosen et al. (2007), Varma et al. (2007), Zareen et al. (2009) Ludermir et al. (2010), Valladares et al. (2009) Nunes et al. (2010), Romito et al. (2009), Tiwari et al. (2008) Karmaliani et al. (2009), Melville et al. (2010) Leung et al. (2002) Gross et al. (2002), Rosen et al. (2007) Bacchus et al. (2004), Beydoun et al. (2010), Gomez-Beloz et al. (2009), Melville et al. (2010) Altarac & Strobino (2002), Fisher et al. (2010), Karmaliani et al. (2009), Leung et al. (2002), Ludermir et al. (2010), Nunes et al. (2010), Romito et al. (2009), Tiwari et al. (2008), Valladares et al. (2005), Valladares et al. (2009), Varma et al. (2007), Zareen et al. (2009) Altarac & Strobino (2002), Bacchus et al. (2004), Beydoun et al. (2010), Fisher et al. (2010), Gomez-Beloz et al. (2009), Gross et al. (2002), Karmaliani et al. (2009), Leung et al. (2002), Ludermir et al. (2010), Melville et al. (2010), Romito et al. (2009), Rosen et al. (2007), Tiwari et al. (2008), Valladares et al. (2005), Valladares et al. (2009) Varma et al. (2007) Nunes et al. (2010), Zareen et al. (2009) McFarlane et al. (1996), Parker et al. (1994) Johnson & Hellersted (2002), Kaye et al. (2006), Kearney et al. (2003), Kearney et al. (2004), Moraes et al. (2006), Rice and Records (2010), Yang et al. (2006) Nunes et al. (2010), Stckl et al. (2010) Johnson & Hellersted (2002), Kearney et al. (2003), Kearney et al. (2004), McFarlane et al. (1996), Parker et al. (1994), Rice and Records (2010) Stckl et al. (2010) Yang et al. (2006) Moraes et al. (2006), Nunes et al. (2010) Kaye et al. (2006) Rice & Records (2010) Johnson & Hellersted (2002), Kearney et al. (2003), Kearney et al. (2004), Moraes et al. (2006), Stckl et al. (2010), Yang et al. (2006) Kaye et al. (2006), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994)

Longitudinal-CC Longitudinal-Cohort

0 8

0.0 44.4

Sample Size

1e99 100e499

0 8

0.0 44.4

500e1499 1500 Response Rate < 50 50e74 75e100

5 5 0 1 13

27.8 27.8 0.0 5.6 72.2

Length of Followup

Violence Type

Not stated Pregnancy to delivery Pregnancy to postnatal period Unclear/ Not stated Postneonatal Domestic Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual

4 2 3 2 1 2 0 4 12

22.2 25.0 37.5 25.0 12.5 11.1 0.0 22.2 66.7

Control for Confounders

Yes

15

83.3

No Other, Not Stated Physical & Nutritional Health-Perinatal (n [ 11 studies) Year of Publication 1990e99 2000e09 2010 N America Europe South Asia Latin America Africa Case-Control (CC) Cross-Sectional (CS) Longitudinal-CC Longitudinal-Cohort

1 2 2 7 2 6 1 1 2 1 1 6 0 4

5.6 11.1 18.2 63.6 18.2 54.5 9.1 9.1 18.2 9.1 9.1 54.5 0.0 36.4

Region

Study Design

K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554 Table 3 (continued ) n Sample Size 1e99 100e499 500e1499 1500 < 50 50e74 75e100 Not stated Length of Followup Pregnancy to delivery Pregnancy to postnatal period Unclear/ Not stated Postneoatal Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual Yes No Other, Not Stated 1 2 6 2 0 2 4 5 3 1 0 0 3 0 1 7 4 5 2 % 9.1 18.2 54.5 18.2 0.0 18.2 36.4 45.5 75.0 25.0 0.0 0.0 27.3 0.0 9.1 63.6 36.4 45.5 18.2 Studies (author, date) Rice & Records (2010) Moraes et al. (2006), Stckl et al. (2010) Johnson & Hellersted (2002), Kaye et al. (2006), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994), Yang et al. (2006) Kearney et al. (2003), Kearney et al. (2004) Moraes et al. (2006), Stckl et al. (2010) Johnson and Hellersted (2002), Kearney et al. (2004), Nunes et al. (2010), Yang et al. (2006) Kaye et al. (2006), Kearney et al. (2003), McFarlane et al. (1996), Parker et al. (1994), Rice & Records (2010) Kaye et al. (2006), McFarlane et al. (1996), Parker et al. (1994) Nunes et al (2010)

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Response Rate

Domestic Violence Type

Moraes et al. (2006), Rice & Records (2010), Yang et al. (2006) Johnson & Hellersted (2002) Kaye et al. (2006), Kearney et al. (2003), Kearney et al. (2004), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994), Stckl et al. (2010) Johnson & Hellersted (2002), Kearney et al. (2003), Kearney et al. (2004), Moraes et al. (2006) McFarlane et al. (1996), Parker et al. (1994), Rice and Records (2006), Stckl et al. (2010), Yang et al. (2006) Kaye et al. (2006), Nunes et al. (2010)

Control for Confounders

(10), although response rates were not stated in half of the studies (9). All studies measured physical domestic violence, with or without other forms. Most studies (12) included controls for confounding. Cross-sectionally in poor countries or poor, minority groups in the U.S., mainly physical domestic violence before or during pregnancy has predicted later entry into prenatal care, less or no rsttrimester prenatal care, or inadequate or no prenatal care (Bailey & Daugherty, 2007; Curry, Perrin, & Wall, 1998; Dietz et al., 1997; Diop-Sidib, Campbell, & Becker, 2006; Goodwin et al., 2000; Hindin, Kishor, & Ansara, 2008; Hyun, Cain, &Viner-Brown, 2010; Moraes, Arana, & Reichenheim, 2010; Taggart & Mattson, 1996). Some women have attributed delayed prenatal care to violencerelated injuries (Taggart & Mattson, 1996), and longitudinal research in the U.S. has conrmed later prenatal care among pregnant women experiencing physical domestic violence (Parker et al., 1994). In cross-sectional and longitudinal studies in diverse settings, domestic violence also has predicted ante- and intrapartum hospitalization for complications. In Kampala, Uganda, Saudi Arabia, and the U.S., women reporting any or physical domestic violence prenatally have had higher risks of obstetric complications requiring antepartum hospitalization (Kaye et al., 2006; Lipsky, Holt, Easterling, & Critchlow, 2004; Rachana, Suraiva, Hisham, Abdulaziz, & Hai, 2002). Any prenatal domestic violence also has predicted a hospital stay at birth in the U.S. (Huth-Bocks et al., 2002). Cross-sectionally, prenatal physical domestic violence has predicted Cesarean section in Saudi Arabia and the U.S. (Cokkinides, Coker, Sanderson, Addy, & Bethea, 1999; Rachana et al., 2002), but a prospective study in Brazil showed no association of any prenatal domestic violence with type of delivery (Nunes et al., 2010). A review of studies across Africa, Asia, and Latin America documents the benets of good prenatal and delivery care on young-child nutrition; specically, training on exclusive breastfeeding and well-baby care in primary, prenatal, and delivery visits has increased the duration of exclusive breastfeeding in a childs rst six months (Bhandari, Kabir, & Salam, 2008). In a pregnancy cohort in Kampala, Uganda, prior domestic violence predicted higher risks of antepartum hospitalization and a LBW newborn, although a formal mediation analysis was not conducted (Kaye et al., 2006).

Domestic violence / fetal growth / pregnancy outcome / child growth At least 48 studies since the late 1980s have assessed the effects of domestic violence on pregnancy outcomes (Table 6). Of these, 36 (or 75%) occurred in the U.S. or Europe, followed by eight in Latin America, two in South Asia, only one in Africa, and one in several sites. Almost one third (14) were longitudinal, 29 had sample sizes of at least 500 women, and a majority (25) had response rates of 75% or higher. All but one study, in which the form of domestic violence was not reported, asked about physical domestic violence, with or without other forms. Case-control and cross-sectional studies in Australia, Europe, India, and the U.S. have shown associations between any or mainly physical domestic violence in pregnancy and higher odds of: fetal injury, placental abruption, miscarriage or fetal wastage, preterm or very preterm labor or birth, LBW or very LBW, lower mean birth weight, intrauterine growth restriction, hospital stay for the newborn, and (trauma-related) perinatal death (Altarac & Strobino, 2002; Berenson et al., 1994; Bullock & McFarlane, 1989; Campbell et al., 1999; Coker et al., 2004; Connolly et al., 1997; Curry et al., 1998; El Kady et al., 2005; Fernandez & Krueger, 1999; Hyun et al., 2010; Janssen et al., 2003; Jejeebhoy, 1998; Kearney et al., 2003; Leone et al., 2010; Lipsky et al., 2004; Neggers et al., 2004; Rosen et al., 2007; Schei et al., 1991; Webster et al., 1996; Yost et al., 2005). In pregnancy cohorts in Latin America, Uganda, and the U.S., any and mainly physical domestic violence has predicted higher odds of abortion, preterm labor or delivery, lower mean gestational age, LBW, lower mean birth weight, hospital stay of the newborn, and fetal distress and death (Arcos et al., 2001; Bohn, 2002; Covington et al., 2001; Dye et al., 1995; Huth-Bocks et al., 2002; Kaye et al., 2006; McFarlane et al., 1996; Nunes et al., 2010; Parker et al., 1994; Renker, 1999; Shumway et al., 1999; Silverman et al., 2006b; Valladares et al., 2009). Studies showing no association between prenatal domestic violence and pregnancy outcome were limited by aggregated forms of domestic violence, small purposive samples, and poor response rates (Audi et al., 2008; Cokkinides et al., 1999; Grimstad et al., 1997; Grimstad et al., 1999; Jagoe et al., 2000; Kearney et al., 2004; OCampo et al., 1994). Other studies nding no or weak associations did so after

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Table 4 Summary of Studies of the Effects of Domestic Violence on Maternal Risk Behaviors (n 14 studies). n Year of Publication 1990e99 2000e09 3 9 % 21.4 64.3 Studies (author, date) Amaro et al. (1990), McFarlane et al. (1996), Parker et al. (1994) Bailey and Daugherty (2007), Fanslow et al. (2008), Goedhart et al. (2009), Goodwin et al. (2000), Heaman (2005), Huth-Bocks et al. (2002), Kearney et al. (2003), Kearney et al. (2004), Quelopana and Champion (2008) Nunes et al. (2010), Stckl et al. (2010) Amaro et al. (1990), Bailey et al and Daugherty (2007), Goodwin et al. (2000), Heaman (2005), Huth-Bocks et al. (2002), Kearney et al. (2003), Kearney et al. (2004), McFarlane et al. (1996), Parker et al. (1994) Fanslow et al. (2008), [New Zealand], Goedhart et al. (2009), Stckl et al. (2010) Nunes et al. (2010), Quelopana and Champion (2008) Heaman (2005), Quelopana and Champion (2008) Bailey and Daugherty (2007), Fanslow et al. (2008), Goedhart et al. (2009), Goodwin et al. (2000), Kearney et al. (2003), Kearney et al. (2004), Stckl et al. (2010) Amaro et al. (1990), Huth-Bocks et al. (2002), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994) Bailey and Daugherty (2007), Huth-Bocks et al. (2002), Quelopana and Champion (2008), Stckl et al. (2010) Amaro et al. (1990), Heaman (2005), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994) Fanslow et al. (2008), Goedhart et al. (2009), Goodwin et al. (2000), Kearney et al. (2003), Kearney et al. (2004) Goedhart et al. (2009) Fanslow et al. (2008) Amaro et al. (1990), Goodwin et al. (2000), Stckl et al. (2010) Bailey and Daugherty (2007), Huth-Bocks et al. (2002), Kearney et al. (2004), Quelopana and Champion (2008), Nunes et al. (2010) Heaman (2005), Kearney et al. (2003), McFarlane et al. (1996), Parker et al. (1994) McFarlane et al. (1996), Parker et al. (1994) Huth-Bocks et al. (2002), Nunes et al. (2010) Amaro et al. (1990) Fanslow et al. (2008), Goodwin et al. (2000), Heaman (2005) Amaro et al. (1990), Goedhart et al. (2009) Bailey and Daugherty (2007), Huth-Bocks et al. (2002), Kearney et al. (2003), Kearney et al. (2004), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994), Quelopana and Champion (2008), Stckl et al. (2010) Amaro et al. (1990), Fanslow et al. (2008), Goedhart et al. (2009), Goodwin et al. (2000), Heaman (2005), Huth-Bocks et al. (2002), Kearney et al. (2003), Kearney et al. (2004), Quelopana and Champion (2008) Bailey and Daugherty (2007), McFarlane et al. (1996), Parker et al. (1994), Stckl et al. (2010) Nunes et al. (2010)

Region

2010 N America

2 9

14.3 64.3

Study Design

Europe South Asia Latin America Africa Case-Control (CC) Cross-Sectional (CS)

3 0 2 0 2 7

21.4 0.0 14.3 0.0 14.3 50.0

Longitudinal-CC Longitudinal-Cohort Sample Size 1e99 100e499 500e1499 1500 Response Rate 0e24 25e49 50e74 75e100 Not stated Pregnancy to delivery Pregnancy to postnatal period Unclear/Not stated Postneoatal Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual

0 5 0 4 5 5 1 1 3 5 4 2 2 1 0 3 0 2 9

0.0 35.7 0.0 28.6 35.7 35.7 7.1 7.1 21.4 35.7 28.6 40.0 40.0 20.0 21.4 0.0 14.3 64.3

Length of Followup

Domestic Violence Type

Control for Confounders

Yes

64.3

No Other, Not Stated

4 1

28.6 7.1

adjusting for the mediating effects of smoking, substance abuse, or maternal stress (e.g., Campbell et al., 1999; Kearney et al., 2004; McFarlane et al., 1996; Schei, Samuelsen, & Bakkerteig, 1991; Valladares et al., 2009; Webster et al., 1996). The above ndings corroborate a prior review, which concluded that preterm delivery, having a LBW or small-for-gestational-age (SGA) newborn, and maternal and infant mortality were more likely among abused than non-abused mothers (Boy & Salihu, 2004). Recent meta-analyses have quantied the association between maternal exposure to domestic violence and pregnancy outcome (Murphy, Schei, Myhr, & Du Mont, 2001; Shah & Shah, 2010). In the most recent meta-analysis of 30 studies, women reporting physical domestic violence in pregnancy or the six months prior had 1.5 times higher adjusted odds of LBW and preterm births (95% condent intervals [CI] 1.3-1.8; 1.3-1.7) (Shah & Shah, 2010). The relationship between poor pregnancy outcomes and child nutrition or growth is better understood for newborns who are LBW or SGA (Saigal & Doyle, 2008). Case-control studies in Brazil and Oman show that LBW predicts lower length-for-age in infancy

(Lima Mde, Motta, Santos, & Pontes da Silva, 2004), and higher odds of protein-energy malnutrition and stunting at 0e5 years (Aerts et al., 2004; Kurup & Khandekar, 2004). Similar effects of being very LBW have been found in prospective studies (see Saigal & Doyle, 2008). Some newborns who are SGA or with intrauterine growth retardation may retain shorter statures into adulthood (Chatelain, 2000). In a long-term follow-up of children in rural Guatemala, cases with intrauterine growth retardation were shorter, lighter, and weaker than non-cases as adolescents and young adults, and birth weight and length at 15 days and 2 years positively predicted height, weight, and fat-free mass at 21e27 years (Li et al., 2003). Domestic violence / maternal infant/toddler care / young child growth A nal way in which domestic violence may indirectly affect early childhood growth and nutrition is through spillover effects on maternal infant and toddler care (Path E, Figure 1) (Anderson & Cramer-Benjamin, 2000; DeVoe & Smith 2002). Care refers to the

K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554 Table 5 Studies of the Effects of Domestic Violence on Prenatal and Delivery Care (n 18 studies). n Year of Publication 1990e99 2000e09 5 10 % 27.8 55.6 Studies (author, date)

1543

Region

2010 N America

3 13

16.7 72.2

Cokkinides et al. (1999), Curry et al. (1998), Dietz et al. (1997), Parker et al. (1994), Taggart and Mattson (1996) Bailey and Daugherty (2007), Diop Sidibe et al. (2006), Goodwin et al. (2000), Hindin et al. (2008), Huth-Bocks et al. (2002), Jagoe et al. (2000), Kaye et al. (2006), Lipsky et al (2004), Pagnini and Reichman (2000), Rachana et al. (2002) Hyun et al. (2010), Moraes et al. (2010), Nunes et al. (2010 Bailey and Daugherty (2007), Cokkinides et al. (1999), Curry et al. (1998), Dietz et al. (1997), Goodwin et al. (2000), Huth-Bocks et al. (2002), Hyun et al. (2010), Jagoe et al. (2000), Lipsky et al. (2004), Moraes et al. (2010), Pagnini and Reichman (2000), Parker et al. (1994), Taggart and Mattson (1996)

Study Design

Europe South Asia Latin America/Caribbean Africa Multi-site/ Other Case-Control (CC) Cross-Sectional (CS)

0 0 1 2 2 1 12

0 0 5.6 11.1 11.1 5.6 66.7

Longitudinal-Cohort Sample Size 1e99 100e499 500e1499 1500

5 1 3 4 10

27.8 5.6 16.7 22.2 55.6

Response Rate

< 50 50e74 75e100 Not stated

1 3 5 9

5.6 16.7 27.8 50.0

Length of Followup Domestic Violence Type

Other Not stated Physical

4 1 10

80.0 20.0 55.6

Nunes et al. (2010) Diop Sidibe et al. (2006), Kaye et al. (2006) Hindin et al. (2008), Rachana et al. (2002) Jagoe et al. (2000) Bailey and Daugherty (2007), Cokkinides et al. (1999), Curry et al. (1998), Dietz et al. (1997), Diop Sidibe et al. (2006), Goodwin et al. (2000), Hindin et al. (2008), Hyun et al. (2010), Moraes et al. (2010), Pagnini and Reichman (2000), Rachana et al. (2002), Taggart & Mattson (1996) Huth-Bocks et al. (2002), Kaye et al. (2006), Lipsky et al. (2004), Nunes et al. (2010), Parker et al. (1994) Jagoe et al. (2000) Bailey and Daugherty (2007), Huth-Bocks et al. (2002), Lipsky et al. (2004) Kaye et al. (2006), Nunes et al. (2010), Moraes et al. (2010), Taggart & Mattson (1996) Cokkinides et al. (1999), Curry et al. (1998), Dietz et al. (1997), Diop Sidibe et al. (2006), Goodwin et al. (2000), Hindin et al. (2008), Hyun et al. (2010), Pagnini and Reichman (2000), Parker et al. (1994), Rachana et al. (2002) Hindin et al. (2008) Cokkinides et al. (1999), Goodwin et al. (2000), Hyun et al. (2010) Bailey and Daugherty (2007), Dietz et al. (1997), Diop Sidibe et al. (2006), Huth-Bocks et al.(2002), Nunes et al. (2010) Curry et al. (1998), Jagoe et al. (2000), Kaye et al. (2006), Lipsky et al. (2004), Moraes et al. (2010), Pagnini and Reichman (2000), Parker et al. (1994), Rachana et al. (2002), Taggart & Mattson (1996) Huth-Bocks et al. (2002), Kaye et al. (2006), Nunes et al. (2010), Parker et al. (1994) Lipsky et al. (2004) Cokkinides et al. (1999), Dietz et al. (1997), Diop Sidibe et al. (2006), Goodwin et al. (2000), Hyun et al. (2010), Jagoe et al. (2000), Lipsky et al (2004), Moraes et al. (2010), Parker et al. (1994), Rachana et al. (2002) Curry et al. (1998), Hindin et al. (2008), Taggart & Mattson (1996) Bailey and Daugherty (2007), Huth-Bocks et al. (2002), Kaye et al. (2006), Nunes et al. (2010), Pagnini and Reichman (2000) Cokkinides et al. (1999), Curry et al. (1998), Dietz et al. (1997), Diop Sidibe et al. (2006), Goodwin et al. (2000), Hindin et al. (2008), Huth-Bocks et al. (2002), Hyun et al. (2010), Lipsky et al (2004), Moraes et al. (2010), Nunes et al. (2010) Bailey and Daugherty (2007), Jagoe et al. (2000), Pagnini and Reichman (2000), Parker et al. (1994), Rachana et al. (2002),Taggart & Mattson (1996) Kaye et al. (2006)

Physical, Psychological Physical, Sexual Physical, Psych, Sexual Control for Confounders Yes

0 3 5 11

16.7 27.8 61.1

No Mixed

6 1

33.3 5.6

feeding practices, preparation and storage of food, newborn care and health practices at home, preventive and curative careseeking, and psychosocial care and stimulation needed for healthy growth and development (Engle & Lhotska, 1999; Engle, Menon, & Haddad, 1999). Below, we review evidence of the links between domestic violence and feeding practices, preventive and curative care, and psychosocial stimulation. Feeding practices Feeding practices include the onset and duration of exclusive breastfeeding as well as the timely introduction of suitable complementary foods (Brown, Dewey, & Allen, 1998). Breastfeeding meets an infants nutrient requirements in its rst six months, fosters bonding between the mother and child, provides maternal antibodies and nutrients through colostrums (rst milk) (Newman, 1995), confers passive immunity, and reduces the risk of infection (Institute of Medicine, 1990). Exclusive breastfeeding is recommended during the rst six months of life, with continued

breastfeeding into the second year (WHO, 2001). The introduction of foods and liquids other than breast milk before six months reduces a childs intake of breast milk and may increase her exposure to pathogens (Newman, 1990). The late introduction of complementary foods also poses a risk for child malnutrition (Huffman & Martin, 1994). Young children have high nutrient needs per kilogram of body weight, but their small gastric capacity and nave immune system limit their intake. So, they rely on their main caregiver to offer high-quality, complementary foods often (Engle et al., 1999). The physical and psychological effects of domestic violence may impair a womans ability to breastfeed (a decit response), or may cause a compensatory response, spurring a woman to breastfeed (Kendall-Tackett, 2007; Klingelhafer, 2007). Few studies have examined this association (Table 7), and the available ndings are mixed. Case reports from Australia, Brazil, Canada, and the U.S. have linked sexual violence in childhood (Klingelhafer, 2007; Wood &

Table 6 Studies of the Effects of Domestic Violence on Adverse Pregnancy Outcomes (n 48 studies). n Year of Publication 1985e89 1990e99 1 18 % 2.1 37.5 Studies (author, date) Bullock and McFarlane (1989) Berenson et al. (1994), Campbell et al. (1999), Cokkindes et al. (1999), Connolly et al. (1997), Curry et al. (1998), Dye et al. (1995), Fernandez and Krueger (1999), Grimstad et al. (1999), Grimstad et al. (1997), Jejeebhoy (1998), McFarlane et al. (1996), OCampo et al. (1994), Parker et al. (1994),Renker (1999), Schei et al. (1991), Shumway et al. (1999), Valdez Santiago and Sanin-Aguirre (1996), Webster et al. (1996) Altarac & Strobino (2002), Arcos et al. (2001), Audi et al.(2008), Bohn (2002), Coker et al. (2004), Covington et al. (2001), El Kady et al. (2005), Huth-Bocks et al. (2002), Jagoe et al. (2000), Janssen et al. (2003), Kearney et al. (2003), Kearney et al. (2004), Kaye et al. (2006), Lipsky et al. (2004), Neggers et al. (2004), Nunez-Rivas et al. (2003), Rachana et al. (2002), Rodrigues et al. (2008), Rosen et al. (2007), Sanchez et al. (2008), Silverman et al. (2006a,2006b), Valladares et al. (2009), Valladares et al. (2002), Yang et al. (2006), Yost et al. (2005) Hyun et al. (2010), Leone et al. (2010), Nunes et al. (2010), Romero-Gutierrez et al. (2010) Altarac & Strobino (2002), Berenson et al. (1994), Bohn (2002), Bullock and McFarlane (1989), Campbell et al. (1999), Coker et al. (2004), Cokkindes et al. (1999), Connolly et al. (1997), Covington et al. (2001), Curry et al. (1998), Dye et al. (1995), El Kady et al. (2005), Fernandez and Krueger (1999), Huth-Bocks et al. (2002), Hyun et al. (2010), Jagoe et al. (2000), Janssen et al. (2003), Kearney et al. (2003), Kearney et al. (2004), Leone et al. (2010), Lipsky et al. (2004), McFarlane et al. (1996), Neggers et al. (2004), OCampo et al. (1994), Parker et al. (1994), Rachana et al. (2002), Renker (1999), Rosen et al. (2007), Shumway et al. (1999), Silverman et al. (2006a,2006b), Yost et al. (2005) Grimstad et al. (1999), Grimstad et al. (1997), Rodrigues et al. (2008), Schei et al. (1991), Webster et al. (1996) Jejeebhoy (1998), Yang et al. (2006) Arcos et al. (2001), Audi et al. (2008), Nunes et al. (2010), Nunez-Rivas et al. (2003), Romero-Gutierrez et al. (2010), Sanchez et al (2008), Valladares et al. (2009), Valladares et al. (2002) Kaye et al. (2006) Valdez Santiago and Sanin-Aguirre (1996) [Australia] Bevenson et al. (1994), Campbell et al. (1999), Fernandez and Krueger(1999), Grimstad et al. (1999), Grimstad et al. (1997), Jagoe et al. (2000), Lipsky et al. (2004), Sanchez et al. (2008), Schei et al. (1991), Valladares et al. (2002) Altarac & Strobino (2002), Bullock & McFarlane (1989), Coker et al. (2004), Cokkindes et al. (1999), Connolly et al. (1997), Curry et al. (1998), El Kady et al. (2005), Hyun et al. (2010), Janssen et al. (2003), Jejeebhoy (1998), Kearney et al. (2003), Kearney et al. (2004), Leone et al. (2010), Neggers et al. (2004), Nunez-Rivas et al. (2003), OCampo et al. (1994), Rachana et al. (2002), Rodrigues et al. (2008), Romero-Gutierrez et al. (2010), Rosen et al. (2007), Valdez Santiago Sanin-Aguirre (1996), Webster et al. (1996), Yang et al. (2006), Yost et al. (2005) Arcos et al. (2001), Audi et al. (2008), Bohn (2002), Covington et al. (2001), Dye et al. (1995), Huth-Bocks et al. (2002), Kaye et al. (2006), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994), Renker (1999), Shumway et al. (1999), Silverman et al. (2006a,2006b), Valladares et al. (2009) Bohn (2002), Jagoe et al. (2000) Arcos et al. (2001), Berenson et al. (1994), Connolly et al. (1997), Covington et al. (2001), Dye et al. (1995), Fernandez and Krueger (1999), Grimstad et al. (1999), Grimstad et al. (1997), Huth-Bocks et al. (2002), Nunez-Rivas et al. (2003), OCampo et al. (1994), Renker (1999), Rosen et al. (2007), Schei et al. (1991), Valdez Santiago and Sanin-Aguirre (1996), Valladares et al. (2009), Webster et al. (1996) Altarac & Strobino (2002), Audi et al. (2008), Bullock & McFarlane (1989), Campbell et al. (1999), Coker et al. (2004), Jejeebhoy (1998), Kaye et al. (2006), McFarlane et al. (1996), Nunes et al. (2010), Parker et al. (1994), Sanchez et al. (2008), Shumway et al. (1999), Webster (1996), Yang et al. (2006), Yost et al. (2005) Cokkindes et al. (1999), Curry et al. (1998), El Kady et al. (2005), Hyun et al. (2010), Janssen et al. (2003), Kearney et al. (2003), Kearney et al. (2004), Leone et al. (2010), Lipsky et al. (2004), Neggers et al. (2004), Rachana et al. (2002), Rodrigues et al. (2008), Romero-Gutierrez et al. (2010), Silverman et al. (2006a,2006b) Berenson et al. (1994), Campbell et al. (1999), Coker et al. (2004), Cokkindes et al. (1999), Hyun et al. (2010), Leone et al. (2010), OCampo et al. (1994), Shumway et al. (1999), Webster et al. (1996) Altarac & Strobino (2002), Audi et al. (2008), Bohn (2002), Covington et al. (2001), Dye et al. (1995), Grimstad et al. (1999), Grimstad et al. (1997), Huth-Bocks et al. (2002), Janssen et al. (2003), Kearney et al. (2003), Kearney et al. (2004), Kaye et al. (2006), Lipsky et al. (2004), Neggers et al. (2004), Nunes et al. (2010), Parker et al. (1994), Rachana et al. (2002), Renker (1999), Rodrigues et al. (2008), Romero-Gutierrez et al. (2010), Schei et al. (1991), Valladares et al. (2002), Valladares et al. (2009), Webster et al. (1996), Yang et al. (2006), Yost et al. (2005) Arcos et al. (2001), Bullock & McFarlane (1989), Connolly et al. (1997), Curry et al. (1998), El Kady et al. (2005), Fernandez and Krueger (1999), Jagoe et al. (2000), Jejeebhoy (1998), McFarlane et al. (1996), Nunez-Rivas et al. (2003), Rosen et al. (2007), Sanchez et al. (2008), Silverman et al. (2006a,2006b), Valdez Santiago et al. (1996)

2000e09

25

52.1

Region

2010 N America

4 31

8.3 64.6

Europe South Asia Latin America

5 2 8

10.4 4.2 16.7

Study Design

Africa Multi-site/ Other Case-Control (CC)

1 1 10

2.1 2.1 20.8

Cross-Sectional (CS)

24

50.0

Longitudinal-CC Longitudinal-Cohort

0 14

0.0 29.2

Sample Size

1e99 100e499

2 17

4.2 35.4

500e1499

15

31.3

1500

14

29.2

Response Rate

<50 50e74

0 9

0.0 18.8

75e100

25

52.1

Not stated

14

29.2

K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554 Table 6 (continued ) n Age of Children  3 years  5 years Prenatal 2 1 45 % 4.2 2.1 93.8 Studies (author, date) Huth-Bocks et al. (2002), Valladares et al. (2002) Rosen et al. (2007) Altarac & Strobino (2002), Arcos et al. (2001), Audi et al. (2008), Berenson et al. (1994), Bohn (2002), Bullock & McFarlane (1989), Campbell et al. (1999), Coker et al. (2004), Cokkindes et al. (1999), Connolly et al. (1997), Covington et al. (2001), Curry et al. (1998), Dye et al. (1995), El Kady et al. (2005), Fernandez and Krueger (1999), Grimstad et al. (1999), Grimstad et al. (1997), Hyun et al. (2010), Jagoe et al. (2000), Janssen et al. (2003), Jejeebhoy (1998), Kearney et al. (2003), Kearney et al. (2004), Kaye et al. (2006), Leone et al. (2010), Lipsky et al. (2004), McFarlane et al. (1996), Neggers et al. (2004), Nunes et al. (2010), Nunez-Rivas et al. (2003),OCampo et al. (1994), Parker et al. (1994), Rachana et al. (2002), Renker (1999), Rodrigues et al. (2008), Romero-Gutierrez et al. (2010), Sanchez et al. (2008), Schei et al. (1991), Shumway et al. (1999), Silverman et al. (2006a,2006b), Valdez Santiago and Sanin-Aguirre (1996), Valladares et al. (2009), Webster et al. (1996), Yang et al. (2006), Yost et al. (2005) Audi et al. (2008), Huth-Bocks et al. (2002), Kaye et al. (2006), Nunes et al. (2010), Parker et al. (1994), Shumway et al. (1999), Valladares et al. (2009) Arcos et al. (2001), Dye et al. (1995) Bohn (2002), Covington et al. (2001), Renker (1999) Arcos et al. (2001), Berenson et al. (1994), Bullock & McFarlane (1989), Cokkindes et al. (1999), Connolly et al. (1997), Covington et al. (2001), Dye et al. (1995), El Kady et al. (2005), Fernandez and Krueger (1999), Hyun et al. (2010), Jagoe et al. (2000), Janssen et al. (2003), Jejeebhoy (1998), Parker et al. (1994), Rachana et al. (2002), Renker (1999), Rodrigues et al. (2008), Rosen et al. (2007), Schei et al. (1991), Shumway et al. (1999), Valdez Santiago and Sanin-Aguirre (1996), Valladares et al. (2002), Yang et al. (2006), Yost et al. (2005) Coker et al. (2004), Grimstad et al. (1999), Leone et al. (2010), OCampo et al. (1994), Sanchez et al (2008) Bohn (2002), Curry et al. (1998), Grimstad et al. (1997), Huth-Bocks et al. (2002), McFarlane et al. (1996) Altarac & Strobino (2002), Campbell et al. (1999), Kaye et al. (2006), Kearney et al. (2003), Kearney et al. (2004), Lipsky et al. (2004), Neggers et al. (2004), Nunes et al. (2010), Nunez-Rivas et al. (2003), Romero-Gutierrez et al. (2010), Silverman et al. (2006a,2006b), Valladares et al. (2009), Webster et al. (1996) Audi et al. (2008) Altarac & Strobino (2002), Audi et al. (2008), Berenson et al. (1994), Bullock & McFarlane (1989), Campbell et al. (1999), Coker et al. (2004), Cokkindes et al. (1999), Covington et al. (2001), Curry et al. (1998), Dye et al. (1995), El Kady et al. (2005), Grimstad et al. (1999), Grimstad et al. (1997), Huth-Bocks et al. (2002), Hyun et al. (2010), Janssen et al. (2003), Jejeebhoy (1998), Kearney et al. (2003), Kearney et al. (2004), Kaye et al. (2006), Leone et al. (2010), Lipsky et al. (2004), McFarlane et al. (1996), Neggers et al. (2004), Nunes et al. (2010), Nunez-Rivas et al. (2003), Rodrigues et al. (2008), Rosen et al. (2007), Sanchez et al. (2008), Schei et al. (1991), Silverman et al. (2006a,2006b), Valdez Santiago and Sanin-Aguirre (1996), Valladares et al. (2002), Valladares et al. (2009), Webster et al. (1996), Yang et al. (2006) Bohn (2002), Connolly et al. (1997), Fernandez and Krueger (1999), Jagoe et al. (2000), OCampo et al. (1994), Parker et al. (1994), Rachana et al. (2002), Renker (1999), Romero-Gutierrez et al. (2010), Shumway et al. (1999), Yost et al. (2005) Arcos et al. (2001)

1545

Length of Followup

Other/NA

64.3

Domestic Violence Type

Pregnancy to birth Prenatal to delivery Physical

2 3 24

14.3 21.4 50.0

Physical, Psychological Physical, Sexual Physical, Psych, Sexual

5 5 13

10.4 10.4 27.1

Other, Not Stated Control for Confounders

1 Yes

2.1 36

75.0

No

11

22.9

Other

2.1

Van Esterik, 2010), sexual domestic violence (Heads, 2007), and domestic violence in pregnancy (Loureno & Deslandes, 2008) with mixed maternal responses to breastfeeding. Two small, facilitybased studies in the U.S. have shown no associations of sexual violence in childhood (Benedict, Paine, & Paine, 1994) or prior physical or sexual domestic violence (Bullock, Libbus, & Sable, 2001) with breastfeeding initiation or duration. Two other facility-based studies in Hong Kong and the U.S. have shown any prenatal domestic violence to negatively predict breastfeeding initiation (Lau & Chan, 2007) and physical domestic violence or maternal sexual violence in childhood to negatively predict breastfeeding at six weeks postpartum (Acheson, 1995). Finally, among women in 26 U.S. states, there was no adjusted association

of physical domestic violence before or in pregnancy with initiation or early cessation of breastfeeding (Silverman, Decker, Reed, & Raj, 2006a), and in a national sample of mother-child dyads in the U.S., women reporting childhood sexual abuse had higher adjusted odds of initiating breastfeeding (Prentice, Lu, Lange, & Halfon, 2002). These inconsistencies may result from non-comparable samples, variation in the denitions or measurements of domestic violence or breastfeeding, and differences in the analytic procedures (Table 7). Our review agrees with prior ones that the effects of domestic violence against women on breastfeeding remain uncertain (BairMerritt et al., 2006; Boy & Salihu, 2004). Also, we found no studies linking domestic violence to complementary feeding, and studies in poorer settings are lacking.

1546

K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554

Table 7 Studies of the Effects of Domestic Violence on Infant and Child Care. n Breastfeeding (n 10 studies) Year of Publication 1990e99 2000e09 2 7 % 20.0 70.0 Studies (author, date) Acheson (1995), Benedict el al. (1994) Bullock et al. (2001), Heads (2007), Klingelhafer (2007), Lau and Chan (2007), Loureno & Deslandes (2008) Prentice et al. (2002), Silverman et al. (2006a,2006b) Wood and Van Esterik (2010) Acheson (1995), Benedict et al. (1994), Bullock et al. (2001), Klingelhafer (2007), Prentice et al. (2002), Silverman et al. (2006a,2006b), Wood and Van Esterik (2010) Lau and Chan (2007) Loureno & Deslandes (2008) Heads (2007) [New Zealand] Bullock et al. (2001), Heads (2007), Klingelhafer (2007), Lau & Chan (2007), Loureno & Deslandes (2008), Prentice et al. (2002), Silverman et al. (2006a,2006b), Wood & Van Esterik (2010) Acheson (1995), Benedict et al. (1994) Heads (2007), Klingelhafer (2007), Loureno & Deslandes (2008), Wood & Van Esterik (2010) Benedict et al. (1994), Bullock et al. (2001) Acheson (1995), Lau & Chan (2007), Prentice et al. (2002), Silverman et al. (2006a,2006b)

Region

2010 N America

1 7

10.0 70.0

Study Design

Europe South Asia Latin America Africa Multi-site/Other Case-Control (CC) Cross-Sectional (CS)

0 1 1 0 1 0 8

0.0 10.0 10.0 0.0 10.0 0.0 80.0

Sample Size

Longitudinal-CC Longitudinal-Cohort 1e99 100e499 500e1499 1500 <50 50e74 75e100 Not stated/Not applicable 1years/Infancy

0 2 4 2 4 0 0 2 3 5 9

0.0 20.0 40.0 20.0 40.0 0.0 0.0 20.0 30.0 50.0 90.0

Response Rate

Age of Children

Length of Followup

Domestic Violence Type

 3 years Other/ Not stated Post-neonatal period 12mo post-partum 24 mo post-partum 60 mo post-partum Other/ Not stated Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual Other, Not Stated Yes No

1 0 0 0 0 0 2 1 0 2 1 6 3 6 1 2 6 0 7

10.0 0.0 0.0 0.0 0.0 0.0 100.0 10.0 0.0 20.0 10.0 60.0 30.0 60.0 10.0 25.0 75.0 0.0 87.5

Bullock et al. (2001), Prentice et al. (2002) Acheson (1995), Benedict et al. (1994), Lau & Chan (2007) Heads (2007), Klingelhafer (2007), Loureno & Deslandes (2008), Silverman et al. (2006a,2006b), Wood & Van Esterik (2010) Acheson (1995), Benedict et al. (1994), Bullock et al. (2001), Heads (2007), Klingelhafer (2007), Lau & Chan (2007), Loureno & Deslandes (2008), Silverman et al. (2006a,2006b), Wood & Van Esterik (2010) Prentice et al. (2002)

Acheson et al. (1995), Benedict et al. (1994) Silverman et al. (2006a,2006b) Acheson (1995), Bullock et al. (2001) Lau & Chan (2007) Benedict et al. (1994), Heads (2007),Klingelhafer (2007), Loureno & Deslandes (2008), Prentice et al. (2002), Wood & Van Esterik (2010) Lau & Chan (2007), Prentice et al. (2002), Silverman et al. (2006a,2006b) Acheson (1995), Bullock et al. (2001), Heads (2007), Klingelhafer (2007), Loureno & Deslandes (2008), Wood & Van Esterik (2010) Benedict et al. (1994) Attala and McSweeney (1997), Brooks et al. (1998) Arcos et al. (2003), Bair-Merritt et al. (2008b), Bair-Merritt et al. (2008a), Kernic et al. (2002), Martin et al. (2001), Onyskiw (2002) Attala and McSweeney (1997), Bair-Merritt et al. (2008b), Bair-Merritt et al. (2008a), Brooks et al. (1998), Kernic et al. (2002), Martin et al. (2001), Onyskiw (2002)

Control for Confounders

Not stated Preventive and Curative Care (n [ 8 studies) Year of Publication 1990e99 2000e09 2010 N America

Region

Study Design

Sample Size

Europe South Asia Latin America Africa Multi-site/Other Cross-Sectional (CS) Longitudinal-CC Longitudinal-Cohort 1e99 100e499 500e1499 1500

0 0 0 0 1 2 2 1 3 0 4 1 3

0.0 0.0 0.0 0.0 12.5 25.0 25.0 12.5 37.5 0.0 50.0 12.5 37.5

Arcos et al. (2003) Attala & McSweeney (1997), Brooks et al. (1998) Martin et al. (2001), Onyskiw (2002) Arcos et al. (2003) Bair-Merritt et al. (2008b), Bair-Merritt et al. (2008a), Kernic et al. (2002) Arcos et al. (2003), Attala & McSweeney (1997), Bair-Merritt et al. (2008a), Kernic et al. (2002) Brooks et al. (1998) Bair-Merritt et al. (2008b), Martin et al. (2001), Onyskiw (2002)

K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554 Table 7 (continued ) n Response Rate < 50 50e74 75e100 Not stated/Not applicable  1years/Infancy  3 years Mixed Other/ Not stated Post-neonatal period 12 mo post-partum 24-36 mo post-partum2 Other/ Not stated Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual Other, Not Stated Yes No 0 1 3 4 2 2 3 1 1 1 0 5 0 0 0 3 3 5 0 2 8 % 0.0 12.5 37.5 50.0 25.0 25.0 37.5 12.5 25.0 25.0 50.0 0.0 62.5 0.0 0.0 0.0 37.5 37.5 62.5 0.0 18.2 72.8 Attala & McSweeney (1997), Attala and Summers (1999) Arcos et al. (2003), Burke et al. (2008), English et al. (2003), Flaherty et al. (2009), Karamagi et al. (2007), Onyskiw (2002), Silverman et al. (2009), Suglia et al. (2009) Rico et al. (2010) Attala & McSweeney (1997), Attala and Summers (1999), Burke et al. (2008), English et al. (2003), Flaherty et al. (2009), Onyskiw (2002), Suglia et al. (2009) Silverman et al. (2009) Arcos et al. (2003) Karamagi et al. (2007) Rico et al. (2010) Attala & McSweeney (1997) Karamagi et al. (2007), Onyskiw (2002), Rico et al. (2010), Silverman et al. (2009) Arcos et al. (2003) Attala & Summers (1999), Burke et al. (2008), English et al. (2003), Flaherty et al. (2009), Suglia et al. (2009) Arcos et al. (2003), Attlala and McSweeney (1997), Attala & Summers (1999), English et al. (2003), Karamagi et al. (2007) Flaherty et al. (2009) Burke et al. (2008), Rico et al. (2010), Onyskiw (2002), Silverman et al. (2009), Suglia et al. (2009) Flaherty et al. (2009), Suglia et al. (2009) Arcos et al. (2003), English et al. (2003), Karamagi et al. (2007), Onyskiw (2002), Rico et al. (2010), Silverman et al. (2009) Attala & McSweeney (1997), Attala & Summers (1999), Burke et al. (2008) Arcos et al. (2003), Burke et al. (2008), Karamagi et al. (2007) Rico et al. (2010), Suglia et al. (2009) Silverman et al. (2009) Attala & Summers (1999), Onyskiw (2002) Attala & McSweeney (1997), English et al. (2003), Flaherty et al. (2009) Arcos et al. (2003) Burke et al. (2008) Attala & Summers (1999), English et al. (2003) Flaherty et al. (2009) Suglia et al. (2009) Arcos et al. (2003), Attala & McSweeney (1997), Flaherty et al. (2009), Suglia et al. (2009) Burke et al. (2008) Rico et al. (2010), Silverman et al. (2009) Karamagi et al. (2007) Attala & Summers (1999), English et al. (2003), Onyskiw (2002) Burke et al. (2008), English et al. (2003), Flaherty et al. (2009), Karamagi et al. (2007), Rico et al. (2010), Silverman et al. (2009), Suglia et al. (2009) Arcos et al. (2003), Attala & McSweeney (1997), Attala & Summers (1999), Onyskiw (2002) Studies (author, date) Bair-Merritt et al. (2008a) Arcos et al. (2003), Martin et al. (2001), Onyskiw (2002) Attala & McSweeney (1997), Bair-Merritt (2008b), Brooks et al. (1998), Kernic et al. 2002) Arcos et al. (2003), Martin et al. (2001) Bair-Merritt et al. (2008a), Bair-Merritt (2008b) Brooks et al. (1998), Kernic et al. (2002), Onyskiw (2002) Attala & McSweeney (1997) Arcos et al. (2003) Kernic et al. (2002) Bair-Merritt et al. (2008a), Bair-Merritt et al. (2008b) Arcos et al. (2003), Attala & McSweeney (1997), Bair-Merritt et al. (2008a), Bair-Merritt et al. (2008b), Martin et al. (2001)

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Age of Children

Length of Followup

Domestic Violence Type

Control for Confounders

Brooks et al. (1998), Kernic et al. (2002), Onyskiw (2002) Bair-Merritt et al. (2008a), Bair-Merritt et al. (2008b), Kernic et al. (2002) Arcos et al. (2003), Attala & McSweeney (1997), Brooks et al. (1998), Martin et al. (2001), Onyskiw (2002)

Not stated Child morbidity (n [ 11 studies) Year of Publication 1990e99 2000e09

Region

2010 N America

1 7

9.1 63.6

Study Design

Europe South Asia Latin America Africa Multi-site/Other Case-Control (CC) Cross-Sectional (CS) Longitudinal-CC Longitudinal-Cohort

0 1 1 1 1 1 4 1 5 0 5 1 5 0 2 6 3 3 2 1 2 3 1 1 2 1 1 4 1 2 1 3 7

0.0 9.1 9.1 9.1 9.1 9.1 36.4 9.1 45.5 0.0 45.5 9.1 45.5 0.0 18.2 54.5 27.3 27.3 18.2 9.1 18.2 27.3 16.7 16.7 33.3 26.7 16.7 36.4 9.1 18.2 9.1 27.3 63.4

Sample Size

1e99 100e499 500e1499 1500

Response Rate

< 50 50e74 75e100 Not stated/Not applicable  1years/Infancy  3 years  5 years Mixed Other/ Not stated Post-neonatal period 12 mo post-partum 24e36 mo post-partum 60 mo post-partum Other/ Not stated Physical Physical, Psychological Physical, Sexual Physical, Psych, Sexual Other, Not Stated Yes

Age of Children

Length of Followup

Domestic Violence Type

Control for Confounders

No Not stated

4 0

36.4 0.0

(continued on next page)

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K.M. Yount et al. / Social Science & Medicine 72 (2011) 1534e1554

Studies (author, date)

Parenting/Parent-child interactions (selective listing of articles cited in text) (n [ 13 studies) Year of Publication 1985e89 1 7.7 Gottman & Katz (1989) 1990e99 2 15.4 Holden and Ritchie (1991), McCloskey et al. (1995) 2000e09 9 69.2 Casanueva et al. (2008), Letourneau et al. (2007), Levendosky et al. (2000), Levendosky Graham-Bermann (2001), Levendosky et al. (2003), Levendosky et al. (2006), Owen et al. (2006), Rea and Rossman (2005), Suglia et al. (2009) 2010 1 7.7 Sturge-Apple et al. (2010) Region N America 13 100.0 Casanueva et al. (2008), Holden and Ritchie (1991), Gottman & Katz (1989), Letourneau et al. (2007), Levendosky et al. (2000), Levendosky Graham-Bermann (2001), Levendosky et al. (2003), Levendosky et al. (2006), McCloskey et al. (1995), Owen et al. (2006), Rea and Rossman (2005), Sturge-Apple et al. (2010), Suglia et al. (2009) Europe 0 0.0 South Asia 0 0.0 Latin America 0 0.0 Africa 0 0.0 Multi-site/Other 0 0.0 Study Design Case-Control (CC) 2 15.4 Holden & Ritchie (1991), Gottman & Katz (1989) Cross-Sectional (CS) 6 46.2 Casanueva et al. (2008), Levendosky et al. (2000), Levendosky et al. (2003), McCloskey et al. (1995), Owen et al. (2006), Sturge-Apple et al. (2010) Longitudinal-CC 1 7.7 Rea and Rossman (2005) Longitudinal-Cohort 3 23.1 Letourneau et al. (2007), Levendosky et al. (2006), Suglia et al. (2009) Case-Control (CC)/Cross-Sectional (CS) 1 7.7 Levendosky Graham-Bermann (2001) Sample Size 1e99 3 23.1 Holden & Ritchie (1991), Levendosky et al. (2000), Gottman & Katz (1989) 100e499 6 46.2 Levendosky and Graham-Bermann (2001), Levendosky et al. (2003), Levendosky et al. (2006), Owen et al. (2006), Rea and Rossman (2005), Sturge-Apple et al. (2010) 500e1499 1 7.7 McCloskey et al. (1995) 1500 3 23.1 Casanueva et al. (2008), Letourneau et al. (2007), Suglia et al. (2009) Response Rate< 50 0.0 50e74 1 7.7 Suglia et al. (2009) 75e100 5 38.5 Casanueva et al. (2008), Levendosky et al. (2000), Levendosky et al. (2006), McCloskey et al. (1995), Owen et al. (2006) Not stated/Not applicable 7 53.8 Gottman & Katz (1989), Holden & Ritchie (1991), Levendosky and Graham-Bermann (2001), Levendosky et al. (2003), Letourneau et al. (2007), Rea and Rossman (2005), Sturge-Apple et al. (2010). Age of Children  1years/Infancy 1 7.7 Levendosky et al. (2006) 3 years 2 15.4 Letourneau et al. (2007), Suglia et al. (2009) Mixed 5 38.5 Holden & Ritchie (1991), Levendosky et al. (2000), Levendosky and Graham-Bermann (2001), McCloskey et al. (1995), Rea and Rossman (2005) Other/ Not stated 5 38.5 Casanueva et al. (2008), Gottman & Katz (1989), Levendosky et al. (2003), Owen et al. (2006), Sturge-Apple et al. (2010) Length of Followup Post-neonatal period 0 0.0 12 mo post-partum 1 25.0 Levendosky et al. (2006) 60 mo post-partum 1 25.0 Letourneau et al. (2007) Other/ Not stated 2 50.0 Rea and Rossman (2005), Suglia et al. (2009) Domestic Violence Type Physical 6 46.2 Casanueva et al. (2008), Holden & Ritchie (1991), Levendosky et al. (2003), McCloskey et al. (1995), Sturge-Apple et al. (2010), Suglia et al. (2009) Physical, Psychological 3 23.1 Levendosky and Graham-Bermann (2001), Rea and Rossman (2005), Owen et al. (2006) Physical, Sexual 0 0.0 Physical, Psych, Sexual 2 15.4 Levendosky et al. (2000), Levendosky et al. (2006) Other, Not Stated 2 15.4 Gottman & Katz (1989), Letourneau et al (2007) Control for Confounders Yes 8 61.5 Casanueva et al. (2008), Letourneau et al. (2007), Levendosky and Graham-Bermann. (2001), Levendosky et al. (2003), Levendosky et al. (2006), McCloskey et al. (1995), Rea and Rossman. (2005), Suglia et al. (2009) No 4 30.8 Holden & Ritchie (1991), Gottman & Katz (1989), Levendosky et al. (2000), Owen et al. (2006) Not stated 1 7.7 Sturge-Apple et al. (2010)

Preventive and curative care In poor settings, there are strong associations of preventive care (Milman, Frongillo, de Onis, & Hwang, 2005), curative care (Santos et al, 2001; Zaman, Ashraf, & Martines, 2008), and chronic infection (Alam, Marks, Baqui, Yunus, & Fuchs, 2000; Assis, Barreto, Santos, Fiaccone, & da Silva Gomes, 2000; Guerrant, Ori, Moore, Ori, & Lima, 2008; Torres et al., 2000) with the diet, nutritional status, weight gain, and growth of young children. The psychological and

physical effects of domestic violence against mothers may affect the health care they seek for their infants and toddlers. Such violence may disrupt routine preventive care, elevating morbidity, the chances of chronic infection, and the need for curative treatment. According to one review (Boy & Salihu, 2004), rigorous studies of the relationships between domestic violence against mothers and health-care-seeking for their young children are lacking. Our review (Table 7) draws a similar conclusion. Of the eight studies

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reviewed, six were published since 2001, suggesting a recent focus on this topic. Seven were undertaken in North America and may not apply to poorer settings. Only two studies were national, but over half involved samples of more than 500 children. The samples included a range of ages, but only four focused on children three years or younger. Only one study had a prospective cohort design, although four others had retrospective cohort designs. In ve studies, response rates were not stated or were below 75%. Despite these drawbacks, the evidence for immunization coverage, well-child visits, and contact with primary care providers is consistent. In two case-control studies in the U.S., preschool and school-aged children of exposed mothers had less complete immunization records than those of non-exposed mothers (Attala & McSweeney, 1997; Brooks, Ferguson, & Webb, 1998). Likewise, in a retrospective cohort in Alaska, the children of mothers with physical domestic violence in the prior 12 months had lower adjusted odds of up-to-date immunizations at age two years (BairMerritt et al., 2008a). Regarding well-child visits, the North Carolina Pregnancy Risk Assessment Monitoring System showed no difference in source or mean number of well-baby visits among the infants of mothers exposed or not to physical domestic violence (Martin, Mackie, Kupper, Buescher, & Moracco, 2001); however, sheltered children in the U.S. have had fewer well-child visits than non-sheltered children (Brooks et al., 1998), and maternal exposure to physical domestic violence in the prior year has predicted lower adjusted odds of ve well-baby visits in a retrospective cohort of infants in Alaska (Bair-Merritt et al., 2008a). Finally, in Wave I (1994/1995) of the National Longitudinal Survey of Children and Youth (NLSCY), children exposed to domestic violence had no more contact with family practitioners and less contact with pediatricians than unexposed children (Onyskiw, 2002). The evidence for higher morbidity and morbidity-related treatment corroborates that of poorer preventive care in exposed children. Studies of morbidity and curative care are recent (Table 7), but often represent poorer settings (4 of 11), are based on national samples (3) and longitudinal cohort designs (6), have response rates exceeding 75% (6), and focus on children three years or younger (5). Studies also tend to focus on physical domestic violence (6), although various measurement scales are used (e.g., Flaherty et al. 2009). With few exceptions (English, Marshall, & Stewart, 2003), studies from several countries have shown higher odds of respiratory infection (Arcos et al., 2003; Silverman et al., 2009), asthma (Suglia, Enlow, Kullowatz, & Wright, 2009), diarrhea (Silverman et al., 2009), illness requiring a doctor (Flaherty et al., 2009), poorer general health (Attala & McSweeney, 1997; Attala & Summers, 1999; Burke, Lee, & OCampo, 2008; Karamagi, Tumwine, Tylleskar, & Heggenhougen, 2007; Onyskiw, 2002), and health complaints (Flaherty et al., 2009) among the children of mothers exposed to domestic violence or family conict. In wave I of the NLSCY, exposed children had more contact with other medical doctors, public health nurses, child welfare workers, and therapists, and more often used prescribed medications (Onyskiw, 2002). Retrospective cohort studies in Chile and the U.S. have shown higher likelihoods of medical consults for neonatal morbidity (Arcos et al., 2003) and of visits to a school nurse for substance abuse and speech pathology referrals (Kernic et al., 2002). Finally, in the National Survey of Child and Adolescent Well-Being, maternal exposure to minor domestic violence predicted lower rates of hospitalization in children, but maternal exposure to severe domestic violence predicted higher rates of emergency-department visits in children (Bair-Merritt et al., 2008b). Thus, domestic violence against mothers overall predicts less preventive care, higher morbidity, and more therapeutic care in their children.

Parenting and psychosocial interaction Positive parent-child psychosocial interactions include frequent physical contact and exchange of positive effect, parental responsiveness to the childs needs, provision of positive reinforcement, and encouragement to explore the environment. In interventions and observational studies controlling for household wealth, such interactions have been important for child growth and development (e.g., Engle & Lhotska, 1999; Grantham-McGregor, Powell, Walker, & Himes, 1991; Jin et al., 2007; Super, Herrera, & Mora, 1990), presumably by inuencing a childs regulatory systems and behaviors. Regarding the effects of domestic violence against mothers on such interactions, the evidence comes largely from small samples of U.S. children of mixed ages in which response rates are unknown or below 75% and domestic violence is variously measured (see Table 7 for examples). Not surprisingly, the ndings are generally mixed. Consistent with a decit response, maternal experience of domestic violence has predicted greater parenting stresses (e.g., Holden & Ritchie, 1991; Levendosky, Lynch, & Graham-Bermann, 2000; Owen, Kaslow, & Thompson, 2006), worse scores for parenting style (e.g., Levendosky & Graham-Bermann, 2001; Levendosky, Leahy, Bogat, Davidson, & von Eye, 2006), more permissive or inconsistent parenting (Holden & Ritchie, 1991; Holden, Stein, Ritchie, Harris, & Jouriles, 1998; Rea & Rossman, 2005), more anger and aggression toward children (e.g., Levendosky et al., 2000), less warmth in interactions with children (McCloskey, Figueredo, & Koss, 1995), a reduced ability to meet the childs emotional needs (Zuckerman, Augustyn, Groves, & Parker, 1995), greater maternal disengagement (Sturge-Apple, Davies, Cicchetti, & Manning, 2010), poorer parent-child interactions (Levendosky, Huth-Bocks, Shapiro, & Semel, 2003), and negative maternal psychological functioning (Levendosky & GrahamBermann 2001). However, consistent with a compensatory response, exposed mothers also have provided as much or more structure for their children (e.g., Holden & Ritchie, 1991), exhibited positive parenting behaviors (e.g., Moore & Pepler, 1998), discouraged violence (e.g., DeVoe & Smith, 2002), and were more empathic or protective and/or less verbally abusive toward their children (Levendosky et al., 2000). National (and in one case longitudinal) data from North America support compensatory parenting in exposed mothers (Letourneau, Fedick, & Willms, 2007; Casanueva, Martin, Runyan, Barth, & Bradley, 2008). Specically, exposed mothers may have lower initial scores for the quality of the home environment (Casanueva et al., 2008), positive discipline, nurturance, and consistency (Letourneau et al. 2007), but their behavior eventually resembles that of unexposed mothers (Letourneau et al., 2007). Longitudinal research on domestic violence and parenting is lacking for poorer settings, and the effects of domestic violence on child growth through parenting have yet to be established empirically in any setting.

Conclusions and recommendations for future research In sum, domestic violence against women is a global problem, as is malnutrition especially in pregnant women and young children. Because young children rely heavily on maternal care, their exposure to domestic violence is disproportionate among children. Such exposures have adverse effects on childrens development (see review above); yet, less is known about how such exposures affect growth and nutrition prenatally and during the rst three years of life (Bair-Merritt et al., 2006), critical periods for subsequent human-capital formation. Even less is known about the pathways by which CEDV affects nutrition and growth during these periods.

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Our conceptual review exposes several drawbacks of prior studies. One drawback is the inconsistent measurement of domestic violence (Ellsberg, Heise, Pena, Agurto, & Winkvist, 2001), which stems from using diverse instruments (e.g., Revised Conict Tactics Scale and the Abuse Assessment Screen) and variables (e.g., any versus only physical domestic violence). A related drawback is the infrequent direct measurement of childrens exposure, requiring assumptions about exposure based on the childs age (Holden, 2003; Edleson et al., 2007). Consequently, estimates of CEDV for the U.S. (McDonald et al., 2006) may be inaccurate, and estimates are lacking for poorer countries. A second drawback is the elds over-reliance on small, purposive samples in the U.S. This geographic bias pervaded the studies reviewed, but was largest for studies of the effects of domestic violence on childrens stress-response (Table 2), prenatal and delivery care (Table 5), pregnancy outcome (Table 6), and infant and toddler care (Table 7). Geographic gaps in research were most apparent for African countries, which appeared in 0e2 studies for each outcome reviewed (Tables 1e7). This gap contradicts the burden of domestic violence (Hindin et al., 2008) and child malnutrition (Kothari & Abderrahim, 2010) in African countries. Fortunately, the national Demographic and Health Surveys (DHS) have collected data concurrently on child anthropometry and domestic violence in over 30 poorer countries, including in Africa. Such data expand opportunities to explore the inuences of domestic violence on young child growth in nationally representative mother-child samples in such settings. A third drawback of research on CEDV is its uneven consideration of older and younger children and outcomes among younger children. The eld has focused on older or mixed age groups of children (Tables 1,2, and 7), when the effects of CEDV may differ by age (Holden, 2003). Also, of the potential outcomes of CEDV in early childhood, some (e.g., pregnancy outcomes, Table 6) have received more attention than others (e.g., breastfeeding, Table 7). Finally, recent process models of the effects of CEDV have tended to explore only selected pathways of effect. These gaps in research complicate a comparative assessment of the pathways by which CEDV may affect growth and nutrition prenatally and through the toddler years. Despite these drawbacks, the ndings from this conceptual review suggest that domestic violence may affect early childhood growth and nutrition through biological and behavioral pathways. The best (albeit geographically limited) evidence concerns the effects of prenatal domestic violence on LBW (Table 6), which strongly predicts subsequent growth. Also evident (in selected settings) is that maternal prenatal risk behaviors, mental impairments, and poor weight gain likely mediate the relationship between domestic violence and LBW. These ndings and gaps in knowledge motivate several recommendations for research. First, efforts are needed to compute global estimates of CEDV from national surveys that provide data on birth histories, domestic violence, and if available, childrens exposure. Second, meta-analyses are needed of the effects of domestic violence on some of the better-studied intervening outcomes in early childhood, such as morbidity and immunization coverage. Third, existing cross-sectional data should be analyzed to address geographic and substantive gaps in research. DHS data on women and children could be matched to construct retrospective cohorts in multiple countries, including understudied countries in Africa. Although the DHS lack some potential mediators (maternal mental health) and confounders (co-occurring child maltreatment), partial path models could be estimated. Ultimately, large, population-based intergenerational studies of diverse populations are needed to assess fully the pathways by which domestic violence affects the nutrition and growth of children prenatally and through the toddler years. An ideal study design would be a multicountry

prospective follow-up of pregnant women and their newborns, in which comparable data were collected on: various forms of domestic violence and its timing, direct questions on CEDV, intervening variables, confounders, and trajectories of child nutrition and growth prenatally through age three years. Our framework and recommendations for research expand scholarship on CEDV in several ways. First, we extend the focus of prior studies from developmental outcomes to nutrition and growth. Second, our focus on early childhood stresses the importance of malnutrition in this period for survival and functional outcomes into adulthood. Third, we provide the conceptual basis to explore the biological and behavioral pathways by which CEDV may affect nutrition and growth, as well as health and development, in young children. Fourth, our model stresses the needs for interdisciplinary research to capture fully the effects of CEDV in early life. Finally, we provide a general conceptual tool to assess whether domestic violence has common direct or indirect effects on early child growth and nutrition across countries and diverse subgroups in the U.S. Such research may further justify the global need to monitor and mitigate domestic violence against women. Existing systems that monitor childhood nutrition (De Onis & Blossner, 2003; Polhamus et al., 2004) may identify children at risk of exposure to domestic violence. New systems also may be developed to monitor directly domestic violence against pregnant women and mothers. Health services for these groups may incorporate screening and treatment for domestic violence to mitigate its effects on maternal risk behaviors, mental impairments, and nutritional conditions predicting poor pregnancy outcomes. This agenda for research and monitoring should inform the efforts underway in U.S. governmental agencies, NGOs, and foundations to reduce the prevalence of domestic violence and to improve childrens nutrition and growth globally. Acknowledgments We thank Emily Misch and Kimi Sato for their assistance with the literature search. The comments from anonymous reviewers on a prior version of this paper also are greatly appreciated. Any remaining errors of omission or commission are the responsibility of the authors. References
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