Linkages between maternal experience of intimate partner violence and child nutrition outcomes: A rapid evidence assessment

Abstract

Background: A strong evidence base indicates that maternal caregivers' experience of intimate partner violence [IPV] impacts children's health, cognitive development, and risk-taking behaviors. Our objective was to review peer-reviewed literature describing the associations between a child's indirect exposure to IPV and corresponding nutrition outcomes, with a particular focus on fragile settings in low and middle-income countries [LMICs].

Methods: We conducted a rapid evidence assessment to synthesize quantitative associations between maternal caregivers' IPV experience and children's nutrition/growth outcomes (birthweight, feeding, and growth indicators). We included peer-reviewed research, published in English or Spanish after the year 2000, conducted in fragile settings in LMICs.

Results: We identified 86 publications that fit inclusion criteria. Amongst all associations assessed, a maternal caregiver's experience of combined forms of IPV (physical, sexual and emotional) or physical IPV only, were most consistently associated with lower birthweight, especially during pregnancy. Women of child-bearing age, including adolescents, exposed to at least one type of IPV showed a decreased likelihood of following recommended breastfeeding practices. Lifetime maternal experience of combined IPV was significantly associated with stunting among children under 5 years of age in the largest study included, though findings in smaller studies were inconsistent. Maternal experience of physical or combined IPV were inconsistently associated with underweight or wasting in the first five years. Maternal experience of sexual IPV during pregnancy appeared to predict worsened lipid profiles among children.

Conclusion: Maternal caregivers' experience of IPV is significantly associated with low birthweight and suboptimal breastfeeding practices, whereas studies showed inconsistent associations with child growth indicators or blood nutrient levels. Future research should focus on outcomes in children aged 2 years and older, investigation of feeding practices beyond breastfeeding, and examination of risk during time periods physiologically relevant to the outcomes. Programmatic implications include incorporation of GBV considerations into nutrition policies and programming and integrating GBV prevention and response into mother and child health and nutrition interventions in LMIC contexts.

Fig 1. PRISMA flow chart.

Fig 2. Harvest plot of maternal experience of IPV and child nutrition and growth outcomes.

Harvest plot depiction of associations between maternal exposure to IPV and child outcomes related to growth and nutritional status, by timepoint of exposure. The figure below the plot shows a life-course and outcome timeline. (a) Shows associations with low birthweight. (b) Shows associations with feeding practices including breastfeeding. (c) Shows associations with stunting, linear growth and growth velocity. (d) Shows associations with underweight/ wasting/ severe malnutrition. (e) Shows associations with lipid biomarkers. The blue bar in the graphs depict maternal lifetime exposure to IPV, the orange bar depicts exposure to IPV in the past year and the gray bar depicts exposure to IPV during pregnancy.