This week Pediatrics is publishing a remarkable study by Pratibha Chander and colleagues (10.1542/peds.2016-1059) that details the impact of intimate partner violence (IPV) experienced by South African women on the behavior and health of their children. The authors point out that while relatively well studied in high income countries, their work is the first to document the impact of IPV on child health in an African country. They utilized data collected as part of the population-based Asenze study in KwaZulu-Natal, South Africa, a “periurban” area whose inhabitants experience ongoing poverty, deprivation and high rates of HIV and unemployment. The researchers interviewed 790 women about IPV exposures in their current romantic relationships, and used the Strengths and Difficulties Questionnaire to assess behavior of their 980 children who were under 7 years old. A great strength of the work is the culturally sensitive manner in which it was conducted. Participants received a ride to the clinic, where surveys were administered in their primary language of isiZulu; women and children were offered HIV testing and referral, as well as counselling related to any IPV disclosures. The researchers clearly sought to give as much as they took, which is welcome and impressive.
The results are not unexpected but nonetheless are shocking. Over 1/3 of women experienced any IPV and 30.1% had a psychiatric disorder; the behavior of their young children suffered also. The authors’ careful analysis is worth reading, especially since multiple potentially confounding variables such as caregiver drinking and caregiver depression had to be considered.
This led me to consider whether the United Nations Sustainable Development goals address the worldwide health problem of IPV. Of the 17 Sustainable Development Goals, Goal 5 seems most pertinent: it is to “achieve gender equality and empower all women and girls.” Each Goal includes a set of Targets, which identify specific areas for change, and Indicators, by which progress can be measured. Target 5.2 is very specific to IPV, and is to “Eliminate all forms of violence against all women and girls in the public and private spheres, including trafficking and sexual and other types of exploitation.” Indicators associated with Target 5.2 include measures of the proportion of women exposed to IPV. At a January 2017 forum in Cape Town, South Africa, the first ever United Nations World Data Forum highlighted the fact that only 41% of countries regularly produce data on violence against women, and this paucity of information is one obstacle to progress. A second important obstacle is enabling access to that data that is collected in order to promote change and accountability. Thus the work of Pratibha Chander and colleagues is not only an important contribution to the pediatric literature, but to global health and achievement of Sustainable Development goals.
