¡¾ÕªÒª¡¿  objective: to investigate the association of women's exposure to marital violence with their child disciplinary actions in the 2005 edhs. methods: a subª²sample of 5249 currentlyª² married women were investigated for ever and the 12 months prior to survey exposure to physical and sexual violence by their current husbands, and its association with their child disciplinary actions specifically hitting or slapping the child on the body and/or the face to address child behavior problem adjusting for the effect of respondents' age, education, work, residence, wealth index, number of children ever borne, and empowerment in household decisions . results: around 29.4% and 5.2% of the studied women have been ever exposed to physical and sexual violence by their current husbands; of them 60% and 65.7% have been subjected to it the 12 months prior to the survey respectively. around 70% of women were slapping or hitting their children aged 3ª²17 years on their body or face as an action to address behavior problems the month prior to the survey. around 40 % of women were slapping their children on face, head, or ears. logistic regression models showed that exposure to marital violence predicted hitting or slapping the child on the body and/or the face to address behavior problems the month prior to the survey adjusted to other confounders.conclusion: marital violence is significantly associated with child maltreatment. the study highlights the need for effective screening and identification of marital violence in families in which child maltreatment has occurred and vice versa.

¡¾¹Ø¼ü´Ê¡¿  vaw; slapping or hitting; child; maltreatment; 2005 efhs

  introduction

    data in the1995 edhs showed that 34% of currentlyª² married women were ever beaten by their current husband while 16% were beaten in the year prior to the survey. higher frequency of beating was associated with nonª²use of a female contraceptive method, and everª²beaten women were more likely to report health problems necessitating medical attention£Û1£Ý.  violence against women (vaw) is common in egypt as elsewhere around the arab world. in sudanese study, from october 2001 to february 2002, abuse was reported by 41.6% of literate, married women attending the arda medical centre, omdurman£Û2£Ý. regrettably, only 42.1% of the sudanese doctors had a fair knowledge of the concept of domestic violence, and 27.4% viewed it as a worthwhile health problem£Û3£Ý.  therefore, the barriers to screen cases as lack of knowledge and training, insufficient time at clinics and fear of problems with perpetrators should be overcome. 3 similar studies had also showed the magnitude of the problem of domestic violence and its determinants in other arab countries as jordan, and lebanon£Û4ª²6£Ý.

    research supports a substantial overlap between domestic violence and child maltreatment. in a previous study, domestic violence occurred in 38% of the cases of confirmed child maltreatment and domestic violence preceded child maltreatment in 78% of the cases of coª²occurrence£Û7£Ý.  history of prior reports of child maltreatment are strongly associated with violence against women£Û8£Ý. therefore researchers recommend that identification of victims of marital violence must include screening of their children for abuse, neglect and other types of adverse exposures£Û9£Ý.

    the current study aimed to investigate the association of currently married women's exposure to marital physical or sexual violence with reporting hitting or slapping their children aged 3ª²17 years the month prior to the survey as ways of disciplinary actions controlling for other predictors as the respondents' age, education, work, residence, wealth index, number of children ever borne, and empowerment in household decisions.

    methods

    the 2005 edhs is a nationally representative household survey of 19 474 ever married women's sample selected using a multistage sampling technique, to whom a faceª²toª²face structured interview was administered. the sample design and study methods and tools of the original study were previously detailed by el zanaty and way£Û10£Ý.

    data from the 2005 egypt demographic health survey (2005 edhs)   was downloaded on 10th october 2006 for free from the demographic and health surveys website£Û11£Ý.   before downloading data, the author submitted a mini proposal as a request for an access to datasets, which was approved before access was granted. access is only granted for legitimate research purposes. secondary inª² depth analysis of survey data was conducted.

    from the 2005 edhs data 11, a subª²sample of women whom were investigated for exposure to marital violence was selected for the current study. accordingly only 5 613 ever married women aged 15ª²49 years were selected, of whom only 5 249 currently married women entered into the statistical analysis.

    the 2005 edhs respondents who had children of age 3ª²17 years were asked questions about the types of actions they took to teach their children the right behavior or to address behavior problems during the month before the survey interview. specifically they were asked if they had used each of the following approaches at any time during the month: 1) hit or slapped the child on the body with a hard object; or 2) hit or slapped the child on the face, head, or ears. the main 2 outcome or dependent variables introduced in the different models of logistic regression analysis in the current study were:  1) slapping or hitting children on their body or their face, head, or ears; and  2) slapping or hitting children on their face, heads, or ears.

    marital violence comprised both physical and sexual violence. physical violence was defined as pushing, throwing something, twisting arm, slapping, punching, kicking, dragging, trying to strangle or burn, or  threaten or attacking with a knife or a weapon. sexual violence was defined as sexual coercion of wife using physical force while she did not want to have sex. the other independent variables were the respondents' age, education, work, residence, wealth index, number of children ever borne, and empowerment in all household decisions. the relationship of ever and past year exposure to marital violence with the aforementioned outcome variables was investigated, controlling for other predictors, in logistic regression models using spss for windows, version 12£Û12£Ý.   data are given as unª² weighted counts, percentages and means. after doing the univariate and bivariate analysis for the study variables, different logistic regression models were run to get the most significant associated predictors adjusted for each others to the outcome variables aforementioned. the outcome dichotomous variables was coded to 0 and 1.  the odds ratio which shows the change in the odds of dependent variable(s) when the independent variable(s) changed from 0 to 1 in case of binary independent variables, or the next category or score in case of categorical or continuous variables,  adjusted for other variables in the model. pª²value equal or below 0.05 was considered significant in all statistical tests.

    results

    the sample of currentlyª² married women, investigated for exposure to marital physical violence was 5 249 women. their mean age was 33.09 years (sd= 8.48). those completed their secondary education or higher constituted 42.1% whereas 18% of the whole sample was working for cash. urban residents constituted 44.8% of the sample. while 44.8% of the sample was empowered in all household decisions, 29.4% and 5.2% of the sample were ever exposed to physical and sexual violenceª²respectivelyª²by their current husbands. of them 60% and 65.7% were exposed to physical and sexual violenceª²respectivelyª²the 12 months prior to the survey. nearly 70 percent of the sample did slap or hit any of their children aged 3ª²17 years the month prior to the survey as a disciplinary action either on their body or face, head, ears by their hands or stick. around 40% did that on their children face, head, ears during the same period as a disciplinary action.  (table 1)

    ever and past year exposure to physical violence predicted slapping or hitting children on body and/or face in the 4 logistic regression models in table 2. similarly, the outcome variables were predicted lower wealth index quintiles, urban residence, younger age, having 3 or more ever born children. contrary to what could be expected,   and although poor level of education independently predicted battering children, women empowered in all household decisions were more likely to hit their children on their face. work status was not a significant independent predictor of hitting children as a disciplinary action in any of the models. (table 2)sexual violence predicted the outcome variables in 3 out of 4 models in table 3. other significant variables showed also similar pattern of relationship with the outcome variables.

    table 1  currentlyª²married women characteristics, n= 5 249 currently married women

    variablesvariables categoriesfrequency£¨%£©agecontinuous variable mean(sd)33.09(8.48)educationbelow secondary3 037£¨57.90£©secondary and above2 212£¨42.10£©work statusnot working for cash4 303£¨82.00£©working for cash946£¨18.00£©wealth index1  poorest1 060£¨20.20£©2  poorer916£¨17.50£©3  middle971£¨18.50£©4  richer1 120£¨21.30£©5  richest1 182£¨22.50£©residencerural2 897£¨55.20£©urban2 352£¨44.80£©empowered in all hh decisionsnot empowered2 899£¨55.20£©empowered2 350£¨44.80£©ever exposure to physical violenceno3 708£¨70.60£©yes1541£¨29.40£©past 12 months' exposure to physical violenceno4 388£¨83.60£©yes861£¨16.40£©ever exposure to sexual coercionno4 973£¨94.70£©yes274£¨5.20£©past 12 months' exposure to sexual coercionno5 069£¨96.60£©yes180£¨3.40£©slapping or hitting children to address their behavior problems on their body or  face the past monthno1 196£¨30.40£©yes2 732£¨69.60£©slapping or hitting children to address their behavior problems on their face, heads, or ears the past monthno2 370£¨60.40£©yes1 556£¨39.60£©

    table 2  relationship of ever exposure and past year exposure to physical violence (adjusted or) with hitting or

    slapping children  aged 3ª²17 years on body and/or face in logistic regression models

    modelsever exposurelast 12 months exposurehitting or slapping children on body or face (0= no, 1= yes) (n=3 928)1hitting or slapping children on face, head, ears (0= no, 1= yes) (n=3 926)hitting or slapping children on body or face (0= no, 1= yes) (n=3 928)hitting or slapping children on face, head, ears (0= no, 1= yes) (n=3 926)marital exposure to physical violence (no= rc)1.88*1.65*1.73*1.89*work (don't work= rc)nsnsnsnseducation (below secondary= rc)ns0.77*ns0.76*empowered in all hh decisions (not empowered= rc)ns1.16*ns1.16*wealth index (poorest quintile= rc0.81*0.79*0.81*0.79*age (in years)0.90*0.94*0.91*0.94*residence (rural= rc)1.30*1.31*1.32*1.31*no. of ever born children (0ª²2=rc)1.68*1.34*1.68*1.45*

    1 n does not equal to 5249 because either the question of child disciplinary actions was answered by women only with children aged 3ª²17 years, or because of missing cells.   

    table 3  relationship of ever exposure and past year exposure to sexual violence (adjusted or) with hitting or

    slapping children aged 3ª²17 years on body and/or face in logistic regression models

    ever exposurelast 12 months exposurehitting or slapping children on body or face (0=no, 1=yes) (n=3 928)1hitting or slapping children on face, head, ears (0= no, 1= yes) (n=3 926)hitting or slapping children on body or face (0= no, 1= yes) (n=3 928)hitting or slapping children on face, head, ears (0= no, 1= yes) (n=3 926)marital exposure to sexual violence (no= rc)1.89*ns1.85*1.70*work (don't work= rc)nsnsnsnseducation (below secondary= rc)ns0.74*ns0.74*empowered in all hh decisions (not empowered= rc)nsnsnsnswealth index (poorest quintile= rc0.80*0.79*0.80*0.79*age (in years)0.90*0.94*0.90*0.94*residence (rural= rc)1.35*1.36*1.35*1.36*no. of ever born children (0ª²2=rc)1.68*1.41*1.68*1.42*

    1 n does not equal to 5249 because either the question of child disciplinary actions was answered by women only with children aged 3ª²17 years, or because of missing cells.

    discussion

    despite the increasing recognition that domestic violence is a global public health concern, populationª²based studies of violence against women, its determinants and consequences remain scarce in developing countries£Û13£Ý.  the current study was the first to examine and prove the association of ever and past year exposure to marital violence with hitting and slapping children on their bodies and/or face as a way of disciplinary behavior adjusting for other covariates in multivariate logistic regression models.

    the type of relationship between marital violence exposure and children maltreatment is characterized by the complexity of its nature£Û14£Ý.  children in violent households are 3ª²9 times more likely to be injured and abused, either directly or while trying to protect their parent£Û15£Ý. research proved that women reported childhood physical abuse or witnessed marital violence during their childhood were at a 4ª²6 fold increase in risk of marital violence in their adulthood£Û16£Ý, which could be explained by the theory of learned helplessness£Û17£Ý.  childhood maltreatment is associated with psychopathology and revictimization in adulthood£Û17£Ý. also, harsh parenting and living with rejecting parents during childhood lead to more shameª² proneness but less guiltª² proneness£Û18£Ý.  moreover, children who witnessed domestic violence in the home and who were abused may be at greater risk for internalized behaviors such as anxiety and depression, and for externalized behaviors such as fighting, bullying, lying, cheating or displaying a greater willingness to use violence£Û19ª²21£Ý.  thus, the currently studied women experiencing marital violence might be exposed to abuse or witnessed violence in their childhood. as such, they might develop more shame and helplessness, and less guilt and externalizing behavior to victimize their children and thereby creating an intergenerational lack of empathy£Û22£Ý.

    violence has become a worldª²wide public health issue especially in the middle east and arab countries. given that violence begins at home £Û15£Ý, we must address the growing concern that our children and adolescents are becoming more violent and victims would become later the victimizers£Û23£Ý.  maltreated children are more likely to grow up to maltreat their own children. 17 in the middle east we need to know more about our children and adolescents, especially the impact on their mental health of socioeconomic problems, level of freedom, and democracy£Û24£Ý. now is the time to confront the problems of child and adolescents' mental health, the more so because infant and maternal health, and communicable diseases pose a less immediate threat to morbidity and mortality in our region.

    albeit the importance of the study, it still has its limitations. potential biases in selfª²reported data and the difficulty to verify its accuracy other than through consistency of reporting is also another limitation. also, some women may have been unwilling to report exposure to marital violence to the interviewer because they associated such experiences, with shame, guilt, fear or blame£Û25£Ý.  moreover, the study did not provide a clear picture of the nature of association between exposure to marital violence and battering children as a way of disciplinary actions due to the cross sectional nature of the study where causality and temporality could not be proved. however, there was still an implied likelihood that exposure to marital violence could proceed battering children because women were asked about their experience with their children for only the past month prior to the survey where as they were asked about ever and the past year exposure to violence.

    despite the study limitations, this study still has its strengths. with its nationally representative large sample size, it contributes to the literature by estimating the prevalence of ever and 12 months exposure to marital violence among egyptian currentª² married women in 2005 and its with an aspect of child maltreatment. the study highlighted the need for effective screening and identification of marital violence in families in which child maltreatment has occurred and vice versa. however, future research is still needed from other developing countries with similar problems to validate our results as well as to inª²depth qualitative studies for further explanation of our findings.

¡¾²Î¿¼ÎÄÏס¿
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