摘要：Objectives. We examined the association between maternal experiences of intimate partner violence (IPV) and the risk of undernutrition among children younger than 5 years in Bangladesh. Methods. We used data from the 2007 Bangladesh Demographic Health Survey. Our analyses were based on the responses of 1851 married women living with at least 1 child younger than 5 years. Exposure was determined from maternal reports of physical and sexual IPV. Outcomes included underweight, stunting, and wasting. Results. Twenty-nine percent of the respondents had experienced IPV in the year preceding the survey. Maternal experience of any physical or sexual IPV was associated with an increased risk of stunting (adjusted odds ratio [AOR] = 1.59; 95% confidence interval [CI] = 1.23, 2.08) and underweight (AOR = 1.33; 95% CI = 1.04, 1.71) but was not significantly associated with wasting (AOR = 1.08; 95% CI = 0.78, 1.49). Conclusions. The association between maternal exposure to physical or sexual IPV and child underweight and stunting suggests that partner violence plays a significant role in compromising child health by impairing child nutrition. Our findings reinforce the evidence that improving child nutrition is an additional reason to strengthen efforts to protect women from physical and sexual IPV. There has been substantial progress over the past decade in reducing child undernutrition. However, Bangladesh continues to have one of the highest rates of child undernutrition in the world, 1,2 and this condition is the leading cause of child morbidity and mortality in the country. 3,4 In 2005, nearly half of Bangladeshi children were underweight or stunted, and roughly two thirds of deaths among children younger than 5 years were attributed to undernutrition. 4 Although biological, 5,6 environmental, 7,8 and socioeconomic 9–11 risk factors for child undernutrition are well documented, research has only begun to investigate the influence of other aspects of the social environment. Intimate partner violence (IPV), defined as the range of sexually, physically, and psychologically coercive acts perpetrated against women by current or former male intimate partners, 12 is considered to be one of the psychosocial factors that might influence child undernutrition. 13 IPV can place psychological stress on children who observe IPV, and stress in turn can affect immune reactivity, predisposing children to severe and chronic infections, most commonly infectious diarrhea. 14 These infections further compromise children's nutritional status. More directly, IPV can affect child nutritional status through familial circumstances such as the withholding of food by abusive family members 15 or through physical or psychological maternal health outcomes 13 that prevent proper care of the child. 16 Within and outside of South Asia, increasing evidence has shown a linkage between high rates of IPV among women 17–20 and poor infant and child health outcomes such as miscarriage, 21,22 morbidity, 23–25 and mortality. 26–29 However, few studies have been conducted in South Asia to assess the relationship between maternal experiences of IPV and poor child nutritional outcomes. The only study examining this issue was an investigation in India involving a statewide sample. It revealed an association between experiences of physical IPV in the preceding year and chronic undernutrition among children. 30 In addition, outside of South Asia, results from a hospital-based study in Brazil indicated a 3-fold increase in the risk of severe acute malnutrition among children aged 1 to 24 months in families with severe and recurrent physical partner abuse. 31 However, the Indian study measured only physical IPV and did so via only a single global question, and the study in Brazil measured only physical IPV via hospital-based data. There is a clear need to use behaviorally specific questions and nationally representative data to better understand whether physical and sexual IPV are associated with child undernutrition. We examined the association of physical and sexual IPV with child underweight, stunting, and wasting in a nationally representative sample of households in Bangladesh.
