Beatriz Vizcarra

International Variations in Harsh Child Discipline

BACKGROUND: Although the history of recognition of child abuse in Europe and North America extends over 40 years, recognition and data are lacking in other parts of the world. Cultural differences in child-rearing complicate cross-cultural studies of abuse. OBJECTIVE: To ascertain rates of harsh and less-harsh parenting behavior in population-based samples. METHODS: We used parallel surveys of parental discipline of children in samples of mothers in Brazil, Chile, Egypt, India, Philippines, and the United States. Data were collected between 1998 and 2003. The instrument used was a modification of the Parent-Child Conflict Tactics Scale, along with a study-developed survey of demographic characteristics and other parent and child variables. Women (N = 14 239) from 19 communities in 6 countries were surveyed. We interviewed mothers aged 15 to 49 years (18–49 years in the United States) who had a child younger than 18 years in her home. Sample selection involved either random sampling or systematic sampling within randomly selected blocks or neighborhoods. RESULTS: Nearly all parents used nonviolent discipline and verbal or psychological punishment. Physical punishment was used in at least 55% of the families. Spanking rates (with open hand on buttocks) ranged from a low of 15% in an educated community in India to a high of 76% in a Philippine community. Similarly, there was a wide range in the rates of children who were hit with objects (9%–74% [median: 39%]) or beaten by their parents (0.1%–28.5%). Extremely harsh methods of physical punishment, such as burning or smothering, were rare in all countries. It is concerning that ≥20% of parents in 9 communities admitted shaking children younger than 2 years. CONCLUSIONS: Physical and verbal punishments of children are common in high-, middle-, and low-income communities around the world. The forms and rates of punishment vary among countries and among communities within countries. A median of 16% of children experienced harsh or potentially abusive physical discipline in the previous year.

World studies of abuse in the family environment--risk factors for physical intimate partner violence.

Objectives: To identify risk factors for physical intimate partner violence against women in Chile, India, Egypt and the Philippines Design: Population-based household survey Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum and Vellore in India and Metro Manila, Philippines. Participants: Women aged 15–49 years of age who care for at least one child younger than 18 years of age. The number of participants was 442 in Chile, 631 in Egypt, 506 in Lucknow, 700 in Trivandrum, 716 in Vellore and 1000 in the Philippines. Main outcome measure: Risk of and protective factors against lifetime physical IPV. Results: Significant associations were found between several risk factors like regular alcohol consumption of the husband/partner, past witnessing of father beating mother, the womans poor mental health and poor family work status, with any lifetime physical IPV. Womans poor mental health and witnessing father beat mother were statistically significant only in a few sites. Poor family work status, differences in employment between husband and wife and experiencing harsh physical punishment during childhood, were not found to be statistically significant across all sites. Protective factors, like higher levels of husbands and wifes education, were only found to be significantly associated with any lifetime physical IPV in Trivandrum, India. Social support was not significantly associated with any lifetime physical IPV across all sites. Conclusions: These large population-based household surveys have provided empirical evidence of the widespread nature of domestic violence and the relative commonality of risk factors across sites.

Partner Violence as a Risk Factor for Mental Health Among Women From Communities in the Philippines, Egypt, Chile, and India

Although studies have documented the association between Intimate Partner Violence (IPV) and mental health, few have been done in developing countries. In this study, the association between IPV and mental health in women from different developing countries was established. Women, 15 to 49 years old with at least one child 18 years old or younger, were randomly selected from communities in Chile, Egypt, India, and the Philippines (N = 3974). The Self Report questionnaire (SRQ) was used to assess mental health. Women with a score on the SRQ of 8 or more, or who reported ever attempting suicide, were classified as having poor mental health. Physical IPV was defined as being slapped, hit, kicked, beaten or threatened by a male partner during the past year. Psychological violence included being insulted or belittled, threatened or abandoned. Between 22.5% (in Egypt) to 41% (in Chile) of participating women reported a score of eight or more on the SRQ. High scores on the SRQ were significantly associated with current physical and psychological IPV in the samples from all participating countries except Chile. Twelve percent of women in Chile, 2.6%, in Egypt, 7.5% in India and 1.6% in the Philippines reported attempting suicide. Suicide attempts were also associated with current physical IPV in the Philippines, Egypt, and India, and with psychological violence in Egypt and India. IPV is a significant risk factor for poor mental health in these developing countries. Efforts to reduce IPV should be considered as part of a mental health program.

Physical intimate partner violence in Chile, Egypt, India and the Philippines.

Background: Violence against women is recognized globally as a serious health and social problem that impedes development. Objectives: To determine the magnitude of physical intimate partner violence against women in six selected communities from Chile, Egypt, India and the Philippines. Design: Population-based household surveys. Settings: Selected urban communities in Temuco, Chile; Ismailia, Egypt; Lucknow, Trivandrum, and Vellore non-slum areas of India; and in Manila, the Philippines. Participants: Women aged 15–49 years who cared for at least one child younger than 18 years old. The number of participants per community was 442 (Santa Rosa, Chile), 631 (El-Sheik Zayed, Egypt), 506 (Lucknow, India), 700 (Trivandrum, India), 716 (Vellore, India) and 1000 (Paco, the Philippines). Main Outcome Measures: Lifetime and Current physical intimate partner violence (IPV) was measured using standard definitions and four behaviors or actions – namely slap, hit, kick and beat. Three derived variables for severity included: disabling IPV, IPV-related injury requiring health care and multiple severe IPV (presence of hit and kick and beat). Results: Percentages of lifetime and current physical intimate partner violence (IPV) against women in our sample of 3975 were as follows: 24.9 and 3.6 (Santa Rosa), 11.1 and 10.5 (El-Sheik Zayed), 34.6 and 25.3 (Lucknow), 43.1 and 19.6 (Trivandrum), 31.0 and 16.2 (Vellore), and 21.2 and 6.2 (Paco). Multiple severe physical IPV was more common in the three communities within India (9.0%, 5.9% and 8.0% in Trivandrum, Lucknow and Vellore) than the other three communities (Santa Rosa 2.1%; El-Sheik Zayed 2.9% and Paco 1.9%). Conclusions: Physical IPV was found to be a common phenomenon in all six communities. Overall, patterns of IPV behaviors were similar among the six communities.

Training and field methods in the WorldSAFE collaboration to study family violence.

Introduction: This paper describes the collaborative efforts of research teams from medical schools in India, Chile, Egypt, the Philippines, Brazil, and the United States to develop and implement a core protocol for household surveys on family violence and to conduct standardized training for field workers. Our objectives are to share successes and difficulties encountered in training and field work and to offer recommendations for similar undertakings. Methods: Study methods, developed by a multidisciplinary group of international investigators, were documented in a procedures manual. On-site standardized training was conducted and field workers were monitored for adherence to protocol. Special attention was given to safety and ethical issues. Results: Overall, the training protocol and field methods were successful with relatively few problems encountered. Study participants were receptive to the interview and cooperated in safety procedures. The most common problem in the field was interruptions of the interview, mostly by children. Community advisory boards were actively involved in some of the sites, providing guidance on the safety and logistical aspects of the study, facilitating access to study communities, and providing community service information that could be shared with all study participants. Conclusions: WorldSAFE successes were attributed to rigorous standardized training and monitoring of field work; meticulous protocol implementation; unflagging attention to the ethical issues and to safeguarding study participants, field workers, and data; and openness and trust developed among the collaborators during the extended developmental phase.

Mejoramiento de la calidad de vida: experiencia con mujeres climatéricas del Consultorio Villa Alegre, Temuco, Chile

IMPROVEMENT OF THE QUALITY OF LIFE: EXPERIENCE WITH CLIMACTERIC WOMEN FROM THE VILLA ALEGRE HEALTH CLINIC, TEMUCO, CHILE The objective of the present article is that of describing tlze experience acquired with the application of an integral ca re program to women in their climacteric period, developed as of the year 2000 in the Villa Alegre Health Clinic of the commune ofTemuco. Tlze m a in objective of this program is that ofpromoting the improvement ofthe quality of life of consulting women, favoring