Reducing Stigma and Discrimination to Improve Child Health and Survival in Low- and Middle-Income Countries: Promising Approaches and Implications for Future Research

Abstract

The social processes of stigmatization and discrimination can have complex and devastating effects on the health and welfare of families and communities, and thus on the environments in which children live and grow. The authors conducted a literature review to identify interventions for reducing the stigma and discrimination that impede child health and well-being in low- and middle-income countries, with a focus on nutrition, HIV/AIDS, neonatal survival and infant health, and early child development. Despite broad consensus on the importance of stigma and discrimination as barriers to access and uptake of health information and services, the authors found a dearth of research and program evaluations directly assessing effective interventions in the area of child health except in the area of reducing HIV-related stigma and discrimination. While the literature demonstrates that poverty and social exclusion are often stigma-laden and impede adult access to health information and services, and to education relevant to family planning, child rearing, nutrition, health promotion, and disease prevention, the child health literature does not document direct connections between these known mediators of child health and the stigmatization of either children or their caregivers. The child health field would greatly benefit from more research to understand and address stigma as it relates to child health and well-being. The authors suggest applying a framework, adapted from the HIV stigma field, to direct future research and the adaptation of existing strategies to reduce HIV-related stigma and discrimination to address social and health-related stigmas affecting children and their families.

Acknowledgments

This article would not have been completed without the expertise, knowledge, and, above all, immense support of the following evidence review team members: Susan Zimicki, FHI 360; Kim Seifert-Ahanda, USAID; Mohan J. Dutta, National University of Singapore; Katherine Fritz, International Center for Research on Women; Zewelanji N. Serpell, Virginia Commonwealth University; Lorraine Sherr, University College London; Janet Shriberg, USAID; and Vicki Tepper, University of Maryland. The authors extend thanks to Benjamin Isquith and Elizabeth Anderson at USAID for their administrative assistance to the team. The authors also thank their colleagues who initiated this project and supported it in every way: Elizabeth Fox, USAID; Rafael Obregón, UNICEF; Robert L. Balster, Virginia Commonwealth University; and Stephanie Levy, USAID.

Notes

Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/uhcm.