Epidemiology of violence against young children in Jamaica

ABSTRACT

Violence against young children is known to have detrimental short and long-term effects. Yet, few studies investigate the prevalence of violence against young children, particularly very young children under the age of 2 years. This paper reports on the prevalence of violence against young children in Jamaica using data obtained from the JA KIDS birth cohort study that undertook pre-enrolment of pregnant mothers in the antenatal period and followed full or sub-samples of parents and children at 9–12 months, 18–22 months and 4–5 years. Violence in pregnancy was experienced by 6.1% of pre-enrolled mothers. As many as 43.1% of Jamaican children ages 9–12 months were shouted at, and almost 30% were slapped. Physical and emotional violence increased with age, and by 4–5 years, approximately 90% of children experienced physical and emotional violence. Non-violent methods, primarily explaining and reasoning with children, were also reported by more than 95% of parents at 4–5 years. Corporal punishment was the most common form of violence experienced, but young children also witnessed hurtful physical and emotional violence between mothers and their partners and lived in communities in which there were violent events. Strategies to reduce young children’s experiences as victims and witnesses of violence are discussed.

KEYWORDS:

• Violence
• young children
• Jamaica

Introduction

Violence against children has been identified as a global public health problem. Researchers have estimated that globally 1 billion children between the ages of 2 and 17 experienced some form of violence in the past year; the highest prevalence rates are in Africa, Asia, and North America, where some 50% of children experienced past year violence (Hillis et al., 2016). Infants and young children are particularly at risk of violence by primary caregivers and other family members because of their dependence and limited social interactions outside the home.

The World Health Organisation (WHO) identifies four main types of violence against children under the age of 5 years, maltreatment, bullying, sexual violence, and emotional or psychological violence, which includes witnessing violence. Maltreatment combines some of the individual types of violence and is comprised of physical violence (including violent discipline), sexual and psychological or emotional violence and child neglect by parents, caregivers and other authority figure. Corporal punishment, as a form of discipline, is the most common form of violence experienced by children, estimated to be experienced by 1.3 billion children (Know Violence in Childhood, 2017).

Violence against young children is detrimental to their growth and development, and begins before some children are born. Physical injury to a pregnant mother can result in intrauterine death to the foetus due to haemorrhage. Women who experience Intimate Partner Violence (IPV) during pregnancy are three times more likely to suffer perinatal death compared with women who have not been so exposed (Pastor-Moreno et al., 2020). Prematurity, low birth weight and growth retardation, all of which are associated with increased child morbidity and mortality (Alhusen et al., 2015) are also more common in the presence of IPV. Psychological stressors in pregnancy, such as exposure to violence, result in increased secretion of steroid hormones which may exacerbate pre-existing maternal medical conditions, precipitate medical conditions and restrict foetal blood flow, resulting in growth retardation. The steroid hormones cross the placenta and impact the developing brain and result in delayed cognitive development at least up to the age of 1 year (Davis & Sandman, 2010). In animal studies, significant maternal stress during pregnancy and poor maternal care during infancy both affect the developing stress system in young animals and alter genes that are involved in brain development (National Scientific Council on the Developing Child[NSCDC], 2005/2014).

The majority of deaths from child maltreatment occur in young children; more than 70% (70.3%) of all child fatalities occur in children younger than 3 years, with just under a half occurring in children under the age of 1 year (US Department of Health and Human Services, 2021). Of the children who died, 72.9% suffered neglect and 44.4% suffered physical abuse either exclusively or in combination with another maltreatment type; 7.8% suffered medical neglect and 0.9% each sexual abuse and psychological abuse. Cortisol and other hormones are also produced excessively by children who are subjected to trauma by witnessing or experiencing violence. Chronic and high levels of stress, such as experienced by children living in a violent environment, are known as toxic stress, and damages the hippocampus and the amygdala, which are responsible for learning, memory, and the ability to regulate certain stress responses. Children exposed to violence therefore have difficulty learning and regulating their behaviour. Longer term impacts include a higher likelihood of stress-related conditions in adulthood, including physical health conditions, such as cardiovascular disease, diabetes, and stroke; and mental health disorders, such as depression, anxiety disorders, alcoholism, and drug abuse (Afifi et al., 2006; Durrant & Ensom, 2012).

Toxic stress has its greatest impact on developing brain circuits and hormonal systems (NSCDC, 2005/2014), as occurs during the foetal and early childhood periods. Additionally, changes due to chronic stress during this critical time of brain development and maturation may be long-lasting and also be harder to treat, as a normal functioning stress response system may never have been established (Mueller & Tronick, 2019).

Despite the recognised impact of violence on the developing brain, there are relatively few national or regional studies on violence against children under the age of 2 years. For example, in the MICS, recognised as the most widely available national survey for child discipline in low- and middle-income countries (LMICs), the age range targeted for the child discipline module is 2–14 years (Cuartas et al., 2021).

The JA KIDS study included a focus on violence against children and offered an opportunity for cross-sectional and longitudinal study of violence against young children in Jamaica. As the study was guided by ecological and transactional models, data were collected not only on violence directed at young children in the form of discipline but also violence within their homes and their communities.

Methods

The JA KIDS study, Jamaica’s second national birth cohort study, enrolled 9,742 mothers and children and 3,410 fathers, throughout Jamaica between July 1 and 30 September 2011. This constituted 87.6% of mothers who delivered during this period and 30.7% of fathers. Of enrolled mothers, 4572 (46.9%) had been pre-enrolled in the antenatal period. Contact was made with 7609 participants when children were 9–12 months old, a randomly selected 3,485 when children were seen at 18–22 months old and a targeted group of 1,311 participants, who had participated at three or more of the four previous contacts. Details of study methods are presented elsewhere (Reece et al., 2023; Samms-Vaughan et al., 2023). Prior socio-demographic analysis of the cohort sub-samples has indicated that, apart from the sample of women enrolled in pregnancy that was biased towards women seeking health care in the public sector, the other samples were similar in maternal age, and socio-economic status (SES) (Reece et al., 2023).

Violence during pregnancy

Women who were enrolled in the antenatal period completed questions on exposure to violence during pregnancy.

Violent discipline

At each of the three post-delivery contacts, parents were offered a number of culturally relevant response options to questions on the use of common forms of violent discipline against children for each age category. Specifically, caregivers (primarily mothers) were asked how they managed frustration with their children at 9–12 months, tantrums at 18–22 months and misbehaviour at 4–5 years. Additionally, at 4–5 years, use of non-violent forms of discipline such as time-out, withdrawal of privileges, and providing an explanation and reasoning (a local term implying an interactive cognitive discussion with the child) were enquired of. Response options were “often (3 or more times per week), ‘occasionally’ (less than three times per week) or ‘never’.

Intimate partner violence

As a proxy measure of children’s likelihood of witnessing intimate partner violence at a young age, mothers who attended in-person at the 18–22-month contact and the in-person contact at 4 years answered questions on whether they had been victims of partner physical and emotional violence, and also whether their children had been victims of violence by their partners since the birth of the JA KID. Mothers were also asked whether their partners ever became angry with them or vice versa and also whether there were arguments with their partners.

Community violence

Participants who were enrolled in the antenatal period were asked about experiences of violence in the communities in which they lived; specifically fighting and robbery in the streets, robberies of homes, rape and murder. This was used as a proxy measure of young children’s exposure to community violence.

Results

Women’s experiences of violence in pregnancy

Of those who completed questionnaires in the antenatal period, 4274 (93.5%) responded to a question on physical injury. Some 261 women (6.1%) reported being physically hurt by being slapped, hit or kicked during pregnancy; 55% (n = 138) reported a single event, 23.4% (n = 59) reported two to three events and 21.8% (n = 55) reported more than three events. Perpetrators were identified by 92.0% (n = 240) of women; the father of the JA KID was the perpetrator in 62.8% (n = 164), followed by male and female family members (n = 22, 9.2%); (brothers, uncles, in-laws, cousins) and parents, step-parents and guardians (n = 20, 8.3%). Partners who were not the father of the current child were identified in 14 cases (5.8%) and previous partners and their friends or girlfriends in 7 cases (2.9%).

Violent discipline

Table 1 shows that 43.1% of Jamaican children ages 9–12 months are shouted at, and almost 30% are slapped with the hand. Shaking is experienced by 6.2%, pinching by 4.3% and biting by 0.1%. Table 1 also shows that the prevalence of emotional and physical forms of violence increases with the age of the child, with the exception of biting. For example, the likelihood of being shouted at doubles between 9–12 months and 4–5 years and the likelihood of being slapped triples. Shouting and slapping are the most common forms of violent discipline experienced at all ages; 88.9% of 4–5-year olds experience shouting and 91.8% of 4–5-year olds are slapped with the hand. These two forms of violent discipline are also more likely to often occur (three or more times per week); 27.0% of 4–5-year olds were shouted at frequently, and almost 20% were slapped frequently, i.e., three or more times per week. Beating with an implement, which was only enquired of when children were 4–5 years old, was experienced by 34.5%. With the exception of biting and shaking at 4–5 years, boys had a consistently higher prevalence of violent experiences of discipline than girls. However, the only significant differences occurred with beating with an implement at 4–5 years; 40.0% of boys were beaten compared with 28.8% of girls.

Table 1. Prevalence of violent forms of discipline experienced by Jamaican children by age.

Age of child	Violent Forms of Discipline
	Shout (%)		Slap (%)		Shake (%)		Pinch (%)		Bite (%)		Beat with Implement (%)
	Often	Occ.	Often	Occ.	Often	Occ.	Often	Occ.	Often	Occ.	Often	Occ.
9–12 months	2.2	40.9	1.0	28.8	0.5	5.7	0.3	4.0	–	–	–	–
18–22 month	6.0	63.9	3.2	54.8	0.9	1.3	0.5	6.1	0.1	2.5	–	–
4–5 years	27.0	61.9	18.8	73.0	4.2	20.8	3.4	24.5	0.2	1.6	3.4	31.1

Table 2 shows that at 4–5 years, parents are also using non-violent forms of discipline. Time out reported by 61.3% and withdrawal of privileges reported by 73.7% are primarily being used occasionally by 46.0% and 54.4%, respectively. Explaining to and reasoning with children are reported to be used by more than 90% of parents, with approximately two-thirds using these methods frequently.

Table 2. Prevalence of non-violent forms of discipline experienced by Jamaican 4–5-year olds.

Types of Non-Violent Discipline	Frequency of use of Non-Violent Forms of Discipline at 4–5 years
	Often (%)	Occasionally (%)	Never (%)
Time-Out	15.3	46.0	38.7
Withdrawal of Privileges	19.3	54.4	26.1
Explaining	63.3	34.3	2.4
Reasoning	64.1	34.0	1.9

Intimate partner violence

Almost three-quarters of mothers (72.9%) reported that the biological fathers of the JA KIDS were fulfilling their roles as father figures when children were 4–5 years old. Fewer women, just under two-thirds (63.0%) considered the biological father to be their partner; current partners were reported to be the father figure in 43.0% of those for whom the biological father was not the partner. Mothers reported that 45.8% of JA KIDS had biological fathers living in the same home. When children were 18 months, 1.5% of mothers reported that their partners physically hurt their children since the birth of the baby; at 4 years, 0.8% of mothers reported this. Physical and emotional hurt were reported by 4.2% and 9.4% of mothers respectively, when children were 18–22 months old. When children were 4–5 years old, physical and emotional hurt by partners was reported by 2.8% and 8.1% of mothers, respectively. Partners becoming angry with mothers was more frequent; 68.5% at 18–22 months and 78.2% at 4–5 years. Mothers becoming angry with partners was also more frequent: 86.3% at 18–22 months and 90.5% at 4–5 years. Arguments between mothers and partners were reported by 78.2% of mothers at 18–22 months and 88.3% of mothers at 4–5 years.

Community violence

Two-thirds of mothers (66.2%) and almost two-thirds of children (63.9%) lived in the same home and community when JA KIDS were 4–5 years, as they did when enrolled at the birth of the JA KID. During the later stages of pregnancy, 44.5% of mothers reported street fights in their communities; 28.3% reported home robberies; 26.2% reported murder; 24.2% reported persons being robbed on the street and 12.3% reported rape in their communities in the prior 3 months (Table 3).

Table 3. Violence in the communities of young children over a 3-month period.

Types of Community Violence	Frequency of Community Violence in Past 3 month
	Never (%)	1–2 occurrences (%)	3 or more occurrences (%)
Street Fights	53.5	27.1	17.4
Personal Robbery	75.8	16.6	7.6
Home Robbery	71.7	20.8	7.5
Rape	87.7	10.5	1.8
Murder	73.8	19.5	6.7

Discussion

Young Jamaican children may be exposed to violence in many different forms, both directly and indirectly. Six of every hundred women experience violence in pregnancy. This is consistent with the reported global average of intimate partner violence of 4–12% (Know Violence in Childhood, 2017) and 5.1% reported for Jamaica (Watson Williams, 2016). In the 2016 study, the perpetrator was the father of the child in almost 90% of cases. In the JA KIDS study, physical violence in a third of cases was not by a current intimate partner. A family member, parent or guardian, typically those who protect women, was twice as likely to cause physical violence to pregnant women (17.5%) than previous partners or their friends (8.7%).

Young Jamaican children were directly exposed to emotional and physical violence as victims at a very early age, many before their first birthday, in response to caregiver perception of their behaviour. As they grow, Jamaican children have an increasingly greater likelihood of violent discipline, except for biting which falls from 2.6% at 9–12 months to 1.8% at 4–5 years. There is a possible cultural explanation. Biting children is sometimes responsive to children’s own biting, which is known to be more frequent at younger ages. One cultural response is for an adult to bite children who have this behaviour persistently; this is perceived to be teaching children not to bite and inflict pain on others, based on their own experience of pain. This underscores the cultural behaviours that may need to be addressed in reducing violence against children. By the time children are 4–5 years old, 9 out of every 10 children have had experiences of physical and emotional violence. This is in keeping with other national data such as the MICS 2011 study, which showed that 84.5% of children age 2–14 years experienced some form of violent discipline, including both psychological aggression and physical punishment (Statistical Institute of Jamaica [STATIN], 2013). Similar to that study, the JA KIDS study showed a consistently higher level of experience of violent discipline by boys. The JA KIDS study adds to our knowledge of the epidemiology of violent discipline against very young children, as data for children under the age of 2 years were not previously available. Though most of the exposures are reported to be occasional rather than often, the prevalence of shouting and slapping for children remains quite high. For children under 2 years, there is particular concern. Discipline is being administered based on behaviour deemed inappropriate, when cognitive processes for determining right and wrong have not yet been developed. Some of the forms of discipline experienced at an early age are detrimental to physical development. For example, shaking an infant can result in cerebral injury known as the shaken baby syndrome. Other forms of discipline experienced later in the early childhood years are also known to have physical consequences. For example, beating with an implement has been associated with significant intentional and unintentional injuries. Many injuries are not obvious; a recent study suggested that spanking may alter neural responses to environmental threats in a manner similar to more severe forms of maltreatment (Cuartas, 2021). By the time children are 4 years old, many parents report using non-violent forms of discipline, but the prevalence rates of violent discipline suggest that these are used in association with non-violent forms. There is also a higher prevalence of violent discipline, particularly the most severe forms, among young boys. Importantly, parents readily report the high prevalence rates, suggesting that parents do not perceive corporal punishment as having negative outcomes for children.

Jamaican parents are aware of non-violent forms of discipline such as time-out and withdrawal of privileges, but use these methods less frequently than verbally interacting with their children. Culturally verbal interactions are also more likely to include some psychological or emotional violence, than time-out and withdrawal of privileges which require more parental emotional control.

Proxy measures of physical partner violence, whether by the current partner or another, indicate relatively low levels of partner violence (4.2%; 2.8%) resulting in physical hurt, when compared with the lifetime prevalence of physical violence of 25.2% reported in 2016. The prevalence in this study was closer to the prevalence rate of current physical IPV, which was 5.9%. Similarly, emotional violence prevalence (9.4%, 8.1%) in this study was lower than the 2016 study with lifetime and current prevalence rates of 28.8% and 11.1%, respectively. Higher prevalence of emotional violence as compared with physical violence was consistent across the studies. IPV and child abuse are known to co-exist; the reported prevalence of injury to children by a partner was 1.5% at 18–22 months and 0.8% at 4 years. Lower lifetime prevalence of IPV rates and violence to children by mothers’ partners at 4 years and similarity with previous data on current IPV prevalence rates suggest recall bias.

Proxy measures of community violence suggest that almost half of children have the potential to be exposed to community violence in the form of street fighting, and over a quarter may experience, or be impacted by, murder and other severe forms of violence in their communities.

As in international studies of older children, corporal punishment and psychological violence are the most common forms of violence experienced by children. However, children are also highly exposed to anger and arguments between mothers and their partners, even if most of these are not perceived to cause hurt. A large proportion of children are also potentially exposed to community violence.

This paper has shown that young children may be impacted by multiple forms of violence, as victims or observers. Reducing violence against young children, with its known long-term effects, requires a comprehensive approach to protect women during pregnancy and beyond, and children in the early formative years from violence. Public education on the impact of violence during pregnancy and the long-term impact of experiencing and witnessing physical and emotional violence on young children may be one strategy. However, it will also be necessary to understand and address cultural behaviours and their impacts on the use of child discipline. The theory behind biting was mentioned earlier. Additionally, reasons for the use of corporal punishment and emotional violence in association with non-violent forms of discipline should be explored. The preference for talking with older children as a form of discipline, rather than using non-violent forms of discipline should also be explored further. This may be one mechanism of non-violent discipline that can be further promoted and potentially extended to younger children. It is hoped that this study will promote further research on the experiences of violence of young children.

There are opportunities for further study, particularly on the impact of violence against young children. This study did not explore the outcome of violence experienced during pregnancy in terms of growth and maturity disorders, such as low birth weight and prematurity. The study also did not explore the impact of exposure to different forms of violence and particularly multiple forms of violence, known as polyvictimisation. Polyvictimisation has been shown to be detrimental to older Jamaican children’s cognition and academic performance and to be associated with disruptive behaviours (Samms-Vaughan & Lambert, 2017).

Study limitations

Measurement of violence against children in the early years before they are able to self-report necessarily requires the use of proxy measures. In this study, apart from maternal reports of violence during pregnancy, all other data were collected from observations of violent exposures by parents and caregivers, who may themselves be potential perpetrators of violence against young children. High rates of reporting of physical and emotional violence suggest this may not be a concern for these variables, but experiences of physical violence in pregnancy and intimate partner violence could be underreported.

Ethical approval

Ethical approval was granted by the Ethics Committee for the Ministry of Health – Jamaica (approval #198; 2011) and the University of the West Indies (approval # ECP 122 10/11). All participants provided written informed consent

Acknowledgments

We are grateful to all the families who took part in this study, the staff in health centres and hospitals throughout Jamaica for their help during recruitment and the JA KIDS team of interviewers, computer and laboratory technicians, clerical and administrative workers, research scientists, volunteers and managers at the University of the West Indies (Mona). The Inter-American Development Bank (Grant ref: ATN/JF-12312-JA; ATN/OC-14535-JA) and the University of the West Indies, Mona Campus provided core support for JA KIDS. Secondary data analysis at the Centre for Maternal and Newborn Health in the UK was funded through a Global Health Grant (Project number OPP1033805) from Bill and Melinda Gates Foundation and WHO. Additional support was provided by the World Bank, UNICEF, the CHASE Fund, the National Health Fund, Parenting Partners Caribbean, the University of Nevada – Las Vegas, the University of Texas Health Science Centre at Houston and Michigan State University and its partners. This publication is the work of the authors listed, who will serve as guarantors for the contents of this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Inter-American Development Bank [ATN/JF-12312-JAATN/OC-14535-JA].