Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse

Abstract

Little is known about co-occurring intimate partner violence (IPV) against women and child abuse within families in humanitarian settings. Baseline data from 203 couples in eastern Democratic Republic of Congo were analyzed to assess associations between childhood experiences of abuse with present co-occurring violence. Over half of women (56.1%) and men (50.5%) reported co-occurring violence. Adjusted models demonstrate experiencing physical abuse as a child was associated with greatest odds of recent co-occurring violence while witnessing parental IPV had mixed influence. Programmatic approaches focused on reducing early childhood violence may be promising to prevent both IPV and child abuse.

Keywords

domestic violence child maltreatment violence against women violence against children family violence

Introduction

Global data estimate that one in three women will experience violence at the hands of their partner in their lifetime (Garcia-Moreno et al., 2013), and approximately one billion, or over half the world's children, have experienced violence or abuse in the past year (Hillis et al., 2016). Such abuse is associated with a myriad of negative physical and mental health outcomes (Machisa et al., 2016; Saile et al., 2013) and has profound economic costs (Elmusharaf et al., 2019). Evidence also suggests these two distinct types of violence often co-occur (Guedes et al., 2016), share several risk factors at multiple levels of the ecological framework, and are rooted in gender inequality, normalization of violence, and cycles of abuse within the family (Falb et al., 2020; Fulu et al., 2017; Namy et al., 2017).

Early life experiences of violence, including childhood exposure to parental intimate partner violence (IPV) or experience of physical abuse as a child, may also point toward intergenerational transmission of violence in families. For example, the effects of witnessing or experiencing violence as a child have been linked to violence in adulthood (Guedes et al., 2016) and experiencing IPV for women can also lead to the use of harsh parenting practices (Fulu et al., 2017) in a cyclical understanding of family violence. Among those who witnessed parental IPV as a child or experienced other forms of childhood trauma, women have shown increased risk of IPV victimization as adults, and men have shown increased risk of IPV perpetration (Fulu et al., 2017; Gartland et al., 2019; Roberts et al., 2010). A recent systematic review found that exposure to IPV in childhood can have up to a fourfold increase in their odds for perpetrating IPV in adulthood, though the evidence base is predominantly limited to studies from high income countries and comprised of low-quality studies (Kimber et al., 2018).

Simultaneous to alarming global rates of violence in the home, a growing number of people live in conflict-affected or fragile countries. Within these settings the prevalence of IPV against women and child maltreatment are staggeringly high (Guedes et al., 2016; Hossain et al., 2014; Hynes et al., 2004; Rubenstein & Stark, 2017) with rates of IPV up to twice the global average in some conflict settings (Ellsberg et al., 2020). In such contexts, the direct exposure to armed conflict and trauma, may result in even higher levels of violence for women and children inside the home (Catani et al., 2008, 2009; Falb et al., 2013; Haj-Yahia & Abdo-Kaloti, 2003; GWI & IRC, 2017; Rubenstein et al., 2020; Saile et al., 2014; Stark & Ager, 2011). Additionally, indirect conflict-related experiences such as displacement, deprivation of basic needs, breakdown in rule of law, changing household composition, and exacerbation of other inequitable gender norms can also perpetuate violence within the home (Annan & Brier, 2010; Falb et al., 2020; Mootz et al., 2019; Rubenstein & Stark, 2017). While evidence points to staggering levels of both men's use of IPV against women and child abuse by caregivers, understanding of the co-occurrence and intergenerational linkages of family violence in conflict settings is limited.

To address these gaps in evidence, the present study examines baseline data from an ongoing family strengthening trial in North Kivu, Democratic Republic of Congo (DRC). Eastern DRC, formerly a Belgian colony, is an area which has experienced over two decades of vacillating levels of armed conflict where prevalence of violence in the home is high, with 68.2% of married women reported experiencing physical, emotional and/or sexual IPV in their lifetime, and even higher rates among women in polygamous households (Tlapek, 2015). Within North Kivu, DRC, nearly half of all women have ever reported some form of physical and/or sexual IPV and over 65% have reported emotional abuse within the past year (Valliant et al., 2020). Little is known about the prevalence of child abuse, but estimates suggest that in South Kivu, approximately one-third and one-fifth of girls aged 13–14 have already experienced some form of physical or sexual violence, respectively, in the past year (Stark et al., 2017). No data currently exist regarding the prevalence or incidence of co-occurrence of IPV and child abuse in communities in North Kivu, DRC.

The objectives are to: (a) examine the frequency of co-occurrence of men's use of IPV against women and child abuse by either caregiver among conflict-affected households in North Kivu, DRC, (b) understand to what extent early life experiences of witnessing parental IPV or experience of physical abuse as a child may be associated with recent violence in the home; and (c) examine to what extent conflict-related traumatic exposures may also be correlated with violence in the home. Further understanding of these issues may illuminate potential entry points to break the cycle of intergenerational violence within families and help to identify potential strategies to prevent multiple forms of co-occurring violence within conflict-affected settings.

Method

Study Design and Sample

The analyses use quantitative baseline data from a cluster randomized controlled trial of the Safe at Home program, which seeks to improve family functioning and prevent the co-occurrence of IPV and child maltreatment in the home. This program was developed by the International Rescue Committee (IRC), a global humanitarian aid organization operating in eastern DRC for nearly 25 years. The program's development is based on formative, qualitative research of drivers of violence against women, children, and older persons in the home (Falb et al., 2020). Baseline data were collected from 203 couple dyads which comprised of 394 participants (196 men and 198 women) across four study sites in North Kivu, DRC between November 2019 and January 2020. IRC program staff, in collaboration with local interlocutors, introduced the program to the communities and assessed interested participants for program eligibility. Inclusion criteria included if they were 18 years of age or older, living with an intimate partner who also wanted to register for the program, had at least one child aged 6–12 years, part of a monogamous couple, and spoke Swahili, Kinyarwanda, or French. Both partners from all eligible couples were asked to be part of the study. Of the 404 eligible individuals, 6 men and 4 women declined to participate in the surveys.

Data Collection

The IRC hired external data collectors to conduct the baseline survey. IRC research staff trained male and female enumerators on survey methodology, concepts of confidentiality and privacy, and informed consent procedures. The IRC DRC Women's Protection and Empowerment and Child Protection teams trained the enumerators on principles of gender-based violence, violence against children and referral pathways. The survey was administered by gender-matched enumerators asking each question aloud to the participant and recording their response in a tablet using the data collection application SurveyCTO. All survey items were translated and back translated into French from English and were additionally translated into Swahili and Kinyarwanda.

Ethics

All informed consents and interviews were conducted in a private space where confidentiality could be maintained. Substantial efforts were made to describe that participants’ decision to participate would have no influence on current or future assistance from the IRC or any other organization. All respondents received information for follow-up services. All study tools and protocols were approved by the IRC Institutional Review Board (WPE 1.00.014) and by the Ministry of Public Health's Ethics Committee (Comité National d’Ethique de la Santé).

Measures

The present study defines the outcome variable of recent past-3-month violence in the home in gender-stratified models through the following outcomes: (a) co-occurring violence, which signifies where both women's experience of IPV (physical, sexual, and/or emotional violence) and child abuse perpetration by either caregiver (physical and/or psychological violent discipline) are present; (b) women's experience of physical, sexual, and/or emotional IPV; and (c) perpetration of physical and/or psychological and child abuse. IPV experience, or past 3-month experience of physical, sexual, and/or emotional IPV, was assessed only among women and measured using the IPV module from the Who Multi-Country Study on Women's Health and Domestic violence against Women (WHO, 2005). This module asks women a series of binary (yes/no) questions to assess their experience with 14 different acts of physical, sexual, and emotional violence, first asking if they had ever experienced the act and then if it occurred in the past 3 months (e.g., Has your husband ever slapped or thrown something that could hurt you, or hit you with something that could hurt you? Did this happen in the past 3 months?). A summary variable was then calculated for each type of violence, indicating an affirmative response (yes) to any act of physical, sexual, and/or emotional IPV. In accordance with standard ethical guidance related to GBV research, only women were asked about experiences of physical, sexual, and emotional IPV against them (WHO, 2005) to minimize any potential backlash from a partner. Therefore, for modeling of men's data, their female partner's report of IPV was used to denote their IPV perpetration.

Child abuse was measured using the MICS discipline module and includes the perpetration of physical and/or psychological violent discipline against the child (UNICEF, 2013). Both men and women within the couple were asked to describe their own experiences with child abuse perpetration based on the index child (oldest child within the age range for the Safe at Home program). Respondents were asked a series of 8 binary (yes/no) questions assessing past 3-month perpetration of different acts of physical and psychological violent discipline (e.g., hit him/her on the bottom or elsewhere on the body with something like a belt, hairbrush, stick or other hard object). A binary summary variable was then created indicating an affirmative response (yes) to any act of physical or psychological violent discipline. Based on these binary summary variables for IPV and child abuse, a final co-occurrence violence variable was created which indicates when both IPV and child abuse were present.

The key correlate variables of interest were binary (yes/no) questions about experiences of violence during childhood: “Did you ever witness your father use violence against your mother as a child?” and “Were you ever badly beaten by your parents as a child?” (Abramsky et al., 2014), as well as number of conflict-related traumatic events experienced. The authors hypothesized that multiple traumatic compounding events (childhood experiences of violence and conflict-related traumatic experiences) would lead to increased risk of co-occurring family violence.

Demographic measures included continuous measures of age in years and number of times displaced in lifetime, as well as categorical measures of education level and disability level (Washington Group on Disability Statistics 2016), and number of times displaced. Disability level was assessed by asking respondents a series of six questions about their level of difficulty with five core functions (vision, hearing, remembering, self-care, communication) using a Likert scale rating. The summary variable was then coded based on any functional difficulty, with respondents having no disability (no difficulty), mild disability (some difficulty), or moderate and/or severe disability (a lot of difficulty and/or cannot do at all).

Analysis

Demographic data and overall frequencies or means were constructed for the male and female samples separately. Cross-tabulations of demographics and key correlates of interest were assessed through unadjusted models in sex-stratified analyses. Covariates that were associated with the outcomes at p < .05 were retained in adjusted models and complete case analyses was implemented for missing data. Missing data are less than 10% for the variables of interest which were also not statistically related to missingness. Logistic generalized estimating equations were created to assess the adjusted association between correlates and three outcomes in separate models: co-occurring IPV and child abuse; intimate partner violence (experienced by women and perpetrated by men), and child abuse perpetration (perpetrated by the mother or father). The use of multinomial modeling was explored to examine these mutually exclusive categories but given the extensive overlap¹ and levels of co-occurrence within the home, variable estimates were imprecise and separate logistic models were used for each type of violence outcome. Models were adjusted for clustering at the site level and were adjusted for other key hypothesized correlate variables and associated demographics.

Results

Participants

The average age of respondents was 32.0 years (SD = 8.7; range: 19–59) for women and 36.9 years (SD = 8.7; range 21–59) for men (Table 1). Men had a higher level of educational attainment overall with nearly half (43.4%) attending secondary or above schooling while only 15.2% of women reporting reaching this same level. Respondents were displaced on average three times over their lifetime and the majority of women (60.1%) reported a mild disability; a lower proportion of men (42.4%) reported a mild disability. Overall, women and men had experienced at least three different forms of conflict-related traumatic events.

Table 1.

Sample Demographics and Frequency of Childhood Violence Co-Occurring Past 3-Month IPV Experience and Child Abuse Perpetration for Women (n = 198) and Men (n = 196).

	Women's sample % (n) M (SD)	Co-occurring past 3-month IPV experience & child abuse perpetration	Men's sample % (n) M (SD)	Co-occurring past 3-month IPV & child abuse perpetration
Overall	—	56.1 (111)	—	50.5 (87)
Demographic variables
Age: M (SD) (range: 19–59)	32.0 (8.7)	31.6 (8.4)	36.9 (8.7)	35.7 (8.4)
Level of education % (n)
None	42.9 (85)	55.3 (47)	12.2 (24)	50.0 (12)
Primary	41.9 (83)	50.6 (42)	44.4 (87)	43.7 (38)
Secondary and above	15.15 (30)	73.3 (22)	43.4 (85)	44.4 (37)
Disability level % (n)
None	21.2 (42)	57.1 (24)	39.3 (77)	44.2 (34)
Mild	60.1 (119)	52.9 (63)	42.4 (83)	39.8 (33)
Moderate/severe	18.7 (37)	64.9 (24)	18.4 (36)	55.6 (20)
Number of times displaced in lifetime: M (SD) (range: 0–10)	3.18 (1.5)	3.2 (1.3)	3.01 (1.1)	3.1 (1.1)
Traumatic experiences of violence
Conflict-related traumatic events experienced (SD) (range: 0–5)	3.6 (1.5)	4.1 (1.2)	3.3 (1.5)	3.4 (1.5)
Witnessing parental IPV % (n)	54.5 (108)	68.5 (74)	37.8 (74)	44.6 (33)
Experiencing physical child abuse % (n)	54.5 (108)	72.2 (78)	51.5 (101)	51.5 (52)

Experiences of Current Violence in the Home

Results are organized by sex, and past 3-month violence outcomes are categorized in three main ways: (1) any co-occurring violence (men's use of IPV and child abuse by either caregiver); (2) any physical and/or sexual and/or emotional IPV, and (3) any physical and/or psychological child abuse perpetration by reported sex. Overall, 56.1% of women reported co-occurring IPV and child abuse within the home (Table 1) as 83.8% indicated perpetration of child abuse and 58.6% reported IPV by their husband. Over one-quarter (27.0%) and one-half (51.4%) of women reported that their partner had beaten them or yelled at them, respectively, when they were angry or unhappy with the children (Table 2). Slightly fewer (50.5%) men indicated co-occurring IPV (as reported by their partner) and child maltreatment perpetration (Table 1).

Table 2.

Frequencies of Co-Occurring Violence Among Women who Reported Experiencing Intimate Partner Violence and Perpetrating Child Abuse in the Past 3 Months (n = 111).

	Women (n = 111)
	n	%
In the past 3 months, has your partner beaten your children when he was angry or unhappy with you?
No	72	64.86
Yes	39	35.14
In the past 3 months, has your partner yelled at your children when he was angry or unhappy with you?
No	58	52.25
Yes	53	47.75
In the past 3 months, has your partner beaten you when he was angry or unhappy with your children?
No	81	72.97
Yes	30	27.03
In the past 3 months, has your partner yelled or shouted at you when he was angry or unhappy with your children?
No	54	48.65
Yes	57	51.35
In the past 3 months, how often were your children present when your husband or partner hit you, threw an object on it, or beat you?
Never	50	45.05
Once or twice	38	34.23
Several times	8	7.21
Many times/most of the time	7	6.31
Husband did not hit, throw something at, or beat me in the last month	8	7.21

Control Variables and Correlates Associated With Past 3-Month Violence in the Home

Unadjusted logistic regressions accounting for clustering at the site level were used to assess which variables should be included in the models (Supplementary Table 1). Those sociodemographic variables that were significantly associated with any type of past 3-month violence in the home were selected as control variables. Women's education level of secondary education and above was significantly associated with co-occurring IPV and child abuse (OR = 2.18; 95%CI: 1.04–4.58), as well as child abuse perpetration (OR = 0.69; 95%CI: 0.48–0.995). Women having moderate and/or severe disability level was also significantly associated with child abuse perpetration (OR = 7.46; 95%CI: 2.11–26.34), and this significant association was also consistent with men's data (OR = 1.98; 95%CI: 1.61–2.43). Variables that were not significant for either women or men were age and number of times displaced due to conflict.

When examining correlate variables for women, having had experienced physical child abuse was most strongly correlated with current co-occurring violence in the home (OR = 4.15; 95%CI: 3.33–5.17), and was associated with both past 3-month IPV experience and child abuse in separate models. Witnessing parental IPV as a child was also associated with all three outcomes, such that women who witnessed such abuse had 2.82 times the odds of reporting co-occurring violence in the home compared to those that did not witness such violence (95%CI: 1.65–4.80). Each additional increase in reporting a conflict-related traumatic experience was associated with a 1.57 change in odds of reporting co-occurring past 3-month violence (95%CI: 1.37–1.81), while number of times displaced was not associated with an increased risk of co-occurring violence.

When examining correlate variables for men, accounting for clustering at the site level, having had experienced physical child abuse was most strongly correlated with perpetration of child abuse (OR = 3.31; 95%CI: 2.21–4.15), and was significantly associated with co-occurring violence perpetration (OR = 1.89; 95CI: 1.53–2.32) and IPV perpetration (OR = 1.29; 95%CI: 1.12–1.49). Witnessing of parental IPV was only associated with perpetration of child abuse (OR = 2.74; 95%CI: 1.06–7.03). Conflict-related traumatic events and displacement were not associated with any violence perpetration outcome for men.

Adjusted Associations Between Past 3-Month Violence in the Home and Shared Correlate Variables

In the final adjusted model, women who reported witnessing parental IPV or experiencing physical child abuse had a statistically significant 1.71 (95%CI: 1.08–2.70) and 3.04 (95%CI: 2.36–3.91) increase in odds of reporting co-occurring violence compared to women who did not experience such forms of abuse (Table 3). Early childhood experiences of violence were also associated with IPV and child abuse in separate adjusted models.

Table 3.

Adjusted Associations Childhood and Conflict-Related Experiences of Violence and Past 3-Month Experience of Co-Occurrence of IPV and Child Abuse, IPV, and Child Abuse as Reported by Women (n = 195) and men (n = 193).^a^,^b

	Women			Men
	Co-occurring IPV & child abuse aOR (CI), p	Experiencing IPV aOR (CI), p	Child abuse perpetration aOR (CI), p	Co-occurring IPV & child abuse aOR (CI), p	IPV perpetration aOR (CI), p	Child abuse perpetration aOR (CI), p
Traumatic experiences of violence
Conflict-related traumatic events	1.47 (1.37, 1.57), <.0001	1.44 (1.33, 1.55), <.0001	1.31 (1.05, 1.65), 0.02	1.10 (0.95, 1.27), 0.23	1.07 (0.92, 1.26), 0.39	1.09 (1.04, 1.14), 0.00
Witnessing parental IPV	1.71 (1.08, 2.70), 0.02	1.63 (0.98, 2.73), 0.06	1.89 (1.24, 2.89), 0.00	0.74 (0.62, 0.90) 0.00	0.76 (0.49, 1.19), 0.24	1.88 (0.91, 3.89), 0.09
Experiencing physical child abuse	3.04 (2.36, 3.91), <.0001	2.93 (2.27, 3.80), <.0001	5.11 (2.47, 10.48), <.0001	2.10 (1.65, 2.67), <.0001	1.41 (1.06, 1.88), 0.02	2.65 (1.63, 4.31), <.0001

Adjusted for significantly associated demographics (education level, disability level, displacement) and clustering at the site level.

Frequency missing: Women (missing = 3); Men (missing = 3).

In the final adjusted model, men experiencing physical abuse as a child was associated with a 1.89 (95%CI: 1.24–2.89) increase in odds of perpetrating co-occurring violence and a 1.88 (95%CI: 0.91–3.89) increase in odds of reporting child abuse, but not IPV. Witnessing parental IPV was not associated with either IPV perpetration of child abuse in adjusted models but was associated with a protective effect in the fully specified model for co-occurring violence (aOR: 0.74; 95%CI: 0.62–0.90). The results of the full adjusted models including sociodemographic variables that were controlled for in the model can be found in Supplementary Table 2.

Discussion

Over half of families participating in the present study reported co-occurring IPV against women and child abuse within the past 3 months. This staggering prevalence is higher than neighboring Uganda which found approximately one-third of adolescent and caregiver dyads had reported co-occurring violence in the past-year (Carlson et al., 2020) and slightly higher than other settings that have examined co-occurrence of violence (Chan, 2011). Approximately 60% of women also reported IPV in the past 3 months; this is comparable with other studies in eastern DRC (Vaillant et al., 2020). Child abuse perpetration was reported at high levels by both partners, yet more so for female caregivers. Higher reported child abuse perpetration among women is consistent with other literature which may underscore the fact that women spend more time caring for children (May-Chahal & Cawson, 2005) or have heightened parenting stress (Niu et al., 2018). As demonstrated in the present study, women may also be subject to abuse from their partner when their partners are angry or unhappy with their children. It is thus plausible women may use harsh discipline practices as a mechanism to ensure they themselves will not be subject to IPV as a sanction for a child's misbehavior; similar pathways have been noted elsewhere (Fulu et al., 2017).

Nearly 70% of adult women and nearly 60% of adult men also reported high levels of violence during childhood, whether it was witnessing parental IPV or experiencing physical child abuse which is consistent with a previous study in North Kivu, DRC (Slegh et al., 2014). Given high frequencies of these early life forms of violence, and strong previous evidence for intergenerational linkages between early forms of abuse and adulthood experiences of victimization and/or perpetration in the home (Gómez & Speizer, 2009; Guedes et al., 2016), including within humanitarian settings (Saile et al., 2014) there is urgent need to break intergenerational cycles of violence.

Such strategies may include bolstering appropriate psychosocial response services for survivors, and especially for children, who reside in homes typified by abuse. This may be a particularly effective avenue to reduce violence in future generations. Yet, despite this urgent need, limited psychosocial and mental health interventions have been tested to date that seek to specifically address intergenerational violence risk in conflict-affected settings. Further testing of psychosocial approaches to address intergenerational violence, and modeling of positive parenting practices for people who have experienced violence in childhood may be useful in conflict-affected settings. Such programs should form part of a wider violence prevention framework that also works to address power inequities that arise as the result of inequitable gender norms and age-related hierarchies, create more opportunities for women and girl's decision-making and empowerment and builds the capacity of duty bearers such as social workers, teachers, health professionals to recognize and respond to violence.

Programming opportunities to address co-occurring violence in the home in humanitarian settings may benefit from further consideration of how experiences of conflict-related traumatic events may influence family wellbeing, although this finding operates differently for men and women. Such exposure to conflict-related traumatic events may serve as a proxy for poor mental health such as post-traumatic stress symptomatology, less warmth toward children (Eltanamly et al., 2021), or other instrumental variables such as loss of key income producing household members due to violence or displacement that exacerbates stressors in families, as well as ongoing daily stressors. For instance, in eastern DRC, such parental mental health and IPV behaviors have previously been found to be related to adolescent outcomes, although variation was noted between boy and girl children (Glass et al., 2018). Common approaches in humanitarian settings such as women's and children's safe spaces, psychosocial support and empowerment activities should be tested and strengthened in conflict-related contexts to continue to support women and children to cope, build resilience, and thrive.

Conversely, however, we find no significant associations between conflict-related traumatic exposures and perpetration of violence in the home for men. This is generally counter to previous literature (Gupta et al., 2009), but given the endemic nature of IPV in this setting, gendered social norms which reproduce systems of gender inequality and condone men's abuse of power may be more explanatory for men's perpetration outcomes. One study in Papua New Guinea has also documented a mixed relationship between men's experiences of conflict-related traumas and long term IPV perpetration such that an association was only seen at higher levels of traumatic exposures (Jewkes et al., 2017). Nonetheless, intervention research seeking to reduce violence in the home in conflict-affected settings should assess for these potential exposures and possible heterogeneity of treatment effect by these previous experiences.

Limitations

Study findings should be interpreted with its limitations in mind. First, all study outcomes were self-reported and there is potential for both underreporting if people felt affirmation of violence experiences could be stigmatized or overreporting if people may have felt that additional services or benefits could be received by the non-governmental organization associated with the study. Second, child voice is absent from the present analyses due to ethical, logistical, and budgetary considerations. Future research should ensure multiple voices in the family are represented if ethical considerations can be appropriately mitigated. Third, measures of childhood experiences of violence are retrospectively reported using a single-item measure and may be subject to recall bias. Future longitudinal studies should be considered to assess the causal evolution of violence patterns within families and relationship to conflict-affected settings through a life course and ecological approach (Rubenstein et al., 2020). Approaches to measuring childhood experiences of violence that do not rely on a single-item measure should also be explored and tested. Particular attention should be paid toward potential pathways such as gender inequality, acceptance of harsh discipline, power, and positive parenting practices within families. Fourth, the data were stratified by gender and therefore did not examine nested couple data or account for clustering at the dyadic level. Future dyadic analyses will be conducted to examine association of reporting between couples but were outside the scope of this paper. Finally, the study draws on an ongoing impact evaluation baseline in which program participants were motivated to improve their family functioning. The sample was also relatively small due to the feasibility of implementation within the location, potentially influencing results. This sampling size and approach may limit generalizability to other households within this setting and more broadly within other conflict-affected settings.

Conclusion

Despite these limitations and while specialized programming remains a critically important strategy to address IPV or child abuse, recognition of intergenerational and co-occurring violence is needed within intervention approaches to better design holistic violence prevention and response approaches. Violence against women and violence against children programming could benefit from more cross-fertilization of key messages and strategies with shared understanding of the correlates of violence in the home, such as power inequities related to gender and age. Further longitudinal research is needed to unpack causal mechanisms and assess whether these potential relationships vary based on different identities or in different contexts. At a minimum, impact evaluations on either IPV or child abuse prevention and response programming could benefit from measuring more than one form of violence in the home to understand potential secondary impacts.

Supplemental Material

sj-docx-1-vaw-10.1177_10778012221145302 - Supplemental material for Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse

Supplemental material, sj-docx-1-vaw-10.1177_10778012221145302 for Co-Occurring Intimate Partner Violence and Child Abuse in Eastern Democratic Republic of Congo: The Influence of Early Life Experiences of Abuse by Kathryn L. Falb, Alexandra Blackwell, Jean de Dieu Hategekimana, Munjireen Sifat, Danielle Roth and Meghan O’Connor in Violence Against Women

Footnotes

Authors’ Note

Among the women who reported experiencing any IPV (n = 116), only 4.3% (5) reported experiencing IPV only. Among the women who reported perpetrating any child abuse (n = 166), only 33.13% of women (55) reported perpetrating child abuse only. Similarly, among men whose partners reported any IPV (n = 113), 23.01% (26) had perpetrated IPV only. Among those men who reported perpetrating any child abuse (n = 146) only 40.0% (58) reported perpetrating child abuse only.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the United States Agency for International Development (grant number 720FDA19GR000186).

ORCID iD

Kathryn L. Falb

Supplemental Material

Supplemental material for this article is available online.

Author Biographies

Kathryn L. Falb, ScD is a social epidemiologist and research director for the Airbel Impact Lab, the International Rescue Committee's hub for research and innovation. Her research focuses on what works to prevent and respond to violence against women, children, and other marginalized populations in humanitarian settings.

Alexandra Blackwell, MPH is a research coordinator for the violence research portfolio at the International Rescue Committee. She employs mixed methodologies to improve the wellbeing of families in conflict-affected settings.

Jean de Dieu Hategekimana leads the implementation of the Safe at Home program in Goma, Democratic Republic of Congo and holds a Bachelor's degree in Development Management. He has over five years of experience specializing in the prevention and response of violence against women and children.

Munjireen Sifat, PhD is a public health researcher and mixed methods researcher. She supported analyses and writing of the present manuscript.

Danielle Roth, MA is the primary prevention technical advisor for the Violence Prevention & Response Technical Unit with the International Rescue Committee and led the development of the Safe at Home programming model.

Meghan O’Connor, MA is a social worker by training and serves as Senior Technical Advisor for the Violence Prevention & Response Unit with the International Rescue Committee.

References

Abramsky

Devries

Kiss

Nakuti

Kyegombe

Starmann

Watts

(2014). Findings from the SASA! Study: A cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda. BMC Medicine, 12(1), 1–17. https://doi.org/10.1186/s12916-014-0122-5

Annan

Brier

(2010). The risk of return: Intimate partner violence in Northern Uganda's armed conflict. Social Science & Medicine, 70(1), 152–159. https://doi.org/10.1016/j.socscimed.2009.09.027

Carlson

Namy

Pala

A. N.

Wainberg

M. L.

Michau

Nakuti

Devries

(2020). Violence against children and intimate partner violence against women: Overlap and common contributing factors among caregiver-adolescent dyads. BMC Public Health, 20(1), 124. https://doi.org/10.1186/s12889-019-8115-0

Catani

Jacob

Schauer

Kohila

Neuner

(2008). Family violence, war, and natural disasters: A study of the effect of extreme stress on children's mental health in Sri Lanka. BMC Psychiatry, 8(1), 33. https://doi.org/10.1186/1471-244X-8-33

Catani

Schauer

Elbert

Missmahl

Bette

J. P.

Neuner

(2009). War trauma, child labor, and family violence: Life adversities and PTSD in a sample of school children in Kabul. Journal of Traumatic Stress, 22(3), 163–171. https://doi.org/10.1002/jts.20415

Chan

K. L.

(2011). Children exposed to child maltreatment and intimate partner violence: A study of co-occurrence among Hong Kong Chinese families. Child Abuse & Neglect, 35(7), 532–542. https://doi.org/10.1016/j.chiabu.2011.03.008

Ellsberg

Ovince

Murphy

Blackwell

Reddy

Stennes

Contreras

(2020). No safe place: Prevalence and correlates of violence against conflict-affected women and girls in South Sudan. PLoS One, 15(10), e0237965. https://doi.org/10.1371/journal.pone.0237965

Elmusharaf

Scriver

Chadha

Ballantine

Raghavendra

Sabir

Duvvury

Kennedy

Grant-Vest

Edopu

(2019). Economic & social costs of violence against women in South Sudan. Washington DC: Georgetown Institute for Women, Peace, and Security.

Eltanamly

Leijten

Jak

Overbeek

(2021). Parenting in times of war: A meta-analysis and qualitative synthesis of war exposure, parenting, and child adjustment. Trauma, Violence, & Abuse, 22(1): 147-160. https://doi.org/10.1177/1524838019833001

10.

Falb

Asghar

Pardo

N. M.

Hategekimana

J. D. D.

Kakay

Roth

O’Connor

(2022). Developing an inclusive conceptual model for preventing violence in the home in humanitarian settings: Qualitative findings from Myanmar and the Democratic Republic of Congo. Journal of Interpersonal Violence, 37(3–4), 1076–1105. https://doi.org/10.1177/0886260520922358

11.

Falb

K. L.

McCormick

M. C.

Hemenway

Anfinson

Silverman

J. G.

(2013). Violence against refugee women along the Thai–Burma border. International Journal of Gynecology & Obstetrics, 120(3), 279–283. https://doi.org/10.1016/j.ijgo.2012.10.015

12.

Fulu

Miedema

Roselli

McCook

Chan

K. L.

Haardörfer

Huque

(2017). Pathways between childhood trauma, intimate partner violence, and harsh parenting: Findings from the UN Multi-country Study on Men and Violence in Asia and the Pacific. The Lancet Global Health, 5(5), e512–e522. https://doi.org/10.1016/S2214-109X(17)30103-1

13.

García-Moreno

Pallitto

Devries

Stöckl

Watts

Abrahams

(2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

14.

Gartland

Giallo

Woolhouse

Mensah

Brown

S. J.

(2019). Intergenerational impacts of family violence-mothers and children in a large prospective pregnancy cohort study. EClinical Medicine, 15, 51–61. https://doi.org/10.1016/j.eclinm.2019.08.008

15.

Glass

Kohli

Surkan

P. J.

Remy

M. M.

Perrin

(2018). The relationship between parent mental health and intimate partner violence on adolescent behavior, stigma and school attendance in families in rural Democratic Republic of Congo. Global Mental Health, 5(e20). https://doi.org/10.1017/gmh.2018.10

16.

Global Women’s Institute & International Rescue Committee. (2017). No safe place: A lifetime of violence for conflict-affected women and girls in South Sudan. Washington DC: GWI and IRC.

17.

Gómez

A. M.

Speizer

I. S.

(2009). Intersections between childhood abuse and adult intimate partner violence among Ecuadorian women. Maternal and Child Health Journal, 13(4), 559. https://doi.org/10.1007/s10995-008-0387-4

18.

Guedes

Bott

Garcia-Moreno

Colombini

(2016). Bridging the gaps: A global review of intersections of violence against women and violence against children. Global Health Action, 9(1), 31516. https://doi.org/10.3402/gha.v9.31516

19.

Gupta

Acevedo-Garcia

Hemenway

Decker

M. R.

Raj

Silverman

J. G.

(2009). Premigration exposure to political violence and perpetration of intimate partner violence among immigrant men in Boston. American Journal of Public Health, 99(3), 462–469. https://doi.org/10.2105/AJPH.2007.120634

20.

Haj-Yahia

M. M.

Abdo-Kaloti

(2003). The rates and correlates of the exposure of Palestinian adolescents to family violence: Toward an integrative-holistic approach. Child Abuse & Neglect, 27(7), 781–806. https://doi.org/10.1016/S0145-2134(03)00119-4

21.

Hillis

Mercy

Amobi

Kress

(2016). Global prevalence of past-year violence against children: A systematic review and minimum estimates. Pediatrics, 137(3): e20154079. https://doi.org/10.1542/peds.2015-4079

22.

Hossain

Zimmerman

Kiss

Kone

Bakayoko-Topolska

David Manan

K. A.

Watts

(2014). Men's and women’s experiences of violence and traumatic events in rural Cote d'Ivoire before, during and after a period of armed conflict. BMJ Open, 4(2): e003644. https://doi.org/10.1136/bmjopen-2013-003644

23.

Hynes

Ward

Robertson

Crouse

(2004). A determination of the prevalence of gender-based violence among conflict-affected populations in East Timor. Disasters, 28(3), 294–321. https://doi.org/10.1111/j.0361-3666.2004.00260.x

24.

Jewkes

Jama-Shai

Sikweyiya

(2017). Enduring impact of conflict on mental health and gender-based violence perpetration in Bougainville, Papua New Guinea: A cross-sectional study. PLoS One, 12(10):e0186062. https://doi.org/10.1371/journal.pone.0186062

25.

Kimber

Adham

Gill

McTavish

MacMillan

H. L.

(2018). The association between child exposure to intimate partner violence (IPV) and perpetration of IPV in adulthood—A systematic review. Child Abuse & Neglect, 76, 273–286. https://doi.org/10.1016/j.chiabu.2017.11.007

26.

Machisa

M. T.

Christofides

Jewkes

(2016). Structural pathways between child abuse, poor mental health outcomes and male-perpetrated intimate partner violence (IPV). PLoS One, 11(3):e0150986. https://doi.org/10.1371/journal.pone.0150986

27.

May-Chahal

Cawson

(2005). Measuring child maltreatment in the United Kingdom: A study of the prevalence of child abuse and neglect. Child Abuse & Neglect, 29(9), 969–984. https://doi.org/10.1016/j.chiabu.2004.05.009

28.

Mootz

J. J.

Stark

Meyer

Asghar

Roa

A. H.

Potts

Bennouna

(2019). Examining intersections between violence against women and violence against children: Perspectives of adolescents and adults in displaced Colombian communities. Conflict and Health, 13(1), 25. https://doi.org/10.1186/s13031-019-0200-6

29.

Namy

Carlson

O'Hara

Nakuti

Bukuluki

Lwanyaaga

Namakula

Nanyunja

Wainberg

M. L.

Naker

Michau

(2017). Towards a feminist understanding of intersecting violence against women and children in the family. Social Science & Medicine, 184, 40–48. https://doi.org/10.1016/j.socscimed.2017.04.042

30.

Niu

Liu

Wang

(2018). Intergenerational transmission of harsh discipline: The moderating role of parenting stress and parent gender. Child Abuse & Neglect, 79, 1–10. https://doi.org/10.1016/j.chiabu.2018.01.017

31.

Roberts

A. L.

Gilman

S. E.

Fitzmaurice

Decker

M. R.

Koenen

K. C.

(2010). Witness of intimate partner violence in childhood and perpetration of intimate partner violence in adulthood. Epidemiology, 21(6), 809–818. https://doi.org/10.1097/EDE.0b013e3181f39f03

32.

Rubenstein

B. L.

L. Z. N.

MacFarlane

Stark

(2020). Predictors of interpersonal violence in the household in humanitarian settings: A systematic review. Trauma, Violence, & Abuse, 21(1), 31–44. https://doi.org/10.1177/1524838017738724

33.

Rubenstein

B. L.

Stark

(2017). The impact of humanitarian emergencies on the prevalence of violence against children: An evidence-based ecological framework. Psychology, Health & Medicine, 22(suppl. 1), 58–66. https://doi.org/10.1080/13548506.2016.1271949

34.

Saile

Ertl

Neuner

Catani

(2014). Does war contribute to family violence against children? Findings from a two-generational multi-informant study in Northern Uganda. Child Abuse & Neglect, 38(1), 135–146. https://doi.org/10.1016/j.chiabu.2013.10.007

35.

Saile

Neuner

Ertl

Catani

(2013). Prevalence and predictors of partner violence against women in the aftermath of war: A survey among couples in Northern Uganda. Social Science & Medicine, 86, 17–25. https://doi.org/10.1016/j.socscimed.2013.02.046

36.

Slegh

Barker

Levtov

(2014). Gender relations, sexual and gender-based violence and the effects of conflict on women and men in north Kivu, eastern Democratic Republic of the Congo: Results from the international men and gender equality survey (IMAGES). Promundo-US.

37.

Stark

Ager

(2011). A systematic review of prevalence studies of gender-based violence in complex emergencies. Trauma, Violence, & Abuse, 12(3), 127–134. https://doi.org/10.1177/1524838011404252

38.

Stark

Asghar

Bora

Baysa

A. A.

Falb

K. L.

(2017). Prevalence and associated risk factors of violence against conflict-affected female adolescents: A multi-country, cross-sectional study. Journal of Global Health, 7(1), 010416. https://doi.org/10.7189/jogh.07.010416

39.

Tlapek

S. M.

(2015). Women’s status and intimate partner violence in the Democratic Republic of Congo. Journal of Interpersonal Violence, 30(14), 2526–2540. https://doi.org/10.1177/0886260514553118

40.

UNICEF. (2013). Multiple Indicator Cluster Surveys (MICS). Available at: mics.unicef.org.

41.

Vaillant

Koussoube

Roth

Pierotti

R. S.

Hossain

Falb

K. L.

(2020). Cluster-randomized controlled trial to reduce intimate partner violence in North and South Kivu, DRC: An engaging men to transform inequitable gender attitudes approach. BMJ Global Health, 5(5): e002223. https://doi.org/10.1136/bmjgh-2019-002223

42.

Washington Group on Disability Statistics. (2016). The Washington Group short set of questions on disability.

43.

World Health Organization. (2005). WHO multi-country study on women’s health and domestic violence against women: Summary report of initial results on prevalence, health outcomes and women’s responses. WHO.

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