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A Study on Relationship between Domestic Violence and Childhood Mortality in India: Using Weibull frailty Modelling Approach
Authors: Ashish Kumar Yadav, Jeetendra Yadav, Sarvesh Awasthi, and Subhash Gautam
Source: Journal of Clinical and Diagnostic Research, 11(12): 5-10; DOI: 10.7860/JCDR/2017/27670.10980
Topic(s): Childhood mortality
Domestic violence
Country: Asia
Published: DEC 2017
Abstract: Introduction: Domestic violence is not an untold story in India but it often goes unreported. According to United Nation Population Fund Report, around two-third of married Indian women are victims of some form of domestic violence. A few studies, mostly from high-income countries, have suggested that domestic violence and under five mortality are linked. Little is known about the possible effect of violence against women on the survival of their offspring. Mosley and Chen had already established the proximate determinants of under-five mortality in developing countries, and accordingly, a lot of emphases have been made on these factors to reduce under-five mortality, but unfortunately, we still are lagging far behind compared to other developed countries. Aim: To explore the relationship between domestic violence and under-five mortality rate in India. The specific objectives of the study were to compare under-five mortality by mother's exposure to domestic violence and to evaluate whether domestic violence acts as an unobserved heterogeneity variable (frailty) that may influence under-five mortality. Materials and Methods: The present study uses National Family Health Survey (NFHS-3) data of India. The third round NFHS-3 in India was completed during 2005-06 covering a nationally representative sample of ever married women aged 15-49 years. The study type was descriptive and the study design was cross-sectional. For the present study aggregated national data of 124,385 women having 51,555 live births and experiencing 3,551 under-five mortality was considered. Modified Conflict Tactics Scale (CTS 2) was used to assess domestic violence experience. Kaplan-Meir method was used to compare survival estimates of under-five mortality by mother's exposure. Logistic regression was used to assess the odds of under-five death in children of mothers exposed to domestic violence. Extended Weibull Proportional Hazard model (PH model) with domestic violence as frailty variable was used. Results: Out of total 124,385 women surveyed 67% (N=83704) women had experienced physical violence in the past 12 months. The study included 51,555 live births out of which 3,551 experienced under-five mortality. More than 35% (N=1245) of children who died before completing their fifth birthday belonged to mothers who were victims of domestic violence. It was found that the survival probability for a child whose mother was exposed to any form of violence was significantly lower than the child whose mother does not have any such experience. The risk of domestic violence was significantly high (30-38%) among mothers who reported unwanted pregnancies and abortions (36-73%). Conclusion: The major finding of the study was that domestic violence was acting as significant frailty variable suggesting that it should be considered along with already established proximate determinants of under-five mortality in India.