Child stunting in Rwanda is not just a matter of living standards and access to food. When there is domestic violence, children are affected and do not grow as they should, according to a thesis at the University of Gothenburg.
Behind the thesis is Jean Nepo Utumatwishima, medical doctor and a doctoral student in global public health at Sahlgrenska Academy at the University of Gothenburg, and also the Minister of Youth in Rwanda.
In his research work, he has studied child stunting in northern Rwanda, a province with rich soils that has nevertheless had the most persistent problems with young children being significantly shorter than they should be according to the WHO Child Growth Standards. The children studied were between the ages of 1 month and up to 3 years.
Previous research has mainly focused on directly child-related factors. The current thesis takes a broader approach and also includes the environment in the household, the health and behavior of the mothers and the family dynamics surrounding child-rearing.
Punishment linked to child stunting
The data includes 601 young children and their mothers. Jean Nepo Utumatwishima and his colleagues visited the randomly selected households and also conducted interviews with the mothers without any partner present. The mothers often had limited schooling and simple jobs.
The results show that 27 percent of the children had stunted growth, a proportion that increased with increasing age. Of those who had passed the age of 2, 40 percent had stunted growth. The risk also increased significantly if the children had been subjected to harsh discipline in the form of physical and psychological punishment.
Of the mothers, 47 percent had endured physical violence in close relationships before pregnancy, and sexual violence in close relationships during pregnancy, which together were clearly linked to stunted growth in the children. Not growing as they should was also more common in families where the mother suffered from mental illness, or if there was no room for her to say no when the man wanted to have sex.
Jean Nepo Utumatwishima describes a patriarchal power-structure where the mother is often alone in the parental role, without social support and without influence over crucial factors in life, including the household economy, which in itself did not have to be bad.
– We saw that the lack of social support and guidance, that the mothers felt that no one could help them, that they did not receive money when they were urgently needed, was linked to child stunting. In that situation, no outside interventions help, the mother's vulnerability means that the efforts do not reach the children anyway, he notes.
The findings will be useful in Rwanda
When it comes to child stunting, people often talk about the first thousand days. What children miss out on during that period of life – height growth, brain development, etc. – cannot be compensated for afterwards, which can be devastating for a nation that wants to develop.
The knowledge Jean Nepo Utumatwishima has built up during his doctoral studies is being taken into government work in Rwanda. He wants to contribute to more focus on mothers' conditions, which requires, for example, maternity care to ask more detailed and systematic questions about family conditions, views on the parental role, and about the mother's mental health. There is a clear need for parental support programs in existing initiatives in nutrition and child health.
Thesis: Investigating the Association Between Household Gender Dynamics, Intimate Partner Violence, Mothers' Mental Health, Child Abuse, and Child Stunting in Rwanda, https://hdl.handle.net/2077/88268