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Children who witness violence between their parents often develop many of the same behavioral and psychological problems as children who are themselves abused (124, 228). In Nicaragua children of battered women were more than twice as likely as other children to suffer from learning, emotional, and behavioral problems and almost seven times as likely to be abused themselves, physically, sexually, or emotionally (131). Among abused women in Nicaragua, 49% said that their children often witnessed the violence (131), as did 64% of women in Ireland (330) and 50% in Monterrey, Mexico (191).

Studies in the US have found that in 30% to 60% of families where husbands abuse their wives, the children also are abused (9, 123). Clinical experience suggests that this pattern exists in the developing world as well (131). While children's reactions to violence vary according to their age, sex, and the social support that they receive (228), children who both witness and experience abuse have the most severe behavioral problems (124).

Violence may undermine child survival as well (11, 232). In León, Nicaragua, researchers found that the children of women who were physically and sexually abused by their partners were six times more likely than other children to die before the age of five. The study controlled for other factors affecting infant and child survival. One-third of all child deaths in this setting were attributable to partner violence (11). A study in the Indian states of Tamil Nadu and Uttar Pradeshalso found that women who had been beaten were significantly more likely than nonabused women to have had an infant death or pregnancy loss from abortion, miscarriage, or stillbirth. The study controlled for other influences on infant mortality such as mother's education, age, and parity (232).

While it is unclear exactly how domestic violence affects child survival, one explanation is that the children of mothers who are abused are more likely to be born underweight, a factor that increases risk of dying during infancy or childhood (see Chapter 4.4). Another possible explanation is that mothers with violent partners may have lower self-esteem, less mobility, weaker bargaining power, and less access to resources and thus are less able to keep their children healthy.

In rural Karnataka, India, a study found that children of mothers who were beaten received less food than other children did, suggesting that these women could not bargain with their husbands on their children's behalf (165). Similarly, 1998 DHS data from Nicaragua show that children of battered women were more likely than other children to be malnourished. They were more likely to have had a recent bout of diarrhea and less likely to have received oral rehydration therapy. They also were less likely to have been immunized against childhood diseases (386) (see Figure 4).