The Differential Impact of Abuse Based on Child Parental Care Status: A Multinational Analysis of Children in Sub-Saharan Africa

Background: UNICEF estimates 140 million children around the world have lost one or both parents, and reports that orphanhood makes children particularly vulnerable to violence and abuse. An analysis of household surveys in Africa by Martin & Zulaika (2016) reveals that globally, about 10% of children reside with neither of their biological parents; some countries in Sub-Saharan Africa have up to 36% of their children living in nonparental care. Prior research suggests that children’s living arrangements may have an impact on their mental health: Nduwimana et al. (2017) found that in Rwanda, when controlling for HIV status, children in nonparental care had greater depression, anxiety, and irritability than children in parental care. This study aims to better understand how experiencing abuse uniquely impacts children in three Sub-Saharan African nations (Kenya, Malawi, Tanzania) based on their parental care status.

Methods: Using data from the Centers for Disease Control and Together For Girls’ Violence Against Children Surveys, this study used ordered logistic regression models in Stata 15.1 to examine the differential impact of experiencing abuse (physical, sexual, and threats of physical) on child mental health based on children’s parental care status. The sample included n = 4,091 survey respondents aged 13 to 17 (mean=14.84, SD=1.40) from Kenya (31%), Malawi (26%), Tanzania (43%). Respondents were 54% male and 46% female. Parental care status included 19% respondents in nonparental care, 21% in maternal care, and 55% in maternal-paternal care.

Results: While experiencing abuse negatively impacts the mental health of all children, the negative impact of experiencing abuse greater for children in maternal care (OR=0.825) compared to children in maternal-paternal care (OR=1.29), and greatest for children in nonparental care (OR=0.819).  The ordered logistic regression models containing parental care status, child mental health and childhood abuse experiences were significant for children in maternal-paternal care (p<.000), maternal care (p<.049) and nonparental care (p<0.018).

Implications: By examining the differential impact of child abuse on child mental health based on parental care status, this study extends knowledge about the situated impact of adverse childhood experiences and about the particular vulnerability experienced by children in nonparental care settings.  These findings fit within an International Adverse Childhood Experiences framework, supporting existing findings that childhood adversity has a greater negative impact on children who have experienced greater adversity (e.g. abuse has a greater negative mental health outcome on children who lack one parent and the greatest negative impact on children who lack both parents).  These findings may have practice considerations for child protection programs in Sub-Saharan Africa, such as considering parental care status (in particular, nonparental care) as a risk factor for violence and abuse when determining criteria for children’s participation in primary prevention programs.