Poverty and Child Maltreatment: A Systematic Review

Background: Poverty has long been indicated as a risk factor for child maltreatment. However, given the ambiguity of what constitutes poverty and how it should be measured, the results had been inconsistent and varied by the definition and indicator of poverty used in the respective studies. This study aims to synthesize the existing literature regarding the causal relationship between individual-level or household-level income and child maltreatment in the US.

Methods: Following the PRISMA guideline, literature was searched in six databases from January 1, 2000 to August 31, 2022 using the following search terms in varying combinations: 1) child maltreatment, child abuse (i.e., physical, emotional/psychological, sexual), child neglect, CPS involvement, and 2) poverty, parent/family/household income, TANF, SSI, SNAP, WIC, Food Stamp, Medicaid, low-income family. There were 1,941 duplicates removed after screening the title and abstracts, and 2,733 studies that did not meet the eligibility criteria were excluded during the full-text review. A total of 27 studies were reviewed and analyzed for the purpose of this study. To ensure the quality of the studies included, all the selected articles underwent the NIH Quality Assessment Tool, which yielded the overall rating of these sources as ‘good.’

Results: Out of 17 (63.0%) studies which assessed poverty with individual/household income, 40.7% focused on general income level, and the other 22.2% were household income based on poverty threshold or federal poverty line. Specifically, 40.7% measured poverty using only income variable, 18.5% with only receipt of welfare benefits, 22.2% with the combination of income and benefits, and 18.5% with more than two welfare benefits. For the measurement tools of child maltreatment, it was mostly administrative data (71.9%) such as the number of CPS investigation or referrals. About 28.1% of the studies used a specific scale as to parent-child conflict tactics scale. Although the type of child maltreatment varied across studies, 18.5% did not specify the type, 18.5% categorized child maltreatment as neglect, physical abuse, sexual abuse, and emotional abuse, and another 18.5% defined it as physical abuse, neglect, and sexual abuse. In conclusion, a negative association between income and child maltreatment (73.2%) was found. This indicates that higher income decreased the risk of child maltreatment, while families living in poverty had a higher risk of child maltreatment. However, not all the welfare benefits decreased the likelihood of child maltreatment, and 37.0% found no significant association between income/welfare benefits and child maltreatment.

Conclusions/Implications: Considering the lack of accuracy and appropriateness of general income to fully capture the extent of poverty, the federal poverty line or poverty threshold, instead of general income level, should be set as a minimum standard to classify poor and non-poor families. Additionally, a concrete definition of emotional abuse should be established, and more attention should be given to the rapidly increasing number of sexual abuses in child maltreatment reports. Finally, to mitigate the parental stress related to economic hardship, supplemental financial support regarding child care with less strict eligibility criteria should be offered to low-income families.