Measuring the impacts of maternal child marriage and maternal intimate partner violence and the moderating effects of proximity to conflict on stunting among children under 5 in post-conflict Sri Lanka

• Published in: SSM - population health Vol. 18; p. 101074
• Main Authors: Fonseka, Ruvani W., McDougal, Lotus, Raj, Anita, Reed, Elizabeth, Lundgren, Rebecka, Urada, Lianne, Silverman, Jay G.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.06.2022; Elsevier
• Subjects: Girl child marriage; Intimate partner violence (IPV); Post-conflict; Sri Lanka; Stunting; Sri Lanka; Intimate partner violence (IPV); Girl child marriage; Stunting; Post-conflict
• ISSN: 2352-8273; 2352-8273
• DOI: 10.1016/j.ssmph.2022.101074

This study aimed to understand whether maternal child marriage and past year intimate partner violence (IPV) impact stunting among Sri Lankan children under 5 years old, and, secondarily, whether proximity to conflict is associated with stunting. Additionally, we assessed whether proximity to conflict moderates the relationships between maternal child marriage and past year IPV (sexual, physical, and emotional). We tested these questions using logistic regression analyses of the 2016 Sri Lankan Demographic and Health Survey (n = 4941 mother-child dyads). In country-wide adjusted analyses, we did not find associations between maternal child marriage or IPV and stunting (p > 0.05). Children in districts proximal and central to conflict were significantly less likely to be stunted compared to children in districts distal to conflict (proximal adjusted odds ratio/aOR: 0.43, 95% confidence interval/CI: 0.22–0.82; central aOR: 0.53, CI: 0.29–0.98). We found significant interaction effects on stunting between proximity to conflict and both sexual and emotional IPV, which we further explored in stratified analyses. In districts distal to conflict, maternal sexual IPV was significantly associated with increased odds of stunting (aOR: 2.71, CI: 1.16–6.35), and in districts central to conflict, maternal emotional IPV was significantly associated with increased odds of stunting (aOR: 1.80, CI: 1.13–2.89). Maternal emotional IPV was significantly associated with decreased odds of stunting in districts proximal to conflict (aOR: 0.42, CI: 0.18–0.96). Maternal child marriage and physical IPV were not associated with stunting in Sri Lanka. Variations in associations between maternal IPV and stunting across Sri Lanka may reflect the lasting and differential impact of conflict, as well as differential humanitarian responses which may have improved child nutrition practices and resources in districts central and proximal to conflict. Policies and programs addressing stunting in Sri Lanka should consider the role of maternal IPV as well as community-level variations based on proximity to conflict. •Across Sri Lanka, stunting is reduced in areas proximal and central to conflict.•Proximity to conflict moderates the impact of sexual and emotional IPV on stunting.•Children's vulnerability to stunting and IPV varies by proximity to conflict.•Humanitarian aid may have decreased stunting in areas most impacted by conflict.