Journal of Social Research & Policy, Vol. 5, Issue 1, July 2014

Violent Disciplinary Practices Towards Children Among Caregivers In Vietnam: A Cross-Sectional Survey NGUYEN HO MINH TRANG 1 College of Economic, Hue University, Vietnam

NGUYEN HUU CHAU DUC Hue University of Medicine and Pharmacy, Vietnam

Abstract Violence against children within the family is one of the most common forms of child maltreatment. We used data from the 2011 Vietnam MICS to examine association between the violent disciplinary practices and socio-demographic factors among Vietnamese mothers/primary care givers. The prevalence of violent disciplinary practices among mothers/primary caregivers was 72.9%. Older women (AOR 0.7, 95% CI 0.5-0.9), having higher education (AOR 0.7, 95% CI 0.6-0.9), belonging to richest quintile (AOR 0.7, 95% CI 0.5-0.9) were less likely to have violent disciplinary practices. Other factors were likely associated with higher violent disciplinary practices included having 2 or 3 or more children, and negative attitudes towards partner violence. Importantly, women who had negative attitudes towards violent discipline were more than three times more likely to have violent disciplinary practices. Developing strategies that include the above interventions could play a crucial role in achieving the decrease violent disciplinary practices in Vietnamese caregivers. Keywords: Child maltreatment; Violent disciplinary practices; Children; Caregiver; Vietnam.

Background Violent discipline is a violation of a children’s right to protection from all forms of violence while in the care of their parents or other caregivers. Violence against children within the family is one of the most common forms of child maltreatment. Violent disciplinary practices, including physical punishment and psychological aggression, are socially accepted and often perceived as needed for children’s upbringing, although they seriously threaten children’s mental and social development and violate their fundamental rights. According to a UNICEF report, on average, three in four children between 2 and 14 years of age, experienced some form of violent discipline at home (UNICEF, 2010). Vietnam was the first Asian country and the second country in the world to sign and ratify the United Nations Convention on the Rights of the Child since 1989. Despite Vietnam has adopted various measures to promote children’s rights and particularly children’s rights to be protected from abuse and exploitation, the percentage of children aged 2-14 who experienced any violent discipline at home was 93.3% in 2005-2006 (General Statistic Office, 2006). In 2010, the Ministry of Labour, Invalids and Social Affairs (MOLISA) reported that more than 4.3 million children were living in “special circumstances”, which is nearly 18 per cent of all Vietnamese boys and girls. It included 126,248 abandoned children and orphans without care of their biological parents, 1,805 abused children and 21,500 children living in institutions (MOLISA, 2010). A large body of evidences shows maltreatment causes stress that can disrupt early brain development. Extreme stress can harm the development of the nervous and immune systems 1

Postal Address: 93/2 An Duong Vuong Street, Hue city, Postal code: 47000, Vietnam. E-mail Address: [email protected]

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(National Scientific Council on the Developing Child, 2005). As a result, children who are abused or neglected are at higher risk for health problems as adults. These problems include alcoholism, depression, drug abuse, eating disorders, obesity, high-risk sexual behaviors, smoking, suicide, and certain chronic diseases (Felitti et al., 1998). Abuse and neglect can occur in families where there is a great deal of stress. The stress can result from a family history of violence, drug or alcohol abuse, poverty, and chronic health problems (Runyan et al., 2002). Although widespread and pervasive, violence against children at home remains hidden and socially condoned. There is a paucity of research on how parents and other caregivers discipline children and why certain methods are used, particularly in developing countries. Our study aims to examine associated factors of violent disciplinary practices in Vietnamese mothers/primary caregivers. The findings of this study may help in fine-tuning suitable national strategies, ensuring a continued improvement in the children’s fundamental rights in Vietnam and in South-east Asia in general. Methods Data source and sampling Our study used data from the 2011 Vietnam Multiple Indicator Cluster Survey (MICS); the most recent national data conducted by the General Statistics Office in Vietnam and was designed by the UNICEF. The survey adopted a two-stage cluster sampling design with stratification into urban and rural areas. Enumeration areas were selected on the basis of the 2009 Vietnam Population and Housing Census, representing 6 regions. A sample of 11642 households was randomly selected from 600 EAs. Detailed descriptions of the study design and methods of data collection are accessible online in household survey reports (General Statistics Office, 2011). The survey included Child Discipline Module and the questionnaires were drafted in English then translated into Vietnamese. The translations were reviewed by experts and volunteers, and a pilot study was conducted for validation exercise. The total sample of 12115 eligible women at reproductive age, 11663 completed the interview, yielding a response rate of 96.3%. Eligible children included children aged 2-14 years in a household. If a household included more than one child in the appropriate age range, the interviewer was instructed to select one child at random using a combination of the number of the children in the household and the last digit of the survey number assigned to the household. In our analyses, we included women aged 15 to 49 years living with at least one child from 2 to 14 years of age (n = 6003). Measurement Violent disciplinary practice was the main dependent variable for our study, and was measured from the answers to the eight questionnaires about psychological aggression and physical punishment. The questionnaires: had they been employed recently (defined as at least once in the past month) in violent disciplinary practice (by the mothers/primary caregivers), included shouting and name calling, as well as shaking and hitting the child on various body parts (with or without an implement). The independent variables included socio-demographic characteristics: age, education, marital status, religion, residence, wealth index, attitudes towards partner violence, and attitudes towards violent discipline. We classified maternal current age into groups (younger age 15-24 years, middle age 25-34, and older age 35-49). Education of the mothers/primary caregivers was defined in terms of the formal education system of Vietnam: no education (0 year), primary (1-5 years), secondary (6-9 years), and higher (10 years or more). Place of residence was categorized as rural or urban. There are more than 50 ethnic minority groups in Vietnam, we combined them into one group (Non-Kinh group) and compare their outcomes with those of the majority ethnic group (Kinh group) (Dang, 2012). A binary variable was created to assess attitudes towards physical punishment, whether the mothers responded on the necessity of using physical punishment to raise/educate a child as yes versus no. Attitude towards partner violence: Women were asked whether they think that a husband is justified in hitting or beating his wife under a series of circumstances, i.e., if his wife burns the food, argues with him, goes out without telling him, neglects the children or refuses sexual relations. If the

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respondents agreed to negative statement, they were given a score “1”, and the rest, a score “0”. The sum was computed and categorized as having an attitude towards partner violence if respondents had scored above “1”, and has no attitude towards partner violence if respondents had no score. Statistical analyses The data were analyzed using SPSS version 18.0 (SPSS, Chicago, Illinois, United States of America). Frequencies were calculated for violent disciplinary practice and explanatory variables. Multivariate logistic regression methods were employed to assess the association between the selected explanatory variables and the main outcome. We entered all the covariates simultaneously in to the multiple regression models. The multicollinearity of the variables was checked by examining the variance inflation factors (VIFs), which was < 2.0. We estimated the adjusted odds ratios (AORs) to assess the strength of the associations and used the 95% confidence intervals (CIs) for significance testing. Ethical consideration The study is based on secondary data analyses of existing publicly available survey data with all identifying information removed. Before participating in the survey, all participants were asked to provide informed consent after being read a document emphasizing the voluntary nature of this project, outlining potential risks, and explaining that the information gathered would be used to assess health needs and to plan health services. Each participant was allowed to withdraw from the study at any time. Confidentiality of the entire data set was maintained at all stages of data collection. Results Table 1 shows that most of mothers/primary caregivers were 25 or above years of age (92.1%) and were married or are still married (99.6%). The majority of mothers/primary caregivers belonged to Kinh ethnicity (83%), they had at least secondary school level of education (71.7%), and had 2 children or more (76.9%). The reported frequencies for violent disciplinary practices at least once in the past month among younger age (15-24 years), had no education, belonged to the poorest, and had 3 or more children were 76.9%, 80.3%, 79.0%, and 76.0%, respectively. Table 1: Socio-demographic characteristics and violent disciplinary practices among mothers/primary caregivers in Vietnam, 2011 (n=6003) Violent disciplinary Indicator N % practices (%) Age 15-24 years 416 6.9 76.9 25-34 years 2691 44.8 74.2 35-49 years 2896 48.3 71.1 Place of residence Urban 2455 40.9 69.1 Rural 3548 59.1 75.5 Ethnicity Kinh 4981 83 72.1 Non-Kinh 1022 17 76.9 Wealth index Poorest 1295 21.6 79.0 Poorer 1018 17.0 76.9 Middle 1093 18.2 73.9 Richer 1244 20.7 72.7 Richest 1353 22.5 63.4 Education No education 462 7.7 80.3

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Primary Secondary Higher Education of household head No education Primary Secondary Higher Marital status Currently married Formerly married Never married Parity 1 2 ≥3

1238 2525 1778

20.6 42.1 29.6

79.6 73.9 64.9

415 1458 2350 1780

6.9 24.3 39.1 29.7

80.2 79.0 72.9 66.1

5660 318 25

94.3 5.3 0.4

73.0 70.8 76.0

1388 2887 1728

23.1 48.1 28.8

69.6 72.6 76.0

The percentage of mothers/primary caregivers who endorsed the belief that husbands are justified in hitting their wives was 37.4%. Most of them agreed and justified violence in instances of when they neglect their children (27.1%), or argue with their husband (22.7%). Approximately 15.6%, 6.9%, and 3.4% mothers/primary caregivers believed that a husband has a right to hit or beat his wife if she goes out without telling him, refuse to have sexual relations with him, and burns the food, respectively (Table 2). Table 2: Descriptive of Attitude towards partner violence, Attitude towards physical punishment and Violent disciplinary practice among mothers/primary caregivers in Vietnam, 2011 (n=6003) Indicators N % Attitudes towards partner violence Negative (Yes) 2243 37.4 Positive (No) 3760 62.6 Think that a husband is justified in hitting or beating his wife if: Goes out without telling him 937 15.6 Neglects the children 1626 27.1 Argues with him 1361 22.7 Refuses sexual relations 414 6.9 His wife burns the food 203 3.4 Attitudes towards physical punishment Believe physical punishment is necessary to raise/educate a child: Negative (Yes) 997 16.6 Positive (No) 5006 83.4 4376 72.9 Violent disciplinary practices Psychological Aggression Shaking 421 7.0 Calling child dumb, lazy or another name 1420 23.7 Physical punishment Shouting 2954 49.2 Hitting on the bottom with bare hand 2605 43.4 Hitting child on the bottom or elsewhere on the body with hard object 1198 20.0 Hitting on the hand, arm, or leg 983 16.4 Hitting on the face, head or ears 229 3.8 Beating child up, that is hit him/her over and over as hard as one can 24 0.4 Table 2 also showed that only 16.6% mothers/primary caregivers believed it was necessary to use physical punishment to raise children, but 72.9% of children experienced violent disciplinary practices. However, all of these violent disciplines towards children varied widely across mothers/primary

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caregivers’ practices. Shouting at children (49.2%) and hitting on the bottom with bare hand (43.4%) were common responses by mothers/primary caregivers. Roughly 23.7% and 20.0% of mothers/primary caregivers reported that they ever called their children names, and hit on the bottom with hard object, respectively. Some mothers/primary caregivers reported hitting the children on hand, arm, or leg (16.4%), and shaking children (7%). The practices of severe physical violence with hitting on children’s face, head, and beating children up were 3.8% and 0.4%, respectively. Table 3: Association between violent disciplinary practices and socio-demographic factors among mothers/primary caregivers in Vietnam, 2011 (n=6003) Violent disciplinary practices Indicators Adjusted odds ratio 95% confidence a (AOR) interval (95% CI) Age 15-24 years 1 -25-34 years 0.8 0.6-1.0 35-49 years 0.7** 0.5-0.9 Place of residence Urban 1 -Rural 0.9 0.8-1.1 Ethnicity Kinh 1 -Non-Kinh 0.8 0.7-1.0 Wealth index Poorest 1 -Poorer 0.9 0.8-1.2 Middle 0.9 0.7-1.1 Richer 0.9 0.8-1.2 Richest 0.7** 0.6-0.9 Education No education 1 -Primary 0.9 0.7-1.4 Secondary 0.9 0.6-1.2 Higher 0.7* 0.5-0.9 Education of household head No education 1 -Primary 0.9 0.6-1.2 Secondary 0.7* 0.5-0.9 Higher 0.6* 0.5-0.9 Marital status Currently married 1 -Formerly married 0.9 0.7-1.1 Never married 1.3 0.5-3.5 Parity 1 1 -2 1.2* 1.0-1.4 ≥3 1.3* 1.0-1.5 Attitudes towards partner violence Positive 1 -Negative 1.4*** 1.2-1.5 Attitudes towards physical punishment Positive 1 -Negative 3.1*** 2.5-3.8 *p<0.05; **p<0.01; ***p<0.001. aAdjusted for mother’s age, place of residence, ethnicity, wealth index, mother’s education, and education of household head, marital status, parity, attitudes towards partner violence, and attitudes towards physical punishment.

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Table 3 shows the association between violent disciplinary practices and socio-demographic factors among mothers/primary caregivers. In the adjusted model, older age group (35-49 years) was 0.7 times (95% confidence interval [CI] 0.5-0.9) less likely to report the use of violent disciplinary practices compared to younger age group (15-24 years). Richest mothers/primary caregivers were 0.7 times (95% CI 0.6-0.9) less likely use violent disciplinary practices compared to the poorest women. Less educated parents are more likely to engage in violent discipline than their peers. Mothers/primary caregivers had higher education were 0.7 times (95% CI 0.5-0.9) less likely use violent disciplinary practices compared to those who had no education. Additional, mothers/primary caregivers who have lived with household head that had secondary education and higher were 0.7 times (95% CI 0.6-0.9) and 0.7 times (95% CI 0.5-0.9), respectively, less likely to report to use of violent disciplinary practices compared to those who lived with household head that had no education (Table 3). Household size is a risk factor for violent child discipline. Mothers/primary caregivers who had two or more children were 1.2 times (95% CI 1.0-1.4) and 1.3 times (95% CI 1.0-1.5), respectively, more likely to report to use violent disciplinary practices compared to those who had one child (Table 3). Table 3 also shows that the mothers/primary caregivers who justified wife-beating were 1.4 times (95% CI 1.2-1.5) more likely to use violent disciplinary practices compared to those who did not justify wife-beating. Children were 3.1 times (95% CI 2.5-3.8) more likely to experience violent disciplinary practices if their mother/primary caregiver thought that physical punishment was necessary. Discussion The present study aimed to examine association between the usage of violent disciplinary practices and socio-demographic factors among Vietnamese mothers/primary care givers. The finding from a large, nationally representative survey showed the approval of the use of violent disciplinary practices were still a belief held by a substantial proportion of mothers/primary caregivers (72.9%), though the majority of women (83.4%) did not approve of physical punishment. This finding may reflect customs and habits as the shifting social norms that give priority to parental rights. Vietnamese parents and other members of the family should discipline their children if they make mistakes or refuse to obey to their parents. In turn, the obligation of children is to submit, obey, and respect their parents and other relatives. There is no question of hatred between parents and children. Children never talk back because of the strict punishment. They have to accept it when they are wrong or when they make a mistake. Additional, provisions against violence and abuse in Law on the Protection, Care and Education of Children 1991 (amended 2004), the Law on Marriage and the Family (art. 26) and the Law on Domestic Violence Prevention and Control 2007 are not interpreted as prohibiting all physical punishment in child-rearing (National Assembly, 2000; 2004; 2007). Our findings of relationships between socio-demographic factors and violent discipline practices are consistent with previous national studies such as age, wealth, education, household size and negative attitudes towards wife-beating (Tang, 2006; Regalado et al., 2004; Frias-Armenta & McCloskey, 1998; Hunter et al., 2000; Hadi, 2000; Isaranurug et al., 2001; Qasem et al., 1998). The older as compared with younger mothers/primary caregivers were less likely to report the use of violent disciplinary practices, finding similar to previous national surveys (Tang, 2006; Regalado et al., 2004). The basis for the association with mothers’ age is uncertain but may be attributed to young parents’ inexperience, knowledge to manage their children, and have suffered from stress due to decreased financial or housing resources. The results of this study suggested that there was a negative association between richest band of wealth and using violent disciplinary practices. This means that mothers/primary caregivers who live in families with lowest income had higher rates of child discipline compared to those who live in richest family. Our finding is consistent with the findings of previous studies in other developing countries (Tang, 2006; Frias-Armenta & McCloskey, 1998; Hunter et al., 2000; Hadi,

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2000; Isaranurug et al., 2001). It is plausible that poorest mothers/primary caregivers are always faced with economic and resources shortage, due to high expenditures of substances, which will in turn increase stress and aggressive behavior towards their children. Our findings have also showed that low education increase violent disciplinary practices towards children. Low educational level was an influencing factor in child abuse. This may be due to the promotion of self-confidence and awareness of human and children rights in views of educated mothers/primary caregivers. These findings are consistent with past research (Hunter et al., 2000; Hadi, 2000; Isaranurug et al., 2001; Qasem et al., 1998) and suggest that increased education opportunities for mothers/primary caregivers and heads of household reduce violent disciplinary practices. The size of the family with a higher parity had a positive association with the risk for abuse. This finding corroborates those of other studies, in which mothers/primary caregivers with a higher parity were more likely to be violent towards their children (Isaranurug et al., 2001; Kim et al., 2000; Tadele, Tefera & Nasir, 1999). As expected, mothers/primary caregivers with negative attitudes towards physical punishment were more likely to use violent disciplinary practices against children. Our finding is in line with evidence on 31 low- and middle-income countries (Cappa & Khan, 2011). Furthermore, the present study noted that mothers/primary caregivers’ attitude on endorsing domestic violence was found to be more likely to utilize violent disciplinary practices. A possible explanation for this finding is that where domestic violence and physical punishment are widely found, the harsh behaviors toward children may be default responses, less guided by individual choices regarding disciplinary strategies than by adoption of common social practices (Lansford et al., 2014). Some limitations should be considered when interpreting our findings. First, the current analyses were cross sectional in nature and involved the reporting of past behaviors; therefore, a possible recall bias existed. However, the recall period was limited to 2 years to minimize the recall bias. Second, the study was based on self-reported outcomes, which might have resulted in a response bias. However, MICS stated that the respondents were informed of the importance of providing accurate responses and were also assured of the confidentiality of their responses. Third, the present study can be criticized for the use of an indirect measure of household wealth. However, since reliable income and expenditure data are difficult to obtain in developing countries, such as Vietnam, an asset-based index is generally considered a good proxy for a household’s wealth status. Finally, because our selection of variables was constrained by the preexisting MICS data, we were unable to include additional, potentially important variables. While limitations in the available data can be identified, we believe that our study has important findings to point to areas where investments are needed to prevent violent discipline towards children in Vietnam. Conclusion The present study indicates that a large majority of mothers/primary caregivers experienced violent disciplinary practices towards children at home even though they do not approve physical punishment. Violent disciplinary practices are associated with younger age, lower education, poorest wealth, high parity, negative attitude towards partner violence, and negative attitudes towards physical punishment. Developing strategies that include the above interventions could play a crucial role in achieving the decrease violent disciplinary practices in Vietnamese mothers/caregivers. Future longitudinal studies however are needed to investigate causal mechanisms of such association. Acknowledgements The authors would like to thank all the teams that conducted the Vietnam Multiple Indicator Cluster Survey.

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