Emotional abuse of girls in Swaziland: prevalence, perpetrators, risk and protective factors and health outcomes

Background: Research on emotional child abuse in sub-Saharan Africa is scarce. Few studies thus far have examined prevalence, risk and protective factors for emotional child abuse or the associations between emotional abuse and girls’ health. Methods: A nationally representative two-stage, cluster-sampled, household survey of females aged 13–24 years (N=1244) on childhood abuse victimisation was conducted. Participants completed interviewer-assisted questionnaires. Associations between emotional abuse and putative risk, and protective factors and health outcomes were analysed using separate logistic regression models accounting for sampling design. Marginal effects of cumulative risk factors for emotional abuse victimisation were examined. Results: Lifetime prevalence of emotional abuse was 28.5% with 58.3% of these girls reporting many abusive incidents. The most common perpetrators were female (27.8%) and male (16.7%) relatives and, more rarely, biological parents. Risk factors associated with emotional abuse were frequent caregiver changes OR 1.42 [CI 1.03-1.97], poverty OR 1.51 [1.12-2.03], and physical abuse OR 1.98 [1.45-2.71] and sexual abuse OR 2.22 [1.57-3.10] victimisation. Being close to one’s mother was a protective factor OR 0.88 [0.80-0.97]. Risk for emotional abuse increased from 13% with no risk factors present to 58.4% -with all four risk factors present. Health outcomes associated with emotional child abuse were suicidal ideation OR 1.85 [1.30-2.63] and feeling depressed OR 1.89 [1.31-2.71]. Conclusions: Girls in Swaziland experience high levels of emotional abuse victimisation. Emotional abuse is associated with economic disadvantage, family factors, other types of abuse victimisation and poor mental health. Therefore, a holistic approach to prevention is needed, incorporating poverty reduction and programmes to improve parent-child relationships, reduce the use of harsh criticism, and change social norms through parenting interventions, and girl-centred approaches that incorporate protective assets