Sidebotham (Sidebotham and The ALSPAC Study Team 2000) identifies a paradigm shift towards an ecological understanding of child maltreatment. He argues that this has arisen as a result of the recognition that child maltreatment is multiply determined by forces at work in the individual, in the family and in the community and culture. This model goes beyond the psychodynamic model, explicitly to include the contribution of society to the phenomenon of child abuse and neglect.
Consistent with the ecological model, registered child abuse and neglect, as well as other sorts of harm, are strongly correlated with poverty and low income (Baldwin and Spencer 1993; Creighton 1992; Thoburn, Wilding and Watson 2000; Tuck 2000). Of all the various forms of child maltreatment, neglect is most strongly correlated with low socioeconomic status (Sedlack and Broadhurst 1996; Tuck 2000). A recent study (Sidebotham et al. 2002), based on the Avon Longitudinal Study of Parents and Children, reported a seven times greater risk of registered child abuse if the family lived in rented accom-modation (a reliable income marker in the UK). Twenty-eight per cent of the registrations were for neglect. Thoburn et al. (2000), in a study of 712 children under eight from 555 families, referred because of concerns about neglect or emotional abuse, acknowledge the link between poor material conditions, problematic and stressful social circumstances and neglect and maltreatment.
Fifty-seven per cent of their sample had no wage earner in the household; 59%
lived in over-crowded housing conditions; 10% had had 5 or more house moves in the previous five years. Forty-seven per cent of households were headed by a lone parent; 26% of parents and 24% of children had a disability or long-term/serious illness. Fifty-six per cent of respondent parents reported high levels of emotional stress.
Macdonald (2001) quotes a study by Sedlak and Broadhurst (1996) which showed that over half the cases of demonstrable harm recorded in the USA were cases of neglect and that the rate of neglect was increasing more quickly than that of physical abuse. She makes the related point that ‘Neglect is a frequently defining characteristic of the context in which physical abuse takes place’
(p.65). In the UK, inquiries such as that of Lord Laming into the death of Victoria Climbié, have shown the role of neglect alongside serious physical harm in a small number of very extreme cases (Lord Laming 2003). Cases of such extreme cruelty and neglect are fortunately very rare, but general concerns about increasing levels of neglect are substantial. Golden et al. (2003) in making a distinction between neglect and what they call deprivational abuse (deliberate deprivation of food and care) argue that severe neglect ‘almost always results from the impoverished circumstances and life stresses affecting the family’ (p.106). They go on to assert that ‘the mother’s time, energy and
thoughts are concentrated elsewhere in an effort to cope; in this respect the neglected child is part of the family and “shares” its distress and deprivation’
(p.106). Fortunately a majority of families living in extremely disadvantaged circumstances do manage to provide safe, nurturing and loving environments for children. Our argument is that it is very much harder to do so in disadvantage.
Policy and practice need to prioritize universal provision which supports healthy child rearing whilst also supporting initiatives which will build resil-ient, nurturing families and increase social capital and supports for child rearing in communities. This approach recognizes the interconnections of harmful influences and can avoid problems which arise from attempts to cate-gorize and target specialist services in ways which may fragment and stigma-tize. For example, increasing concern about the parenting capacities of people who abuse drugs and alcohol is leading to specialist provision. This needs to be planned and co-ordinated with mainstream provision to promote children’s well-being. In the same way, services to reduce and respond to neglect need to be in the mainstream of child-centred services, concerned with each child’s needs over time.
The powerful association of child neglect with poverty and low income suggests that rich societies with high levels of child poverty associated with their economic and social policies are increasing the probability of child neglect within families. Indeed, it has been argued that on a global level societal neglect is a common problem, resulting from unethical inequalities in health care and social support, associated with poverty (Golden et al. 2003). In 1999, the UK and the USA had very high child poverty rates (the proportion of households with children with incomes less than 50% of the national median income) – 19.8% and 22.4% respectively – compared with other rich nations such as Sweden (2.6%) and Belgium (4.4%) (UNICEF 2000). Although some progress has been made in Britain towards the eradication of child poverty, the rate remains high by European standards. The different rates are a direct reflec-tion of the level of economic protecreflec-tion provided for children. Figure 2.1 shows the impact of different tax and credit transfer policies on child poverty rates among lone parents in selected rich nations.
Child poverty rates are most closely linked to the percentage of lone parent households in a country, the proportion of households with no working adult and the proportion of households in which the main breadwinner earns less than two thirds of the national average income (UNICEF 2000). The UK has high proportions of all three of these factors. UNICEF (2000) estimate that it would only take 0.48% of Gross National Product (GNP) to close the poverty gap in the UK, indicating that current UK child poverty rates are not the result of historical accident but of economic and social policy priorities and decisions.
High child poverty rates mean that there are many children living in families with material resources insufficient to enable them to participate fully
100 2030 4050 6070 80
USA Canada Netherlands Sweden
Pre-tax
& benefit poverty ratePost-tax
& benefit poverty rate
in the life of society. The activities in which children can participate are restricted; for example, poor families report that they cannot afford to send their children on school trips and outings with friends (Cohen et al. 1992). The Poverty and Social Exclusion Survey (Gordon 2000), using a consensus method to define monetary levels of absolute poverty (unable to afford essen-tials for daily living) and overall poverty (unable to afford to do the things that most people in the society take for granted), defined a weekly household income level of £227 for a British couple with two children in 1999 to avoid absolute poverty and a level of £301 to avoid overall poverty. Benefit levels on which so many families with children depend are inadequate to ensure that families avoid these levels.
Demographic changes affecting particularly rich nations have profoundly changed the lives of many children. Increasing rates of births to single mothers and higher prevalence of separation, divorce and reconstituted families (Howard et al. 2001) affect economic and social opportunities, place demands on child rearing practices and affect levels of stress. As indicated above, children of lone parents are more likely to be poor (Howard et al. 2001) and there is a body of research suggesting that these children are more vulnerable to neglect. However, a detailed study of children’s emotional and behavioural well-being (McMunn et al. 2001) indicated that the high prevalence of psycho-logical morbidity among children of lone parents is a consequence of socio-ecoomic factors. In the UK, it is teenage girls who are the age group most likely to have a birth outside marriage and to be the sole parent on the birth certificate (NCH Action for Children 2000). The increase in lone parents and single motherhood, seen particularly in the UK and the USA, has been explained by changes in individual behaviour, prompted by welfare benefits available to young mothers (Murray et al. 1990). However, there is evidence that limited career opportunities, poor educational attainment and economic influences may underlie the high levels of teenage births in some countries (Spencer 1994, 2002). Thus, these demographic changes cannot be characterized simply as
%
Figure 2.1 Effects of tax and benefits on low income. Source: Ross, Scot and Kelly (1996).
Percentageofloneparents livinginpoverty
cultural shifts or individual moral choices, but must also be seen as reflections of economic and social conditions. Their role in influencing circumstances for children needs to be recognized as one factor in complex, multidimensional processes and dynamics.