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.
Pathways through which societal level factors influence
Benefits relating to child rearing
Financial and other support given to parents during pregnancy and the early years of the child’s life is a powerful indicator of the commitment of a society to the welfare of its children. Pregnancy is a critical time in which adequate levels of nutrition and freedom from stress are important. Maternity benefits can con-tribute to ensuring that the nutrition and well-being of expectant mothers is protected. In the UK, maternity benefits are set too low to ensure that all women can afford an adequate diet (Maternity Alliance 2001). Poor women dependent on income support or Job Seeker’s Allowance would have to spend 40% of their income on food to eat the kind of diet recommended by health professionals (Maternity Alliance 2001). Young pregnant women are the most disadvantaged due to restricted benefits for those aged 16–24 and no separate benefits for those aged under 16 years. Maternity benefits in some other European countries are set at levels adequate to purchase a healthy diet in pregnancy.
Without adequate safeguards, childbirth can precipitate poverty; for example, in the UK, for one in three people, the birth of a child results in a drop down the income distribution graph by a fifth or more, and for 10–15%, it results in poverty (Howard et al. 2001). Some European countries, notably the Scandinavian countries, the Netherlands and France, protect new mothers with child benefits sufficient to ensure an adequate income during early child rearing. Paid parental leave is another pathway through which societies can assist parents and diminish the probability of child neglect. Parental leave gives parents time to establish close attachment with their child and gives them a brief but important respite from the need to balance the demands of work and the demands of child rearing. As with other benefit provision, some countries make generous provision, others have very limited protected leave with limited financial entitlement (Moss 2002). Swedish parents (both mother and father) have protected leave on 90% of pay for over a year (Ruhm 2000). Maternity and parental leave have recently been improved in the UK (Maternity Alliance 2003) but levels remain less generous than in many other European countries.
Ruhm (2000) has shown a correlation between levels of parental leave in 17 rich nations and post-neonatal mortality rates from which he postulates that parental leave acts as a protective factor for early childhood well-being.
Early childhood daycare and education
Demographic and economic changes have resulted in an increase in lone parent families and in families in which the mother is the main breadwinner (Howard et al. 2001). In households with pre-school children, affordable daycare provi-sion becomes a crucial requirement to maintain the economic stability of the family unit and protect the well-being of the children. This is even more
impor-tant in countries such as the UK where many parents work long hours.
Forty-five per cent of UK women work over 40 hours per week and 30% of men over 50 hours; 61% of working families have parents who work shifts or work during the evenings, nights or weekends (Daycare Trust 2002). In addition, there is good evidence, particularly from US studies (Schweinhart, Barnes and Weikart 1993), that high quality early daycare has positive effects on child well-being and development especially among low income children.
High quality, affordable daycare is universally available for infants beyond the age of three years in many European countries and beyond the age of one year in Sweden (Moss 2002). As with other services designed to assist families in the difficult task of child rearing, daycare provision in the UK has been allowed to lag behind comparable European countries and provision is now mainly dependent on the private sector. The Daycare Trust estimate average costs for a nursery place for a child under two years at around £6650/year. Not only does this put daycare for children out of the reach of many families but it also directly excludes the poorest families. In 2002, there was only one subsidized child care place for every 14 children under three living in poverty.
Education as a protective factor
The educational level of a society, especially female education, is likely to be a further mechanism for protecting children and ensuring their needs are met and their rights promoted. Educational failure within rich consumer societies is associated with lower earnings, increased chance of unemployment and social exclusion (OECD and Statistics Canada 2000). Rich nations vary considerably in the investment they make in education and the extent of educational disad-vantage (UNICEF 2002). For example, the International Adult Literacy Study of adults aged 15–64 in 22 Organization of Economic Co-operation and Development (OECD) countries (OECD and Statistics Canada 2000) reported that Sweden has more than 70% of its population with document and prose literacy at the higher levels and only a very small percentage at the lowest level, in contrast with the UK and the USA with 50% at the higher levels and 20% at the lowest level. However, among 15-year-olds studied in 2000, the UK had relatively low levels of educational disadvantage (9.4% of pupils scoring below an international benchmark for literacy, maths and science) compared with the USA (16.2%) and Germany and Denmark (both 17.0%) (UNICEF 2000). This variable picture suggests that educational progress has been made in the UK although many adults continue to suffer the detrimental effects of poor func-tional literacy, with current adverse consequences for the well-being of their children.
Societal influences on parenting
Parenting is the final common factor through which the pathways from society to child neglect exert their effect. We have discussed the social, economic and political context of parenting elsewhere (Taylor et al. 2000), reviewing studies showing the impact of economic hardship and low income on parenting and parenting styles and the association of poor social circumstances and problems in childhood. Here we briefly summarize the relationship between factors at the societal level and parenting. Sacker et al. (2002) show that parental involve-ment and interest in their child’s education is socially patterned, with both lower social class and higher levels of material deprivation associated with lower levels of parental interest/involvement. Hobcraft (1998), based on the same 1958 British birth cohort (National Child Development Study) but using slightly different measures of socioeconomic status, also reports a close associa-tion of poverty with low parental interest, which in turn is associated with high levels of aggression and other mental health problems at ages 7, 11 and 16.
These childhood outcomes tend to be transmitted into adult life influencing psychological and physical health as well as health-related behaviours (Hobcraft 2003). Debt and disadvantage in adult life have been shown to increase the risk of maternal depression (Reading and Reynolds 2001). Poor psychological health of the parent is influenced by social risk exposures in childhood and is known to be associated with higher rates of behavioural problems among children. Thus, there is compelling evidence to support the contention that poverty and low income increase the pressures on parents, make the job of parenting more difficult, and increase risks of neglect and other harmful behaviours.
The extent to which economic policies such as family taxation and benefits, employment opportunities and practices such as parental leave, length of working day and unsocial hours support or impede mothers and fathers in their caring, educational and socializing roles, affects the general context and quality of child rearing.
Cultural expectations
Gender roles, cultural attitudes to mothers’ and fathers’ responsibilities for caring, are further influences on parenting. Assumptions that mothers will instinctively know how to look after children and will be able to provide adequate care in severely limited material and social circumstances, places great burdens on mothers. Lone mothers may have the added burden of being expected to provide competent care even when responsible on their own 24 hours a day. Equally, views that fathers only have a limited caring and socializ-ing role limits their opportunities and relationships.
The cost of stereotypical attitudes to gender can be high. Smyth (1998), working with young people exposed to the troubles in Northern Ireland, gives stark examples of these problems:
The longstanding ‘uncoolness’ of articulation of emotional vulnerability or any emotional expression for males (except perhaps anger), is particularly marked in a militarized culture and in situations where violence and danger to life are commonplace. (p.76)
She draws attention to the different routes to satisfaction taken by young women, in a society with increasing numbers of births to mothers between 14 and 16, through personal relationships and child care, and the limitations which these traditional roles impose:
A number of young women and girls left with the burden of childcare at increasingly younger ages, and young men isolated outside the structure of family and personal life, consigned to the world of unemployment and deper-sonalized violence. (p.77)
These issues are common to many societies (Garbarino 1995; Wolfe, Wekerle and Scott 1997) forming part of the backcloth to our understanding of contexts of neglect and maltreatment.
Violence, often associated with alcohol abuse, is a major source of stress for parents raising children in disadvantaged areas. Domestic violence is commonly associated with breakdown of family relationships and child maltreatment, yet is surprisingly tolerated (Mullender et al. 2000; Scottish Women’s Aid 1999; Zero Tolerance Charitable Trust 1998).
Attitudes to physical punishment of children may connect with these values and practices. Among Northern European countries, Britain is in a minority in not having laws which protect children from physical punishment by parents and carers. A vigorous debate continues in the media and in Parlia-ment, but cultural attitudes favouring physical punishment remain strong. The essential principle of the UN Convention on the Rights of the Child, that children have rights as individuals and are not the property of their parents, appears to remain contentious in a number of countries. The convention has been ratified by Britain, but Britain has been criticized by the UN for its record on physical punishment. The Convention has not been ratified by the USA.
The ecological model provides a framework for understanding the wide range of societal influences on parenting and on child well-being, operating at different levels, and the interactions between material, political, social and interpersonal factors.
Local supports for effective parenting
Environmental factors and social support at neighbourhood level have been shown to affect the health and functioning of families, with access to informal support networking helping to lessen some of the adverse consequences of stress and disadvantage (Garbarino and Kostelny 1994; Garbarino and Sherman 1980). The well-being of children within a community has been related to factors such as neighbourhood support available to the family and social support available to the mother (Runyan et al. 1998). The concept of social capital has been developed to characterize the extent of perceived support available to families and individuals within a community, although its exact components may not be agreed by researchers (Cooper et al. 1999).
However, some of the variables used as measures of social capital are strongly socially patterned: size of social networks, degree of network participation and levels of perceived social support increase with socioeconomic status (Cooper et al. 1999) suggesting that social capital may be, in part, a reflection of family and neighbourhood economic capital. Cattell (2001), based on a qualitative study of two disadvantaged neighbourhoods, argues that, although social capital may be a helpful construct for identifying conditions which contribute to quality of life, it cannot adequately deal with the extent and range of delete-rious effects on health and well-being of poverty and disadvantage. Using a range of country-level measures of economic inequality, social capital and political capital, Muntaner et al. (2002) report very weak association of social capital variables with child health status indicators (low birth weight; infant mortality; unintentional injury at less than 1 year) but strong association with economic inequality. They question the extent to which social capital influ-ences health and well-being and argue that economic and political factors at country level are likely to be more powerful determinants.
Too narrow a focus on localities risks placing the burden of change on the most vulnerable, emphasizing the moral and social responsibilities of parents and demonizing young people, without taking full account of wider influ-ences. Regeneration and community development initiatives can only play a part in building safe, healthy and supportive communities alongside far-reaching economic, educational and employment policies. Attempts to increase social capital need to take full and realistic account of these structural factors alongside far-reaching economic, educational and employment policies.
The non-random distribution of child neglect has prompted major policy and practice debates related to the optimal approach to preventing child neglect and promoting child well-being. A dominant paradigm in policy and practice is based on the ‘risk’ approach, in which families at risk (usually multiply disadvantaged families) are targeted for special interventions and enhanced services. This paradigm has informed the development of risk scoring and attempts to improve individualized prevention of child abuse and
neglect (Browne and Saqui 2002; Hamilton and Browne 2002). However, there are good theoretical grounds for challenging both the efficacy and the ethics of these approaches as the starting point, or main plank in a strategy to reduce neglect and harm. Rose (1992) argues that risk strategies for the preven-tion of disease or harmful condipreven-tions such as child neglect, which are non-randomly distributed across the population, are flawed. Applied to the prevention of child abuse and neglect, Rose’s critique raises the following concerns:
· High risk strategies are limited by a poor ability to predict child abuse and neglect positively.
· High risk programmes professionalize prevention and label and stigmatize parents.
· High risk strategies do nothing to alter the underlying risk
exposures and little to achieve overall reductions in child abuse and neglect within a population.
· The expectations for behavioural change associated with high risk strategies are often unrealistic.
Rose argues for an alternative approach, to attempt to change the underlying risk across the whole population. Put simply, this would mean that a strategy to reduce neglect would be based on policies to ensure that all families have access to the resources necessary for safe and healthy child rearing. This is a straight-forward public health approach, aiming to eliminate or substantially reduce the conditions in which disease and harm flourish.
Another example which illustrates this approach is the current attempt to change legislation relating to physical punishment of children. Popular accep-tance of physical punishment of children is likely to increase the chance of some children experiencing extreme violence and of themselves seeing violence as an acceptable response to others. Changes in general attitudes and behaviour are likely to lead to an increased level of protection for all children.
Sweden, a country with well-developed child and family support policies, was the first country to enact legislation (1979) to ban the physical punishment of children. They have seen a decrease of 26% in prosecutions for violence against children since 1982, and child deaths have reduced by 90%. Nine other European countries have now followed this policy. Germany adopted a ban on smacking in 2000, after research established a clear link between childhood experiences of physical punishment and the likelihood of later anti-social behaviour and violence (Children are Unbeatable 2002).