Original Article
Mothers' Attitude and Practice toward Child Physical Punishment as a Discipline Strategy in Saudi Arabia Ahmed H. ALJadani1*, Samiah A. ALMehmadi2, Amna S. Zaki3, Majdah A.
AlMehmadi4, Hella O. ALOthman5, Ahmed M. Alhuwaydi6
1Department of Medicine, College of Medicine, Hail University, Saudi Arabia, 2Family Medicine Department, Ministry of health, Saudi Arabia, 3Family Medicine Department, Ministry of Health, Saudi Arabia, 4Family Medicine Department, National Guard Hospital, Riyadh, Saudi Arabia, 5Ibn Sina National College for Medical studies, Saudi Arabia, and, 6Department of Psychiatry, College of Medicine, Jouf University, Saudi Arabia.
*Corresponding author: Dr.a.aljadani@gmail.com
Abstract
Background: Children maltreatment is a major social problem in Saudi Arabia which could lead to serious physiological and psychological consequences on children. Many Saudi parents perceive physical punishment as a reasonable discipline method.
Objectives: This study was conducted to assess Saudi mothers' attitude and practice toward child physical punishment as a discipline strategy.
Participants and Methods: A cross-sectional study was carried out among Saudi mothers visiting primary healthcare centers in Riyadh city. The sampling was selected from ten primary healthcare centers belonging to Ministry of Health, Riyadh city. We chose two primary healthcare centers from each one of the five clusters inside Riyadh city (North, South, West, East, and Middle) by cluster sampling technique. However, subjects were selected by convenient method. Inclusion criteria included Saudi mothers who had at least one child at the age of one year and above. We investigated socio- demographics of mothers in addition to the Parenting Profile Assessment by Anderson and the parent-child conflict tactics scale by Murray.
Results: The study included 391 mothers. Overall, positive attitude “encouraging child physical punishment as a discipline strategy” was observed among 54.2% of Saudi mothers. Among studied factors that could affect the attitude of mothers, only income and house type were significant. Active practice of child physical punishment was reported by 53.2% of mothers. Mothers with lower education level, lower income or have children of both genders were more likely to practice child physical punishment.
63.7% of mothers who had a positive attitude towards physical punishment of children (encouraging) expressed active practice of it compared to 41.3% among mothers who had a negative attitude towards physical punishment of children, p<0.001.
Conclusion: Child physical punishment was encouraged and practiced by more than half of mothers with a significant association between attitude toward child physical punishment and practicing it.
Key Words: Corporal punishment, Pphysical punishment, Parenting, Child abuse, Child discipline, Saudi Arabia.
Citation: ALJadani AH, ALMehmadi SA, Zaki AS, AlMehmadi MA, ALOthman HO, Alhuwaydi AM. Mothers' Attitude and Practice toward Child Physical Punishment as a Discipline Strategy in Saudi Arabia. AUMJ, June 1, 2018; 5(2): 17 - 24.
Introduction
Child abuse by parents is a serious problem that include any action that they should not be doing as well as omission of
an action they should be doing to ensure the safety of their children(1). Worldwide many studies have been conducted to determine the prevalence of child
maltreatment in different societies. In a study conducted in the United Kingdom, it was found that the subject before the age of 16 who had experience of physical abuse, sexual abuse and neglect were 21%, 11% and 6%, respectively(2). Child physical (corporal) punishment predisposes to medical conditions such as cardiovascular disease, bronchial asthma, arthritis and obesity(3-5). Also predisposes to hypertension, diabetes mellitus and hypercholesterolemia(6). The child physical punishment increases the risk of multiple psychiatric morbidities such as depression, anxiety, aggression, antisocial behaviors and alcohol and drug use disorder(7-9).
Child maltreatment is an important public health concern in Saudi Arabia also.
Various studies conducted in different parts of Saudi Arabia have reported an increasing prevalence of child abuse over the past years. It has also been shown that physical abuse and neglect are more prevalent compared to other forms of child abuse in the Saudi Arabia(2,10). The physical punishment is one of the most common discipline strategies in Saudi society. Saudi national family safety program, which was established in 2005, started since then to provide reports on prevalence, prevention and raise awareness about the child abuse in Saudi Arabia(11).
There are not enough studies that demonstrated the relationship between the Saudi mother’s perspective of child physical punishment as a discipline method and practicing of this method.
Taking into consideration the increasing number of child abuse in the kingdom of Saudi Arabia, this study was conducted to answer our key questions: What is the perspective of Saudi mothers about using physical punishment as a discipline strategy for their children? and what is the physical methods of discipline used by the Saudi mothers?.
Participants and Methods Setting
A cross-sectional study was conducted in Riyadh city among Saudi mothers attending primary healthcare centers of the ministry of health by distributing a
self-administered questionnaire with a written consent. 391 women were involved from December 2017 to March 2018. Responding rate was 100%. We chose two primary healthcare centers from each of the five clusters inside Riyadh city (North, South, West, East, and Middle) by cluster sampling technique. Subjects were selected by convenient method. Inclusion criteria include Saudi mothers who had a child at the age of 1 year old and above.
Exclusion criteria include non-Saudi mothers or Saudi mothers with only one child under the age of 1 year old. This study was approved by King Fahad Medical City Institutional Review Board (IRB), Riyadh, Saudi Arabia.
Data Collection Tool
Sociodemographic data were collected and the Parenting Profile Assessment by Anderson that evaluates the parent’s potential to be abusive or non-abusive(12). The Anderson Questionnaire includes the opinions and attitudes of the mothers towards the use of physical punishment by using a Likert scale (strongly agree, Agree, disagree, strongly disagree) including nine items. The responses were scored in the way that, the highest the score, the more in the view and attitude that supporting physical punishment of children and vice versa. Therefore, the score of some questions (1, 3, 4, 5, 6, and 9) was reversed. The Parenting Profile Assessment was validated in Arabic by Al Dosari MN et al. and we received permission to use it(13). A total score was computed for each mother, and the median score was estimated. Mothers considered as having the positive attitude towards physical punishment (encouraging) if their scores are equal to the median value or above, whereas, mothers considered as having negative attitude towards physical punishment (against) if their scores are below the median value. The third part is parent- child conflict tactics scale(14). It contains 12 items ask about different types of physical punishment and assess the attitude toward physical punishment, scored by: 0 = never happened, 1 = happened once, 2 = happened twice, 3 = happened between 3-5 times, 4 =
happened between 6-10 times, 5 = it's happened in the past 6 months, but I cannot remember how many times.
Regarding the practice of physical punishment, the score was given to 12 statements concerning the practice of different forms of physical punishment for children, in the way that the highest the score the more involvement in physical punishment. The total score was computed for each mother and the median score was estimated. Mothers scored at or above the median value were considered as having an active practice of physical punishment, whereas, those scored below the median value were considered as passive towards physical punishment.
Statistical Analysis
The data entry and analysis were done by using SPSS statistical program version 22.
The descriptive statistics were done using the frequency and percentage of categorical variables and mean ± standard deviation for continuous quantitative variables. Chi-square test was utilized to investigate the association between attitude and practice regarding physical punishment of children from one side and demographic characteristics of mothers from the other side. P value <0.05 was considered statistically significant.
Results
391 mothers were included. Their age ranged between 17 and 63 years (36.3 ± 8.3) years. Majority of mothers (94.4%) were married. Most of them were university graduates or higher (70.1%).
Regarding working status, 50.6% were working with 44.8% of the mothers reported that their work is stressful. The income of 29.4% of mothers ranged between 5001 and 10000 SR/month, whereas that of 12% exceeded 15000 SR/month. The number of children ranged between one and three in 54% of the participants. 68.3% had both male and female children and 61.1% living in owned houses. Household smoking was mentioned by 28.6% of the participants.
Regarding attitude towards physical punishment of children, 30.7% of them agreed that use of physical punishment is a useful and effective educational means if the child is naughty or annoying. 11.2%
agreed that it is necessary sometimes to discipline the child by slapping him or her on the face. 15.6% of mothers agreed that physical punishment is not harmful to children. 26.8% disagreed that there should be a law or a system prohibiting the use of physical punishment with children. About two-thirds of mothers agreed that parents have the right to discipline their children the way they see fit. Overall, positive attitude (encouraging) physical punishment was observed among more than half of the mothers (54.2%).
Among the studied factors that could affect attitude of mothers towards physical punishment of children, only income and house type were statistically significant. The lowest positive attitude was reported among mothers with income ranging between 10001 and 15000 SR/month (41.3%) while the highest positive attitude was observed among those with income ranged between 3000 and 5000 SR/month (68.1%; p = 0.011).
Mothers living in governmental houses had the highest positive attitude towards physical punishment of children (85%) compared to 52.7% and 52.3% of those living in owned and rented houses, respectively (p = 0.018) (Table 1).
Regarding children physical punishment practice in the past 6 months, 84.1%
threatened to spank or beat their child, 61.1% pinched their children, 57% of mothers punished their children by shaking vigorously, 53.2% slapped their children, 47.6% hit their children on bottom with hard objects, 52.9% spanked their children, 25.8% kicked their children, 11,8% threatened to kick their child outside the house, 7.7% burned their children, 4.4% choked their children and 2.8% threatened their children with a knife. Overall, active practice of physical punishment of children was reported by more than half of mothers (53.2%).
Mothers with a lower educational level
"elementary school" were more likely to practice child physical punishment compared to mothers with a high educational level. (University and above) (73.3% vs. 51.5%; p = 0.041). The highest rate of practicing physical
punishment of children was reported by mothers whose income ranged between 3000 and 5000 SR/month (68.1%) compared to 42.6% among those whose income exceeded 15000 SR/month (p = 0.017). Mothers who have children of
both genders were more likely to practice physical punishment of children than those who had either male only or female kids only (57.7% vs. 47.1% and 40.7%, respectively) (Table 2).
Table 1: Factors associated with the attitude of mothers towards physical punishment of children.
Data shown are frequency; n and (%) and χ2 and (p values).
Variables Attitude towards physical
punishment of children
χ2 (p) Negative
(n = 182)
Positive (n = 209) Age (years) ≤30 (n = 116)
31-40 (n = 170)
>40 (n = 105)
53 (45.7) 82 (48.2) 44 (41.9)
63 (54.3) 88 (51.8) 61 (58.1)
1.05 (0.592) Marital Status Married (n = 369)
Divorced (n = 15) Widowed (n = 7)
170 (46.1) 7 (46.7) 2 (28.6)
199 (53.9) 8 (53.3) 5 (71.4)
0.85 (0.653)
Educational level
Elementary school (n = 15) Intermediate school (n = 12) Secondary school (n = 90) University/higher (n = 274)
5 (33.3) 4 (33.3) 41 (45.6) 129 (47.1)
10 (66.7) 8 (66.7) 49 (54.4) 145 (52.9)
1.87 (0.599)
Job nature
Health industry (n = 46) Education (n = 154)
Governmental sector (n = 18) Private sector (n = 15) House wife (n = 158)
26 (56.5) 74 (48.1) 10 (55.6) 5 (33.3) 64 (40.5)
20 (43.5) 80 (51.9) 8 (44.4) 10 (66.7) 94 (59.5)
5.86 (0.210)
Work stress Yes (n = 175) No (n = 216)
82 (46.9) 97 (44.9)
93 (53.1) 119 (55.1)
0.15 (0.700)
Income (SR/month)
≤3000 (n = 90) 3001-5000 (n = 47) 5001-10000 (n = 115) 10001-15000 (n = 92)
>15000 (n = 47)
40 (44.4) 15 (31.9) 45 (39.1) 54 (58.7) 25 (53.2)
50 (55.6) 32 (68.1) 70 (60.9) 38 (41.3) 22 (46.8)
12.98 (0.011)
Number of children 1-3 (n = 211) 4-7 (n = 154)
≥8 (n = 26)
100 (47.4) 68 (44.2) 11 (42.3)
111 (52.6) 86 (55.8) 15 (57.7)
0.51 (0.774)
Children gender Males only (n = 70) Females only (n = 54) Both (n = 267)
39 (55.7) 24 (44.4) 116 (43.4)
31 (44.3) 30 (55.6) 151 (56.6)
3.41 (0.182) Housing type Owned (n = 239)
Rented (n = 132) Governmental (n = 20)
113 (47.3) 63 (47.7)
3 (15.0)
126 (52.7) 69 (52.3) 17 (85.0)
8.05 (0.018) Household smoking Yes (n = 112)
No (n = 279)
51 (44.5) 128 (45.9)
61 (54.5) 151 (54.1)
0.004 (0.951)
Table 2: Factors associated with the practice of mothers’ physical punishment of children. Data shown are frequency; n and (%) and χ2 and (p values).
Variables The practice of physical
punishment against children
χ2 (p)
Passive (n = 182)
Active (n = 209) Age (years) ≤30 (n = 116)
31-40 (n = 170)
>40 (n = 105)
55 (47.4) 75 (44.1) 52 (49.5)
61 (52.6) 95 (55.9) 53 (50.5)
0.81 (0.666) Marital Status Married (n = 369)
Divorced (n = 15) Widowed (n = 7)
169 (45.8) 10 (66.7)
3 (42.9)
199 (53.9) 5 (33.3) 4 (57.1)
2.56 (0.278)
Educational level
Elementary school (n = 15) Intermediate school (n = 12) Secondary school (n = 90) University/higher (n = 274)
4 (26.7) 9 (75.0) 36 (40.0) 133 (48.5)
11 (73.3) 2 (25.0) 54 (60.0) 141 (51.5)
8.28 (0.041)
Job nature
Health industry (n = 46) Education (n = 154)
Governmental sector (n = 18) Private sector (n = 15) House wife (n = 158)
24 (52.2) 81 (52.6) 7 (28.9) 9 (60.0) 61 (38.6)
22 (47.8) 73 (47.4) 11 (61.1) 6 (40.0) 97 (61.4)
8.37 (0.079)
Work stress Yes (n = 175) No (n = 216)
75 (42.9) 107 (49.5)
100 (57.1) 109 (50.5)
1.73 (0.188)
Income (SR/month)
≤3000 (n = 90) 3001-5000 (n = 47) 5001-10000 (n = 115) 1001-15000 (n = 92)
>15000 (n = 47)
38 (42.2) 15 (31.9) 53 (46.1) 49 (53.3) 27 (57.4)
52 (57.8) 32 (68.1) 62 (53.9) 43 (46.7) 20 (42.6)
5.67 (0.017)
Number of children 1-3 (n = 211) 4-7 (n = 154)
≥8 (n = 26)
105 (49.8) 68 (44.2)
9 (34.6)
106 (50.2) 86 (55.8) 17 (65.4)
2.72 (0.257)
Children gender Males only (n = 70) Females only (n = 54) Both (n = 267)
37 (52.9) 32 (59.3) 113 (42.3)
33 (47.1) 22 (40.7) 154 (57.7)
6.54 (0.038) Housing type Owned (n = 239)
Rented (n = 132) Governmental (n = 20)
120 (50.2) 57 (43.2)
5 (25.0)
119 (49.8) 75 (56.8) 15 (75.0)
5.62 (0.060) Household smoking Yes (n = 112)
No (n = 279)
46 (41.1) 136 (48.7)
66 (58.9) 143 (51.3)
1.89 (0.169) Association between attitude towards
physical punishment of children and practicing it among mothers:
Almost two-thirds (63.7%) of mothers who had a significantly higher positive attitude towards physical punishment of
children (encouraging) expressed active practice of it compared to 41.3% among mothers who had a negative attitude towards physical punishment of children (Table 3).
Table 3: Association between attitude towards physical punishment of children and practicing it among participating mothers. Data shown are frequency; n and (%) and χ2 and (p values).
Attitude towards physical punishment of children
The practice of physical punishment against children χ2 (p) Passive (n = 182) Active (n = 209)
Negative (n = 179) Positive (n = 212)
105 (58.7) 77 (36.3)
74 (41.3) 135 (63.7)
19.47
<0.001 Discussion
Both parents are involved in child-rearing responsibilities, but it is natural that mothers are more involved in than fathers;
that is why our study focused on mothers.
In the present study, 53.2% of Saudi mothers practicing physical punishment as a discipline method. The prevalence in Germany, Netherlands and Bulgaria was low (3.4%, 3%, 9%, respectively)(15). The difference could be attributed to illegal status of corporal punishment in Europe Union Countries. According to our results, it is noted that 54.2% of Saudi mothers encouraging physical punishment as a discipline method. The findings by Qasem et al study in Kuwait showed that child physical punishment as a discipline strategy was encouraged by 86%(16). In Taif city, Western of Saudi Arabia, Helmy et al reported that 12.7% of mothers physically punish their children(17). The high Prevalence of mothers encouraging physical punishment in Arabian Gulf countries compared to western countries could be related to cultural differences and common beliefs about parenting styles. Moreover, the wide variation in reported rate of physical punishment could be attributed to the use of different instruments in assessing physical punishment. In our study we asked specifically about multiple methods of punishment which might helped the mothers to answer more accurately.
The current study showed that mothers of lower socioeconomic status, manifested by lower income and living in governmental housing had a more positive attitude towards using physical punishment with children. This could be explained by understanding that low socio-economic status leads to a stressful life and Coohey et al suggested that physical abuse is associated with multiple life stressors and emotional distress(18). The present study did not observe a role of mother`s age in the practice of physical
punishment for children. Other studies showed that younger mothers are more abusive than older mothers(19,20). This can be explained by the fact that younger Saudi mothers have enough family support. An interesting finding in our study was the association of practicing of physical punishment for children with mothers having both male and female children compared to those having only one gender of children. The explanation of our finding could be attributed to having more problems with children if they are not of the same gender. So, the mothers need to learn different and multiple ways of discipline that are suitable for each gender, and this can be considered as an additional burden on the mothers which might lead to emotional distress and then to use physical punishment as a discipline method.
Our study showed that mothers who had a significantly higher positive attitude towards physical punishment of children (encouraging) expressed active practice of it more than the mothers who had a negative attitude. This illustrates that the perception and attitudes of discipline play an important role in practicing of child physical punishment as a discipline strategy.
This study demonstrated that mothers, who had a better socioeconomic status and education, and who have more negative attitudes toward child physical punishment will be less likely to use physical punishment as a discipline strategy. However, further exploration with population-based survey is necessary for any definitive conclusion to be drawn.
We recommend instituting education programs for both expectant and existing parents regarding the importance of avoiding physical punishment as a tool for children discipline. In this regard, mass media should have a role in increasing awareness regarding disadvantages of physical child abuse. Community-based support services should be available in
primary healthcare centers. Screening for risk factors of child abuse or early signs of physical violence by family physicians and having early intervention by them with parents(21,22).
Conclusion
Physical punishment of children as a discipline method was a common practice
& encouraged by more than half of mothers attending primary healthcare centers in Riyadh, particularly those with low socioeconomic status, lower educated, those with relatively lower income and mothers with both children of both genders. There was a significant association between attitude towards physical punishment of children and it`s practicing. Instituting an educational program for mothers may increase the awareness & reduce the problem.
Limitations of the Study
The study has few limitations, such as, it was carried out at primary healthcare centers belonging to the Ministry of Health, so the results cannot be generalized over the general population since important health sectors were not included such as National Guard, Military, Academic institutions, and the private sector centers that are playing a significant role nowadays. Since this topic is sensitive, and answers were subjective, the possibility of bias could be high as some parents may not answer questions properly in the used questionnaire.
Despite those limitations, the study could be of public health importance through exploring a sensitive subject prevailed in our community and had an adverse outcome on our children.
Funding
This study was funded by the authors' respective institutions as a part of their employment duties.
Conflict of Interests
The authors declared no conflict of interests.
Acknowledgement
The authors wish to thank Nura Ayyadah ALAnazi, Areej Abdullah ALQahtani, Aroob Laheg ALMogati, Roba Ibrahim Abuabat and Buthainah Saleh Binrshoud, medical students, Princess Nourah bint
Abdulrahman University, Riyadh, Saudi Arabia for their contribution in data collection.
Contribution of the Authors AHJ and SAA designed the study. SAA and HOA contributed to the data collection. AHJ, SAA, ASZ, HOA, MAA, AMA and AHH did the data interpretation, statistical analysis and discussion. AHJ and SAA were responsible for writing the initial draft of the manuscript. ASZ, MAA, HOA, AMA and AHH were responsible for revising the initial draft. All authors revised and approved the final version of the manuscript to final publication.
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