Reducing Stigma and Discrimination to Improve Child Health and Survival in Low- and Middle-Income Countries: Promising Approaches and Implications for Future Research

Abstract

The social processes of stigmatization and discrimination can have complex and devastating effects on the health and welfare of families and communities, and thus on the environments in which children live and grow. The authors conducted a literature review to identify interventions for reducing the stigma and discrimination that impede child health and well-being in low- and middle-income countries, with a focus on nutrition, HIV/AIDS, neonatal survival and infant health, and early child development. Despite broad consensus on the importance of stigma and discrimination as barriers to access and uptake of health information and services, the authors found a dearth of research and program evaluations directly assessing effective interventions in the area of child health except in the area of reducing HIV-related stigma and discrimination. While the literature demonstrates that poverty and social exclusion are often stigma-laden and impede adult access to health information and services, and to education relevant to family planning, child rearing, nutrition, health promotion, and disease prevention, the child health literature does not document direct connections between these known mediators of child health and the stigmatization of either children or their caregivers. The child health field would greatly benefit from more research to understand and address stigma as it relates to child health and well-being. The authors suggest applying a framework, adapted from the HIV stigma field, to direct future research and the adaptation of existing strategies to reduce HIV-related stigma and discrimination to address social and health-related stigmas affecting children and their families.

Postpartum sex taboos and child growth in Tanzania: Implications for child care

“…Similar behaviours have been reported elsewhere (Mabilia, 2000;Mbekenga et al, 2013). As Narayan, Chambers, Shah, and Petesch (2000) have pointed out, stigma and shame can result in increasing isolation, as people become less able to participate in the traditions that bring communities together. In this study, we found that when a baby showed signs of poor growth considered indicative of kubemenda, the baby was often stigmatized, and the mother was frequently blamed and shamed, which seems to have resulted in the mother having low self-esteem, and less freedom to interact with others in the community.…”

Proximate Context of HIV-Related Stigma and Women’s Use of Skilled Childbirth Services in Uganda

“…Our findings suggest that interventions should target individuals to reduce stigmatizing attitudes, but they should also aim to reduce stigma at the level of the community through the use of structural interventions [75,76] to encourage an environment that does not isolate or discriminate against persons with HIV. Specifically, in Uganda where the 2014 HIV and AIDS Prevention and Control Act mandates HIV testing for pregnant women and their partners and permits health care providers to disclose HIV serostatus, increased efforts to reduce HIV-related stigma will be needed to encourage pregnant women not to avoid health facilities for childbirth.…”

“…As PMTCT efforts are promoted more widely, parallel efforts to reduce HIV-related stigma should be scaled up as well. Tackling HIV-related stigma will help advance the twin goals of lowering maternal and child mortality and HIV prevalence [76][77][78].…”

Where Do We Go Next? Behavioral and Social Change for Child Survival

“…Many articles in this issue reach this conclusion and recommend further attention. No doubt, progress has been made in recent years, as shown by the articles on stigma (Nayar et al, 2014 ), community engagement (Farnsworth et al, 2014 ), health system strengthening (Vélez et al, 2014 ), and gender empowerment (Kraft et al, 2014 ). Yet, much remains to be done, particularly linking health policies and programs with behavioral outcomes.…”