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Corporal punishment and health

• Corporal or physical punishment is highly prevalent globally, both in homes and schools. Around 60% of children aged 2–14 years regularly suffer physical punishment by their parents or other caregivers. In some countries, almost all students report being physically punished by school staff. The risk of being physically punished is similar for boys and girls, and for children from wealthy and poor households.
• Evidence shows corporal punishment increases children’s behavioural problems over time and has no positive outcomes.
• All corporal punishment, however mild or light, carries an inbuilt risk of escalation. Studies suggest that parents who used corporal punishment are at heightened risk of perpetrating severe maltreatment.
• Corporal punishment is linked to a range of negative outcomes for children across countries and cultures, including physical and mental ill-health, impaired cognitive and socio-emotional development, poor educational outcomes, increased aggression and perpetration of violence.
• Corporal punishment is a violation of children’s rights to respect for physical integrity and human dignity, health, development, education and freedom from torture and other cruel, inhuman or degrading treatment or punishment.
• The elimination of violence against children is called for in several targets of the 2030 Agenda for Sustainable Development but most explicitly in Target 16.2: “end abuse, exploitation, trafficking and all forms of violence against and torture of children”.
• Corporal punishment and the associated harms are preventable through multisectoral and multifaceted approaches, including law reform, changing harmful norms around child rearing and punishment, parent and caregiver support, and school-based programming.

Corporal or physical punishment is defined by the UN Committee on the Rights of the Child, which oversees the  Convention on the Rights of the Child , as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort, however light.”

According to the Committee, this mostly involves hitting (smacking, slapping, spanking) children with a hand or implement (whip, stick, belt, shoe, wooden spoon or similar) but it can also involve, for example, kicking, shaking or throwing children, scratching, pinching, biting, pulling hair or boxing ears, forcing children to stay in uncomfortable positions, burning, scalding or forced ingestion.

Other non-physical forms of punishment can be cruel and degrading, and thus also incompatible with the Convention, and often accompany and overlap with physical punishment. These include punishments which belittle, humiliate, denigrate, scapegoat, threaten, scare or ridicule the child.

UNICEF’s data from nationally representative surveys in 56 countries 2005–2013 show that approximately 6 out of 10 children aged 2–14 years experienced corporal punishment by adults in their households in the past month. On average, 17% of children experienced severe physical punishment (being hit on the head, face or ears or hit hard and repeatedly) but in some countries this figure exceeds 40%. Large variations across countries and regions show the potential for prevention.

Apart from some countries where rates among boys are higher, results from comparable surveys show that the prevalence of corporal punishment is similar for girls and boys. Young children (aged 2–4 years) are as likely, and in some countries more likely, as older children (aged 5–14 years) to be exposed to physical punishment, including harsh forms. Physical disciplinary methods are used even with very young children – comparable surveys conducted in 29 countries 2012–2016 show that 3 in 10 children aged 12–23 months are subjected to spanking.

Most children are exposed to both psychological and physical means of punishment. Many parents and caregivers report using non-violent disciplines measures (such as explaining why the child’s behaviour was wrong, taking away privileges) but these are usually used in combination with violent methods. Children who experience only non-violent forms of discipline are in the minority.

One in 2 children aged 6–17 years (732 million) live in countries where corporal punishment at school is not fully prohibited. Studies have shown that lifetime prevalence of school corporal punishment was above 70% in Africa and Central America, past-year prevalence was above 60% in the WHO Regions of Eastern Mediterranean and South-East Asia, and past-week prevalence was above 40% in Africa and South-East Asia. Lower rates were found in the WHO Western Pacific Region, with lifetime and past year prevalence around 25%. Physical punishment appeared to be highly prevalent at both primary and secondary school levels.

Consequences

Corporal punishment triggers harmful psychological and physiological responses. Children not only experience pain, sadness, fear, anger, shame and guilt, but feeling threatened also leads to physiological stress and the activation of neural pathways that support dealing with danger. Children who have been physically punished tend to exhibit high hormonal reactivity to stress, overloaded biological systems, including the nervous, cardiovascular and nutritional systems, and changes in brain structure and function.

Despite its widespread acceptability, spanking is also linked to atypical brain function like that of more severe abuse, thereby undermining the frequently cited argument that less severe forms of physical punishment are not harmful. 

A large body of research shows links between corporal punishment and a wide range of negative outcomes, both immediate and long-term:

• direct physical harm, sometimes resulting in severe damage, long-term disability or death;
• mental ill-health, including behavioural and anxiety disorders, depression, hopelessness, low self-esteem, self-harm and suicide attempts, alcohol and drug dependency, hostility and emotional instability, which continue into adulthood;
• impaired cognitive and socio-emotional development, specifically emotion regulation and conflict solving skills;
• damage to education, including school dropout and lower academic and occupational success;
• poor moral internalization and increased antisocial behaviour;
• increased aggression in children;
• adult perpetration of violent, antisocial and criminal behaviour;
• indirect physical harm due to overloaded biological systems, including developing cancer, alcohol-related problems, migraine, cardiovascular disease, arthritis and obesity that continue into adulthood;
• increased acceptance and use of other forms of violence; and
• damaged family relationships.

Th ere is some evidence of a dose–response relationship, with studies finding that the association with child aggression and lower achievement in mathematics and reading ability became stronger as the frequency of corporal punish ment increased.

Risk factors

There are few differences in prevalence of corporal punishment by sex or age, although in some places boys and younger children are more at risk. Children with disabilities are more likely to be physically punished than those without disabilities. Parents who were physically punished as children are more likely to physically punish their own children.

In most of the countries with data, children from wealthier households are equally likely to experience violent discipline as those from poorer households. In contrast, in some resource-poor settings, especially where education systems have undergone rapid expansion, the strain on teachers resulting from the limited human and physical resources may lead to a greater use of corporal punishment in the classroom.

Prevention and response

The INSPIRE technical package presents several effective and promising interventions, including:

• Implementation and enforcement of laws to prohibit physical punishment. Such laws ensure children are equally protected under the law on assault as adults and serve an educational rather than punitive function, aiming to increase awareness, shift attitudes towards non-violent childrearing and clarify the responsibilities of parents in their caregiving role.
• Norms and values programmes to transform harmful social norms around child-rearing and child discipline.
• Parent and caregiver support through information and skill-building sessions to develop nurturing, non-violent parenting.
• Education and life skills interventions to build a positive school climate and violence-free environment, and strengthening relationships between students, teachers and administrators.
• Response and support services for early recognition and care of child victims and families to help reduce reoccurrence of violent discipline and lessen its consequences.

T he  earlier such interventions occur in children's lives, the greater the benefits to the child (e.g., cognitive development, behavioural and social competence, educational attainment) and to society (e.g., reduced delinquency and crime).

WHO Response

WHO addresses corporal punishment in multiple cross-cutting ways. In collaboration with partners, WHO provides guidance and technical support for evidence-based prevention and response. Work on several strategies from the INSPIRE technical package, including those on legislation, norms and values, parenting, and school-based violence prevention, contribute to preventing physical punishment. The Global status report on violence against children 2020 monitors countries’ progress in implementing legislation and programmes that help reduce it. WHO also advocates for increased international support for and investment in these evidence-based prevention and response efforts.

• Global Partnership to End Violence Against Children
• International Society for the Prevention of Child Abuse and Neglect
• Violence Against Children – UNICEF Data

Evidence Against Physically Punishing Kids Is Clear, Researchers Say

AUSTIN, Texas — A conclusive narrative review has found physical punishment of children is not effective in preventing child behavior problems or promoting positive outcomes and instead predicts increases in behavior problems and other poor outcomes over time. The study by an international group of scientists including a researcher from The University of Texas at Austin was published today in The Lancet .

Caregivers in many parts of the world use physical punishment as a response to children’s perceived misbehavior: 63% of children between the ages of 2 and 4 worldwide – approximately 250 million children – are regularly subjected to physical punishment by caregivers .

Sixty-two countries have banned the practice, which is increasingly seen as a form of violence.

The team looked at studies involving physical punishment such as spanking and excluded any behaviors that could constitute child physical abuse. The researchers found ample evidence to support a United Nations statement from the Committee on the Rights of the Child that recommended countries end the use of all types of physical punishment on children.

“There is no evidence that physical punishment is good for children,” said Elizabeth Gershoff, the Amy Johnson McLaughlin Centennial Professor in Human Development and Family Sciences at The University of Texas at Austin and senior author of the paper. “All the evidence indicates that physical punishment is harmful to children’s development and well-being.”

The review looked at 69 studies, most of which were from the United States, with eight from other countries. Scientists found that physical punishment was not associated with any positive outcomes for children and increased the risk that children would experience severe violence or neglect. The paper points out that negative outcomes associated with physical punishment, such as behavior problems, occurred no matter the child’s sex, race, or ethnicity and regardless of the overall parenting styles of the caregivers. The authors also found evidence that the magnitude of negative outcomes for children increased the more frequently physical punishment was used.

“Parents hit their children because they think doing so will improve their behavior,” Gershoff said. “Unfortunately for parents who hit, our research found clear and compelling evidence that physical punishment does not improve children’s behavior and instead makes it worse.”

In the U.S., it is legal in all 50 states for parents to use physical punishment. It is also legal in 19 states for schools to use physical punishment against children. The paper was intended as a resource for policymakers and people who work with families, such as medical and mental health providers.

Gershoff previously authored a landmark 2016 meta-analysis of dozens of studies and found that physical punishment was not associated with any positive outcomes for children and was heavily associated with a variety of negative outcomes. Gershoff’s work was cited by former Secretary of Education John B. King Jr. in a 2016 federal letter urging states to consider ending the use of physical punishment in schools. Gershoff also helped to inform policy statements from the American Academy of Pediatrics and the American Psychological Association that use research on the harmful effects of physical punishment as a basis for recommending that caregivers no longer use it.

Heilmann, Anita Mehay, Richard G. Watt and Yvonne Kelly of University College London (U.K.); Joan E. Durrant of the University of Manitoba (Canada); and Jillian van Turnhout, former senator, Irish Parliament, also contributed to the research. The research was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the U.K. Economic and Social Research Council.

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• Open access
• Published: 20 December 2022

Physical punishment and child, adolescent, and adult outcomes in low- and middle-income countries: protocol for systematic review and meta-analysis

• Jorge Cuartas   ORCID: orcid.org/0000-0002-0451-3298 1 , 2 ,
• Elizabeth T. Gershoff 3 ,
• Drew Bailey 4 &
• Dana C. McCoy 1  

Systematic Reviews volume  11 , Article number:  276 ( 2022 ) Cite this article

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Physical punishment at home and in schools is widespread around the world. Systematic reviews and meta-analyses have synthesized evidence, mostly from high-income countries (HICs), showing that physical punishment relates to multiple detrimental individual outcomes. Yet, less work has been done to synthesize the evidence on the association between physical punishment at home and schools and child, adolescent, and adult outcomes in low- and middle-income countries (LMICs), where more than 90% of children live and physical punishment is most socially normative and prevalent. In this manuscript, we present a protocol for a systematic review and meta-analysis on the characteristics of the research, associations, and variation in associations, between physical punishment at home and in schools and child, adolescent, and adult outcomes in LMICs.

We will conduct a review of studies published in peer-reviewed journals using quantitative methods to assess the association between physical punishment in childhood and/or adolescence and individual outcomes in LMICs. We will search for studies in 10 different databases using keywords in English, Spanish, Portuguese, Arabic, and Chinese related to physical punishment. We will extract qualitative data from the studies and the statistics needed to transform all study-level effect sizes into standardized mean difference effect sizes. For the analyses, we will employ multi-level meta-analyses to use multiple effect sizes per study and leverage within-study variation as well as between study variation using moderation analysis. Besides the meta-analyses, we will also conduct a narrative synthesis of the findings.

The proposed systematic review and meta-analysis will provide timely evidence to inform global research, policy, and practice on the links between physical punishment and lifelong individual outcomes.

Systematic review registration

PROSPERO CRD42022347346

Peer Review reports

At least two out of three children younger than five living in low- and middle-income countries (LMICs) are exposed to physical punishment (also known as corporal punishment) in the home, early childhood care and education centers, or schools [ 1 , 2 , 3 ]. Extensive evidence from meta-analyses and reviews of cross-sectional and longitudinal studies—conducted mostly with samples from the USA and other high-income countries (HICs)—suggests that physical punishment relates to an array of detrimental child, adolescent, and adult outcomes [ 4 , 5 , 6 , 7 ]. In addition, the United Nations (UN) has firmly stated that physical punishment is a form of violence against children and a violation to children’s rights [ 8 ].

Despite evidence that physical punishment might be harmful, there is still some academic and extensive societal debate on the specific consequences of physical punishment. Most of the ongoing controversies are fueled by concerns of internal and external validity. First, there is disagreement on whether physical punishment causes worse child, adolescent, and adult outcomes versus whether confounding factors that plausibly influence both the likelihood of punishment and later individual outcomes (e.g., children’s initial levels of behavior) can fully explain observed associations between physical punishment and such outcomes [ 9 , 10 , 11 ]. Second, there has been a vast underrepresentation of samples from LMICs in prior meta-analyses and systematic reviews about physical punishment [ 5 , 6 , 9 , 12 ]. This lack of studies in LMICs calls into question the generalizability of past findings given that 90% of children in the world live in LMICs and that physical punishment is prevalent in these countries [ 1 ]. Finally, most meta-analyses to date have focused on physical punishment at home and less is known about the potential links between physical punishment in schools and child, adolescent, and adult outcomes, with some recent exceptions [ 13 , 14 ].

Defining physical punishment considering a global perspective

Physical punishment is the use of physical force intended to cause some degree of pain or discomfort to correct or punish a child’s behavior [ 4 , 15 , 16 , 17 ]. As such, physical punishment could vary in its frequency and severity, and could include actions like spanking, hitting a child with objects, or forcing a child to stay in an uncomfortable position, among others. A key feature of physical punishment is that adults have the intention to punish, correct, or control the child’s behavior [ 4 , 16 ]. Some scholars have tried to distinguish between physical punishment (i.e., spanking) and abuse (e.g., hitting with hard objects or hitting the child frequently) based on how socially normative are different behaviors [ 18 ]. Yet, these US-centered distinctions, which have been common in the literature [ 9 , 19 ], are far from universal and are difficult to operationalize (e.g., there is not a clear threshold that divides physical punishment from abuse and the same behaviors are not normative across countries/cultures). Despite this, to date little is known about the specific forms of physical punishment that have been studied in research conducted with samples from LMICs, where, in contrast with US-centered perspectives, behaviors like hitting with objects are as socially normative as spanking [ 3 , 20 ].

Theoretical and empirical links between physical punishment and child, adolescent, and adult outcomes

Developmental and educational theories and empirical evidence indicate that physical punishment can compromise children’s, adolescents’, and adults’ development, learning, and well-being through several biological and social mechanisms. According to traditional developmental and educational theories like social learning theory [ 21 ], social information processing theory [ 22 ], and attachment theory [ 23 ], by using physical punishment, caregivers and educators (intentionally or unintentionally) model aggression as a means to solve problems, inculcate in the child expectations of aggression, and erode the attachment bond, with downstream negative consequences on the relationship between children and their caregivers and children’s social-emotional development, behaviors, and mental health.

Contemporary neurodevelopmental models like the dimensional model of adversity [ 24 ] indicate that physical punishment can also affect children’s social-emotional and cognitive skills through neural mechanisms. The dimensional model of adversity predicts that exposure to threatening experiences, such as physical punishment, influence neural networks that facilitate the rapid identification of and response to environmental threats, including heightened response to negative emotional cues in brain regions that tend to underlie social and emotional processing and some cognitive functions [ 25 , 26 ] Furthermore, the model predicts that the neural consequences of exposure to threatening experiences scale in relation to the severity of the threat involved. Finally, neurodevelopmental perspectives also indicates that threatening experiences might be more consequential if they occurred early in life, when the brain is more malleable and sensitive to experiences and contexts [ 27 ]. Consistent with these models, nascent evidence from neuroimaging studies shows associations between experiencing physical punishment early in life and atypical brain structure and function [ 28 , 29 ], in ways that may lead to downstream behavioral, emotional, and cognitive consequences.

These theoretical perspectives also align with a growing number of studies from LMICs that have shown consistent associations between physical punishment and individual outcomes, which do not seem to vary across settings. A rapid review of 42 studies using samples from LMICs concluded that there is robust evidence on the associations between physical punishment and individual social-emotional and mental health outcomes, but the evidence for cognitive outcomes is scarcer and mixed [ 17 ]. In addition, studies using nationally representative samples for more than 49 countries across LMICs indicated that social normativeness does not modify the associations between physical punishment and individual outcomes [ 30 , 31 ].

With these theoretical perspectives and empirical findings, we can hypothesize that: (1) physical punishment will likely be more strongly associated with social-emotional and mental health outcomes than with cognitive outcomes, (2) physical punishment could lead to stronger consequences if it occurs in early childhood relative to later in life (3) different forms of physical punishment could lead to different consequences that will likely scale in relation to the severity of threat involved, and (4) the same mechanisms linking physical punishment and individual outcomes might be relevant in different settings (e.g., in LMICs and HICs, between regions and countries, or if physical punishment takes place at home vs. schools).

Issues of internal validity and effect sizes

Despite consistent evidence on the associations between physical punishment and negative individual outcomes, establishing credible causal links between physical punishment and child, adolescent, and adult outcomes is not straightforward. It would be unethical to randomly assign children to physical punishment vs. non-physical punishment conditions and to date it has proven impossible to identify arguable exogenous sources of variation for physical punishment to conduct instrumental variables or regression discontinuity designs. For example, programs aimed at preventing physical punishment tend to include other components that might promote positive parenting (for example, content on the importance of play and/or emotional communication), therefore making them endogenous (see as examples the ACT Raising Safe Kids program [ 32 ], the Irie Toolbox [ 33 , 34 ], and Parenting for Lifelong Health [ 35 , 36 ]). Therefore, researchers have mostly relied on observational designs, with some exceptions using fixed effects models [ 11 , 37 ] and matching methods, in an attempt to improve the internal validity of estimates [ 38 , 39 ]. Yet, none of these approaches rules out all potential confounders (i.e., characteristics that might simultaneously affect physical punishment and outcomes), even if researchers have longitudinal data [ 38 , 40 ]. Failing to control for most confounders will likely lead to overestimating the association between physical punishment and different outcomes. For example, maternal depression will likely have a positive correlation with physical punishment and negative association with individual outcomes. As such, failing to account for it may lead to an artificially inflated estimate of the relation between physical punishment and individual outcomes. A similar situation will arise with variables related to socioeconomic status (SES), self-efficacy, and even genetics.

Given these challenges to establishing causal links between physical punishment (and other developmental characteristics/exposures) and child, adolescent, and adult outcomes, researchers have increasingly recognized the importance of strong theory and assessing the sensitivity or robustness of estimates to the inclusion of covariates, multiple methodological approaches, and different identifying assumptions [ 11 , 38 , 41 ]. While even meta-analyses of physical punishment have recognized the importance of sensitivity/robustness checks in research on the consequences of physical punishment, to date all meta-analyses have included only one effect size per outcome per study, therefore making it impossible to test how robust are effect sizes within studies.

Besides allowing to assess the robustness of estimates, the inclusion of more than one effect size per outcome per study is useful to exploit all available data, increasing statistical power and leveraging informative within-study variability. Including multiple effect sizes in a meta-analysis is not entirely straightforward, as conventional meta-analytic methods assume independence of effect sizes. However, multiple effect sizes from the same study (e.g., different outcomes) are likely to be non-independent for different reasons, including correlations between sampling errors (due to the use of same sample) or nesting within the primary study [ 42 ]. Under such circumstances, the results from conventional meta-analytic methods are inappropriate and could even be misleading [ 42 , 43 ] and researchers have recommended the use of multilevel random-effects models to analyze datasets that include more than one effect size per study [ 43 ].

The proposed systematic review and meta-analysis

The proposed study has two main objectives. The first aim is to conduct a systematic review of the literature examining the associations between physical punishment in childhood or adolescence and child, adolescent, and adult outcomes in LMICs to describe the quantity and characteristics of studies, including geographic distribution, definitions of physical punishment used, methodological approaches, and main findings, among other basic characteristics. The second objective is to conduct a series of meta-analyses of the associations between physical punishment and child, adolescent, and adult outcomes in LMICs. We will conduct searches in multiple languages and databases to find more studies from LMICs in addition to those considered in prior meta-analyses. Furthermore, we will include all relevant effect sizes and use state-of-the-art multilevel random effects models to analyze the data. In addition, these meta-analyses will, for the first time in the literature, include physical punishment both at home and in schools. Finally, we will conduct moderation analyses to assess variability in the links between physical punishment and child, adolescent, and adult outcomes in LMICs.

Research questions and hypotheses

RQ1: What are the main characteristics of the published research on the associations between physical punishment and child, adolescent, and adult outcomes in LMICs regarding (a) geographic distribution, (b) the different forms of physical punishment that have been studied, and (c) methodological approaches?

We hypothesize that prior research (a) has not been widespread in different LMICs, but is scarce and has concentrated in specific countries, (b) has likely examined multiple forms of physical punishment, including spanking, hitting children with objects, and pinching the child, among others, and (c) has mostly relied on linear regression models with conventional covariate adjustment.

RQ2: What are the average associations between physical punishment and a range of child, adolescent, and adult outcomes in LMICs?

We hypothesize that all forms of physical punishment will associate with detrimental individual outcomes.

RQ3. Do the associations between physical punishment and child, adolescent, and adult outcomes vary by (a) different forms of physical punishment (e.g., spanking, hitting a child with objects), (b) developmental period at time of physical punishment [0–2 years; 3–5 years; 6–10 years; +10 years], (c) whether punishment occurred in homes or in schools, (d) region (i.e., East Asia and Pacific, Europe and Central Asia, Latin America & the Caribbean, Middle East and North Africa, North America, South Asia, Sub-Saharan Africa) or country income group (i.e., low-income, lower-middle income, upper-middle income), and (e) methodological approach (e.g., data structure and analytic strategy)?

We hypothesize that the association between physical punishment and individual outcomes will (a) vary according to different forms of physical punishment, (b) be stronger if physical punishment took place early in life relative to later developmental periods, (c) be similar regardless of whether punishment takes place in homes or in schools, (d) not vary across countries or regions, and (e) will be stronger in studies with weaker internal validity (e.g., cross-sectional, observational with poor covariates) relative to more internally valid studies (e.g., longitudinal, rich set of covariates, experimental, quasi-experimental) due to issues of selection bias.

Protocol registration and reporting

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis for Protocols (PRISMA-P) to develop this protocol (see Additional file 1 : Appendix 1). This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) on August 1, 2022.

Inclusion and exclusion criteria

Table 1 presents the inclusion criteria for studies in the review, considering the PICO framework. The systematic review and meta-analysis will assess the average association (and variation in such associations by characteristics listed above) between physical punishment at home and schools and child, adolescent, and adult outcomes in LMICs.

The review will consider studies published in peer-reviewed journals employing quantitative methods, including experimental, quasi-experimental (e.g., instrumental variables, difference-in-differences, matching), and observational approaches. Following prior meta-analyses on physical punishment and child, adolescent, and adult outcomes [ 5 ], we will exclude gray literature (e.g., dissertations, unpublished manuscripts) and qualitative, theoretical, and case studies. To be considered for inclusion, the studies should provide sufficient basic information to confidently calculate effect sizes (ES). If information to calculate ES is unavailable, we will contact the corresponding authors via email to request the information. If we do not receive a reply in 2 weeks to respond the original request, we will send a reminder and extend with another week. If we do not receive a reply, we will exclude the study.

The population will be restricted to children, adolescents, and adults living in LMICs. We will consider all countries that were categorized as LMICs in the period of the study (i.e., 2002 onwards) by the World Bank Country and Lending Groups [ 44 ].

This systematic review and meta-analysis will focus on all forms of physical punishment, following the definitions discussed above. In the review we will include studies that measure any form of physical punishment vs. no exposure to physical punishment and those that use continuous measures of physical punishment frequency or severity. Studies will be included as long as authors assert that they are measuring physical punishment. We will exclude studies that measure beliefs of or attitudes towards physical punishment rather than actual exposure to physical punishment, and studies that use only indices (e.g., Adverse Childhood Experiences - ACEs) and do not allow to measure physical punishment independently from other adversities or forms of violence.

The review will include studies that compare children exposed to physical punishment to a comparison group of children, adolescents or adults who were never exposed to physical punishment or were exposed less to less frequent or severe physical punishment.

We will follow prior meta-analyses [ 4 , 5 , 9 ] of the association between physical punishment (or spanking, specifically) and child, adolescent, and adult outcomes to focus on outcomes related to (1) externalizing behavior problems (e.g., aggression), (2) internalizing behavior problems, (3) mental health problems, (4) alcohol or substance abuse, (5) parent-child relationships, (6) cognitive development (including academic achievement), (7) social-emotional development (e.g., self-esteem and self-regulation), (8) probability of being a victim of physical abuse, and (9) support for physical punishment and other forms of violence. We may add new or collapse some of the abovementioned outcome categories after conducting the data extraction.

Search strategy

We consulted five librarians from Harvard University to identify relevant databases that might include studies from LMICs. Furthermore, we searched journals in Arabic, Chinese, Spanish, Portuguese, French, Hindi, and Swahili specialized in psychology, education, medicine, and public health in UlrichsWeb [ 45 ]. Subsequently, we identified the indexation of the journals and included additional databases as long as they had a Thesaurus (i.e., specialized subject terms) to ensure reproducibility of our searches. With such information, we decided to search the following 10 databases: (1) APA PsycInfo, (2) PubMed, (3) EMBASE, (4) ERIC, (5) Sociological Abstracts, (6) Global Health, (7) CINAHL Plus with full text, (8) Academic Search Premier, (9) Bibliography of Asian Studies, and (10) Education Source.

We will search the databases for the following keywords in English, Spanish, Portuguese, French, Arabic, and Chinese in titles and abstracts: spank*, corporal punishment*, physical punishment*, physical disciplin*, corporal disciplin*, harsh punishment*, harsh disciplin*, and smack* (see Additional file 2 : Appendix 2 for the search code). In all searches, we will use the filters for publication date (i.e., published after 2002) and type of publication (i.e., peer-reviewed journals).

In addition, we will consider all the studies that met our inclusion criteria from prior published systematic reviews and meta-analyses on the association between physical punishment and child, adolescent, and adult outcomes [ 4 , 5 , 6 , 9 , 12 , 13 , 14 , 46 , 47 ].

Screening and full text-review

We will export all prospective studies to Covidence ( www.covidence.org ) in order to ensure reproducibility of the decision process. Before title and abstract screening, we will remove all duplicates from the Covidence library. Two reviewers (JC and a trained research assistant) will independently examine all titles and abstracts following pre-established inclusion criteria. All disagreements will be resolved by consensus through discussion among the reviewers and a third reviewer (ETG) will help resolve remaining conflicts if consensus is not reached. Subsequently, JC and a trained research assistant will independently review the full text of the remaining records considering the inclusion criteria, and all disagreements will be solved following the same procedures of the title and abstract screening phase.

Data extraction

At least two reviewers will extract data for the studies meeting the inclusion criteria using a pre-piloted standardized data extraction template. We will extract qualitative data from the studies in Covidence and the statistics needed to calculate ES in an Excel spreadsheet. Among other information, we will extract data on:

Basic details about the study (e.g., authors, year of publication)

Details related to sample characteristics (e.g., country, sample size, distribution by sex, age)

Data structure (e.g., cross-sectional, longitudinal, experimental, retrospective)

Methodological approach (e.g., experimental or observational)

Covariates included in the models, if any

Measure of physical punishment (e.g., observation, parent report, child report, child report retrospective, both parent and child report)

Definition of physical punishment used in the study

Setting where physical punishment occurred (i.e., home or school)

If available, prevalence of physical punishment in the sample

Characteristics of the measure of physical punishment (e.g., frequency, severity, period in which spanking was administered [last week, ever in life, last month, last year], developmental period at time of physical punishment [0–2 years; 3–5 years; 6–10 years; +10 years])

Measure of outcome(s) (e.g., direct assessment, parent report, child report)

Definition of outcome and age at which outcome was measured

Independence of measures of physical punishment and outcome (e.g., same or different rater)

Narrative synthesis of main results and moderation (e.g., variation in the association between physical punishment and outcomes due to sex, caregiver’s education or household wealth, among other characteristics)

Statistics to calculate effect sizes (e.g., means, standard deviations) for the association between physical punishment and outcomes

Effect size calculation

At least two reviewers will extract all the available relevant ES for each study. We will include all ES that allow us to compare between (1) unadjusted and adjusted models, (2) models with different identifying assumptions, and (3) associations between physical punishment and child, adolescent, and adult outcomes in different countries. We will transform all study-level effect sizes into standardized mean different effect sizes (i.e., Cohen’s d ). For studies that report effect sizes as group comparisons (e.g., exposed to physical punishment vs. not exposed) we will use Cohen’s formula \(d=\frac{\mu_1-{\mu}_2}{\sigma }\) , where μ 1 is the mean for the group exposed to physical punishment, μ 2 the mean of the comparison group, and σ the pooled standard deviation. For studies that do not report effect sizes as group comparisons (e.g., frequency or severity of physical punishment), we will follow the procedures presented in Borenstein and colleagues [ 48 ] to convert correlations and other quantitative measures of associations to Cohen’s d effect sizes.

Data synthesis

We will begin by conducting a narrative synthesis of the findings, including (1) definitions of physical punishment used in research from LMICs, (2) geographic distribution and methodological approaches, (3) main findings, and (4) results of moderation analyses.

It is likely that many studies included in the review will include more than one effect size (e.g., multiple outcomes, unadjusted and adjusted, for two models with different identifying assumptions). The sampling errors of multiple effect sizes from a single study might be correlated due to nesting within the same study and usage of the same sample, thus violating the assumption of independence and threatening the validity of the meta-analyses [ 42 ]. One solution proposed in prior meta-analysis on physical punishment and individual outcomes was to select one effect size per sample or averaging across effect sizes [ 9 , 46 ]. Yet, such practice leads to loss of information that decreases statistical power and might obscure important variability to assess the sensitivity or robustness of the estimated effect sizes.

We will follow current best-practice recommendations [ 42 , 43 ] to dealing with multiple effect sizes and non-independence and will employ multilevel random effects models to analyze the data. Multilevel random effects models will allow us to include all relevant effect sizes and model the dependence between effects within the same sample or study [ 43 ]. We will employ random effects, rather than fixed effects models, under the assumption that differences between studies in observed effect sizes might be due to both “real” differences and measurement error (rather than exclusively measurement error) [ 48 ]. The random effects meta-analysis will allow us to estimate a mean effect size along with a 95% CI around such estimate and a measure of heterogeneity ( I 2 ) to assess the extent to which effect sizes differ between studies.

The moderation analysis will depend mostly on the final sample of studies and the extent to which the sample of studies provides enough statistical power to do such analyses. Given that there are no prior systematic reviews about physical punishment and child, adolescent, and adult outcomes in LMICs, we do not have an a priori estimate of the number of studies we will likely identify. In any case, we expect to do some subgroup analysis according to characteristics listed in the third research question listed above. We will assess risk of bias and quality of the evidence through moderation analysis in order to assess whether the links between physical punishment and individual outcomes is robust to different methodological approaches.

Dissemination plans

We will submit the findings of the review for publication to a peer-reviewed journal. We expect to disseminate findings from the review in blogs, conferences, and other outlets.

Physical punishment constitutes a violation to children’s rights [ 15 ] and a setback to global policy goals, as one indicator for the UN Sustainable Development Goals (SDGs) is the proportion of children exposed to physical punishment [ 49 ]. Furthermore, extensive evidence, mostly from the USA and other HICs [ 5 , 6 ], shows consistent links between physical punishment at home and detrimental outcomes throughout the lifespan. Nonetheless, less work has been done to synthesize the evidence on the association between physical punishment at homes and schools and child, adolescent, and adult outcomes in LMICs, where more than 90% of children live [ 50 ] and physical punishment is most socially normative and prevalent [ 1 ]. In addition, there is a need for new analyses that employ state-of-the-art meta-analytic methods to strengthen the claim that physical punishment might be detrimental for individuals, assessing robustness of estimates and variation between studies and groups.

The proposed meta-analysis seeks to contribute to filling the above-mentioned gaps by focusing on studies conducted with samples from LMICs, considering physical punishment that takes place at home and schools, considering all relevant effect sizes from each study, and using novel multilevel random effects modeling. Using such information, the meta-analysis will not only estimate the average association between physical punishment and different outcomes but also assess within and between study variability in effect sizes, as well as moderation due to study, individual, and contextual characteristics.

While the meta-analysis will have several strengths, we also anticipate some limitations. First, we do not expect finding any experimental studies conducted with samples from LMICs, and we expect few studies with longitudinal or quasi-experimental designs. As such, we anticipate that most studies will be cross-sectional, observational, and employ conventional covariate adjustment. Yet, we will assess within-study variability and assess moderation due to data structure and methodological approach to assess the sensitivity of estimates. Second, we anticipate that several included studies will have measurement issues, including parent reported measures of physical punishment and measures that are limited regarding temporality (e.g., physical punishment in the past week or month). However, measurement error due to these issues might drive the estimates against our stated hypotheses (i.e., will lead to coefficient attenuation, or an underestimation of the “true” association between physical punishment and individual outcomes). Finally, given the vast underrepresentation of samples from LMICs in research about physical punishment, we anticipate some inconveniences with availability of studies/information and statistical power to conduct some moderation analyses.

To conclude, this meta-analysis will offer new evidence on the potential consequences of physical punishment in LMICs. The meta-analysis will help identify some strengths and weaknesses of existing evidence in order to inform future research on the links between physical punishment and child, adolescent, and adult outcomes. Furthermore, the new evidence will inform policies aimed at protecting children from psychosocial threats to their development, as well as practice regarding caregiving in LMICs.

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Acknowledgements

We would like to thank to the Harvard University librarians Kathleen Donovan, Carla Lillvik, Bassey Irele, Ramona Crawford, Molly McInerney, and Xiao-He Ma for their help in identifying relevant databases and developing the overall search strategy. We would also like to thank to Hirokazu Yoshikawa, Charles Nelson III, Aisha Yousafzai, James S. Kim, Juliana Sánchez, Linxi Lu, Kaitlin Paxton Ward, and Catalina Rey-Guerra for their feedback. This project was supported the National Academy of Education/Spencer Dissertation Fellowship and a fellowship from the American Psychological Foundation.

The authors received no financial support for the research, authorship, and/or publication of this article.

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Population Research Center, University of Texas at Austin, Austin, USA

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JC and EG conceptualized the study. JC consulted with EG, DB, and DM throughout the protocol drafting process. JC and EG defined the search strategy. JC, EG, and DB defined the analytic plan. All authors provided critical review of intellectual content and approved final manuscript.

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Cuartas, J., Gershoff, E.T., Bailey, D. et al. Physical punishment and child, adolescent, and adult outcomes in low- and middle-income countries: protocol for systematic review and meta-analysis. Syst Rev 11 , 276 (2022). https://doi.org/10.1186/s13643-022-02154-5

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Physical punishment and child outcomes: a narrative review of prospective studies

Affiliations.

• 1 Department of Epidemiology and Public Health, University College London, London, UK. Electronic address: [email protected].
• 2 Department of Epidemiology and Public Health, University College London, London, UK.
• 3 Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
• 4 Royal College of Physicians of Ireland, Faculty of Paediatrics, Dublin, Ireland.
• 5 Population Research Center and Department of Human Development and Family Sciences, University of Texas at Austin, Austin, TX, USA.
• PMID: 34197808
• PMCID: PMC8612122
• DOI: 10.1016/S0140-6736(21)00582-1

Physical punishment is increasingly viewed as a form of violence that harms children. This narrative review summarises the findings of 69 prospective longitudinal studies to inform practitioners and policy makers about physical punishment's outcomes. Our review identified seven key themes. First, physical punishment consistently predicts increases in child behaviour problems over time. Second, physical punishment is not associated with positive outcomes over time. Third, physical punishment increases the risk of involvement with child protective services. Fourth, the only evidence of children eliciting physical punishment is for externalising behaviour. Fifth, physical punishment predicts worsening behaviour over time in quasi-experimental studies. Sixth, associations between physical punishment and detrimental child outcomes are robust across child and parent characteristics. Finally, there is some evidence of a dose-response relationship. The consistency of these findings indicates that physical punishment is harmful to children and that policy remedies are warranted.

Copyright © 2021 Elsevier Ltd. All rights reserved.

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Declaration of interests We declare no competing interests.

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It’s Time to Disappear Corporal Punishment for Kids

There is ample evidence that physical punishment is harmful – now and long-term..

Posted May 3, 2021 | Reviewed by Kaja Perina

• Empirical research demonstrates that physical punishments do kids considerably more harm than good.
• Physical punishment makes it more, rather than less, likely that children will be defiant and aggressive in the future.
• Physical punishment puts children at risk for a range of negative outcomes, including increased mental health problems.
• Adults who were hit frequently as children are more likely to suffer from depression and other negative social and mental health outcomes.

Over the last five decades, attitudes in the United States about physical discipline, also known as corporal punishment , have evolved dramatically. Physical discipline in the forms of spanking, slapping, punching, kicking, and hitting children with objects of all sorts (belts and extension cords were especially popular) was once widely accepted. To a now disturbing extent, it was often encouraged and supported, based on the misguided belief, “Spare the rod and spoil the child.” When I attended elementary school in the 1960s and early 1970s, teachers could hit students with impunity—and that was in public school!

Having had two children of my own, I know well the impulse to strike out at a child. I can’t help but understand and empathize with it. There are circumstances when the apparent unwillingness of kids to listen to their parents is absolutely exasperating. When we want our kids to do something and they don’t do it, especially when they ignore or blow off repeated requests (to clean up, turn off the TV, do their homework, brush their teeth, don’t pull on the dog’s fur or leave food on the table or mess with the remote control), the natural consequent emotional reactions are a mix of “You’ve got to be f’ing kidding me,” confusion, impatience, hurt, frustration, and anger . Yet, there is a world of difference between having the occasional understandable, natural and—I dare say—normal impulse to hit a child and acting out that impulse by actually doing it.

The only time I ever “hit” one of my daughters occurred when my eldest daughter (now 33 and a parent herself) was about two and a half years old. She picked up something from a shelf on a bookcase, and I told her to put it back. The fact that I can’t even remember what she picked up shows just how inconsequential the item was. Although she understood my request, she refused to listen and held on to whatever it was.

Developmentally speaking, she simply did what a two-and-a-half-year-old child is supposed to do: test her independence during that first phase of the separation-individuation process (the second phase being adolescence ), experiencing herself as her own person distinct from me and her mother. It was early in my clinical social work career , and although I had an intellectualized sense of this, I was tired and cranky, and could feel my impatience and frustration rising. I asked her several times to put whatever it was back on the shelf, but she continued to hold on to it. Finally, I grabbed it from her tiny, delicate hand and put it back myself.

I stood in stunned disbelief as she looked right at me, walked over to the shelf, and reached out her hand to pick up the item again. I sternly told her once, and then a second time, “Don’t pick that up.” By now, my anger was coiled like a rattlesnake, ready to strike. She went ahead and picked it up, looked directly at me, and started to smile. Chances were that she thought we were playing some sort of game, but I automatically interpreted her actions as willful unmitigated defiance that demanded a strong response. Impulsively, I smacked her hand—hard.

My guilt -laden regret was instantaneous. I watched in horror as the change in her demeanor seemed to start at her feet and work its way up her little body in slow motion until her smile dissolved into a frown, and her lips began to quiver. As she started to cry, she looked at me as if to say, “How could you do that to me? You’re supposed to protect me.” I felt as though I had betrayed her—because I had. I don’t know if it was traumatic for her, but it was for me. Shortly thereafter, she didn’t remember the experience. I, on the other hand, will never forget it.

Although there are (and may always be) holdouts that insist on reserving the so-called right to spank or otherwise physically discipline their kids, since approximately the 1980s, these activities have generally and appropriately been viewed as child abuse. Ample research demonstrates that physical punishments do kids considerably more harm than good.

The Report on Physical Punishment in the United States: What Research Tells Us about Its Effects on Children by Elizabeth T. Gershoff, PhD, addresses the association between parental physical punishment and eleven child behaviors and experiences. A meta-analytic and theoretical review of over one hundred years of social science research and hundreds of published studies on physical punishment, conducted by professionals in the fields of psychology, medicine, education , social work, and sociology, found that

• There is little evidence that physical punishment improves children’s behavior in the long term, and increasing empirical data indicates the physical punishment of children is an ineffective parenting practice.
• Children who are physically punished are at greater risk of serious injury and physical abuse.
• When administered regularly, physical punishment increases antisocial behaviors such as lying , stealing, cheating, bullying , assaulting a sibling or peers, and lack of remorse for wrongdoing.
• Physical punishment serves as a model for aggressive behavior and inappropriate ways of dealing with conflict.
• Physical punishment erodes trust between a parent and child.

Copyright 2021 Dan Mager, MSW

E.T. Gershoff, Report on Physical Punishment in the United States: What Research Tells Us About Its Effects on Children. Columbus, OH: Center for Effective Discipline (2008).

Dan Mager, MSW is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain and Roots and Wings: Mindful Parenting in Recovery .

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Physical discipline is harmful and ineffective

A new APA resolution cites evidence that physical punishment can cause lasting harm for children

By Eve Glicksman

May 2019, Vol 50, No. 5

Print version: page 22

• Physical Abuse and Violence

APA adopted a new policy about the ineffectiveness and dangers of physical discipline against children to raise awareness among parents, caregivers and mental health professionals.

The Resolution on Physical Discipline of Children By Parents , adopted by APA’s Council of Representatives in February, relies on strong and sophisticated longitudinal research that finds physical discipline does not improve behavior and can lead to emotional, behavioral and academic problems over time, even after race, gender and family socioeconomic status have been statistically controlled.

To start, the research finds that hitting children does not teach them about responsibility, conscience development and self-control. "Hitting children does not teach them right from wrong," says Elizabeth Gershoff, PhD, an expert on the effects of corporal punishment on children who provided research for the resolution. "Spanking gets their attention, but they have not internalized why they should do the right thing in the future. They may behave when the adult is there but do whatever they want at other times."

In addition, children learn from watching their parents. Parents who use physical discipline may be teaching their child to resolve conflicts with physical aggression. Researchers found that spanking can elevate a child’s aggression levels as well as diminish the quality of the parent-child relationship. Other studies have documented that physical discipline can escalate into abuse.

The purpose of this resolution is to promote effective forms of discipline for parents that don’t contribute to antisocial behaviors, aggression and trust issues. "Children do not need pain to learn," says Gershoff, a professor at the University of Texas at Austin, "We don’t allow aggression among adults. It’s a sad double standard that we don’t give children the same protection against violence."

Better discipline models

Upward of 80 percent of mothers spank their children between kindergarten and third grade, according to a large study conducted by Gershoff ( Child Development , May/June 2012).

Most parents raise children the way they were raised and have not been exposed to other models of discipline, says APA President Rosie Phillips Davis, PhD. "I don’t think most people know how to discipline without spanking. We don’t teach people to do it differently; alternatives seem time-consuming," she says.

The APA resolution presents effective alternatives that draw broadly on respectful communication, collaborative conflict resolution and parental modeling. Specifically, these approaches could include conveying anxiety about a dangerous action, taking away privileges or using praise to shape behavior.

Sometimes, simply ignoring the behavior and not engaging in a fight is the best tactic, says Christina Rodriguez, PhD, an associate professor at The University of Alabama at Birmingham and chair of the APA Committee on Children, Youth and Families, who led the resolution effort. "Parents need to learn what they should or shouldn’t respond to."

Parents of 3- to 5- year-olds are the most likely to spank. So, what about a preschooler who can’t be reasoned with? Rodriguez advises parents to think strategically and plan ahead. If your child is prone to act out while you get groceries, bring snacks and toys to redirect the child or choose a time to shop when the child isn’t sleepy, she suggests.

Calling a time-out for certain behaviors can be effective but it is often misused as a stand-alone strategy, Gershoff observes. "Looking at a wall for five minutes won’t teach a child how to behave."

Rather, parents need to give children guidance about what to do differently, what is known as "time out from positive reinforcement (TOPR)." This technique makes time-out an opportunity to regroup and think about how to do better next time.

A new study in American Psychologist offers guidelines in using TOPR to maximize the development of the child’s self-regulation skills while avoiding any weakening of the parent-child attachment bond from the time out ( American Psychologist , Feb. 25, 2019).

Give parents the facts

The APA resolution is clear that any perceived short-term benefits from physical discipline do not outweigh the potential detriments. By adopting the resolution, APA joins a number of professional and public health organizations in recommending that parents reject all physical discipline. The resolution also directs APA to support funding for research in the United States and other countries related to why parents turn to physical discipline.

Davis wants to see more training programs on parental discipline for psychologists. Currently, more than 75 APA members are collaborating to create a toolkit to facilitate conversations in the community about disciplining children. Multiple modules are being developed for parents, colleges, civic organizations and places of worship that will include frequently asked questions. APA also offers the ACT Raising Safe Kids Program to teach positive parenting skills.

Rodriguez hopes the resolution will prompt psychologists to guide parents toward healthier discipline practices than were used in the past. Now that we know the risks of not wearing seatbelts, most parents make sure children buckle up, she comments. "Why is it not the same for rejecting physical discipline when the risks are known?"

Some psychologists feel that it’s not their place to tell parents how to discipline their children, Rodriguez says. "But it is long past opinion that physical discipline makes things worse," she says. "It is incumbent on psychologists to take the opportunity to discuss the facts and share what we know. If mental health professionals don’t take this on, then who?"

To read the full APA resolution on child punishment, go to www.apa.org/about/policy/physical-discipline.pdf .

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Physical punishment of children by US parents: moving beyond debate to promote children’s health and well-being

• Cindy Miller-Perrin 1 &
• Robin Perrin 1  

Psicologia: Reflexão e Crítica volume  31 , Article number:  16 ( 2018 ) Cite this article

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Physical punishment remains a common practice in the USA despite significant empirical evidence of its potential harm and ineffectiveness, arguments that its use violates children’s human rights, and professional recommendations against its use. The purpose of the current paper is to offer explanations as to why, in the face of a worldwide movement to protect children from violence, the USA continues to support physical punishment of children. The paper also summarizes the various debates engaged in by experts that stem from these explanations for physical punishment and argue that the time has come to move beyond these debates and eliminate the physical punishment of children. We offer suggestions for changing attitudes and practices related to physical punishment of children in order to promote their health and well-being. We conclude by suggesting that the burden of proof in debates about physical punishment, which has typically fallen upon those who argue children should never be physically punished, should shift to those who continue to promote its use despite evidence of its harm and ineffectiveness.

Introduction

The physical punishment of children, defined as “any punishment in which physical force is used and intended to cause some degree of pain or discomfort” (United Nations, Committee on the Rights of the Child [UNCRC], 2007 , p. 4) is a worldwide issue that has attracted considerable attention in recent years. Attitudes and practices regarding physical punishment and its most common form, spanking with an open hand, have dramatically changed around the world. The United Nations Committee on the Rights of the Child, which was adopted in 1989, states in Article 19 that member nations should “take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence.” The Committee stressed that all physical punishment of children, including that in homes, should be eliminated through “legislative, administrative, social and educational measures” (Committee on the Rights of the Child, 2006 , para. 18). Currently, 196 countries are party to the treaty, including every member of the United Nations except the USA. Parental use of physical punishment has also been banned in more than 50 countries to date (Global Initiative to End All Corporal Punishment of Children, 2017 ). These trends suggest a decrease in attitudes and practices supportive of physical punishment of children and are no doubt due to a number of factors, including empirical research questioning its use, as well as international legislation suggesting that physical punishment violates the human rights of children (Gershoff & Grogan-Kaylor, 2016 ; UNCRC, 2007 ).

This worldwide movement to end the physical punishment of children should not lead us to conclude, however, that the problem is solved. In many of the 196 nations who are party to the United Nations Convention on the Rights of the Child, physical punishment of children remains common (Lansford et al., 2017 ). For example, in South Korea, which ratified the United Nations Convention on the Rights of the Child in 1991, physical punishment of children remains common. A national study on the prevalence rate of violence toward children led the researchers to conclude, “Korean society needs to lower significantly its tolerance level for all forms of violence,” and to “raise awareness regarding the ineffectiveness and damaging effects of corporal punishment” (Ahn et al., 2017 ). In the USA, physical punishment, while declining (see Straus, Douglas, & Medeiros, 2014 ), also continues to be viewed largely positively and is commonly practiced.

The purpose of the current paper is to offer explanations as to why, in the face of worldwide movement to protect children from violence, physical punishment against children remains normative in much of the world. We focus on the USA because the use of physical punishment by parents is very common in the USA, but many of the issues we highlight are relevant to other countries. We also summarize the various debates about physical punishment and argue that the time has come to move beyond these debates to eliminate the physical punishment of children. We offer suggestions for changing attitudes and practices related to physical punishment of children in order to promote their health and well-being. Finally, we conclude by suggesting that the burden of proof in debates about physical punishment, which has typically fallen upon those who argue children should never be physically punished, should shift to those who continue to promote its use despite evidence of its harm and ineffectiveness.

Support for physical punishment in the USA

Although US federal law does not provide a definition of physical punishment, its legality is typically stated in the form of a provision that gives parents immunity from prosecution for child physical abuse if the actions are deemed to represent “reasonable force” when used for the purposes of correction and control (Straus, 2010 ). Unreasonable force, or child physical abuse, is defined by actions that result in “serious physical or emotional harm” (Child Abuse Prevention and Treatment Reauthorization Act, 2010 ). In all 50 states, physical punishment by parents—that is, acts that may cause physical pain but that do not cause harm or injury—is legal.

Attitudinal and behavioral surveys of the US population generally support the legal status of physical punishment. Three fourths of adults agree or strongly agree with the statement, “It is sometimes necessary to discipline a child with a good, hard spanking” (Smith, Hout, Marsden, & Kim, 2015 ), and behavior surveys estimate that 80% of parents have spanked their child at some point during childrearing (Gershoff, Lansford, Sexton, Davis-Kean, & Sameroff, 2012 ).

Explaining support for physical punishment in the USA

Some argue that the fundamental parental right to control the upbringing of their own child is protected by the Fourteenth Amendment (Pagliocca, Melton, Lyons Jr, & Weisz, 2002 ). While this interpretation is a subject of considerable legal debate (Shulman, 2014 ), the fact remains that the dual concepts of “parental freedom” and “parental rights” are strongly embedded in the US culture (Lane, 1998 ). Parental rights and freedoms, furthermore, continue to be upheld by US courts and judges, even under conditions involving harsh physical punishment (Moya-Smith, 2013 ; Schworm, 2015 ). For example, in a 2013 California case, in which a mother who hit her daughter five or six times with a wooden spoon, resulting in bruises, the judge on the case concluded that the local department of social services violated the mother’s right to impose reasonable discipline upon her child (Moya-Smith, 2013 ).

The high rate of adherence to Christianity in the USA, especially compared to Europe, also contributes to high rates of support for corporal punishment. Conservative Protestants, in particular, are likely to believe that parents have a right and a responsibility to impose physical discipline. Several Old Testament passages, primarily from the book of Proverbs, have often been interpreted by Conservative Christians to mean that a parent who spares the rod, spoils the child (Ellison & Sherkat, 1993 ; Perrin, Miller-Perrin, & Song, 2017 ).

The view that physical punishment is harmless is also reflected, to some degree, in the attitudes of professionals. In a survey of medical center staff conducted by Gershoff et al. ( 2016 ), less than half of medical center staff agreed that spanking is harmful to children. In a recent survey of psychologists, approximately one-third were either unsure or disagreed that spanking is harmful to children (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted).

A final reason that cultural beliefs persist is reflected in parental attitudes and behaviors toward child discipline. Most people are spanked in the USA, and parents tend to parent the way they were parented (Graziano & Namaste, 1990 ). In addition, some believe that because they were spanked and “turned out ok,” physical discipline is effective and harmless (Kish & Newcombe, 2015 ). Others believe that children who are spanked are disciplined and respect authority, while those who are not are uncontrolled and disrespectful (Benjet & Kazdin, 2003 ). Finally, many US adults equate discipline with physical punishment, as if spanking were the only way to discipline a child (Knox, 2010 ).

Hitting is rarely viewed as a violent act

Some object to the term “hitting,” when describing the physical punishment of children arguing that it is biased, or too harsh, or has an overly negative connotation. However, as Straus ( 2010 ) notes, the word “hit” is no more inherently biased or harsh than any other label that might be used to describe “spanking” (e.g., “swat,” “paddle,” “whack,” “beat,” “whip”). Most US child advocates, as well as those in other countries, actually expand the term “hitting” one step further, arguing that hitting is a form of violent behavior. Violence is “an act carried out with the intention of, or an act perceived as having the intention of, physically hurting another person” (Steinmetz, 1987 ). Physical punishment, including spanking, is, by definition, a violent act. It is intended to hurt—cause pain—to a child. Physical punishment of children may be “subabusive violence” (Graziano & Namaste, 1990 ), it may be “acceptable violence,” but it is still a form of violence, no matter what we call it.

In the USA, it is not socially acceptable for a husband to hit his wife, or for a wife to hit her husband. Children on a playground are not allowed to hit. Even dogs, many would argue, should never be hit. Children, however, are the only members in US society for whom hitting is deemed acceptable. One reason why hitting children might be deemed permissible could be the reluctance of adults to view physical punishment as a form of violence. As Bussmann and colleagues have noted, “parents are not aware of the contradiction between their attitude toward nonviolent childrearing and their own use of corporal punishment, simply because they do not define what they do as violence” (Bussmann, Erthal, & Schroth, 2011 ).

Moving beyond debates about physical punishment of children

Debates about parental use of physical punishment have been ongoing in the USA for decades. Calls to “move beyond” the research, or to “end the debate,” have become commonplace (e.g., Durrant & Ensom, 2017 ; MacMillan & Mikton, 2017 ). Three questions, it seems, sit at the center of these debates. Is physical punishment of children a Human Rights Issue? Is physical punishment effective? Is physical punishment harmful?

Physical punishment is a human rights issue

A growing number of international bodies have declared that physical punishment is a violation of a child’s human rights, including six multilateral human rights documents and treaties (Bitensky, 2006 ; Gershoff & Bitensky, 2007 ). Most significantly, as discussed above, the United Nations, as articulated in its Convention on the Rights of the Child (United Nations Convention on the Rights of the Child, 1989 ), states that physical punishment is a form of “legalized violence against children” (Committee on the Rights of the Child, 2006 , para. 18) that is prohibited by Article 19 of the CRC’s prohibition on “all forms of physical or mental violence” (United Nations Convention on the Rights of the Child, 1989 , Article 19, para. 1).

The USA signed the treaty in 1995 but has never ratified it. This means, essentially, that the USA has endorsed the general principles outlined in the treaty but is unwilling to be legally bound by the treaty’s mandates. This unwillingness to ratify illustrates the continuing tensions between those who affirm and promote “children’s rights” and those who affirm and promote “parental rights.” Criticism of the treaty has come, in large part, from the political and religious right, which has expressed concerns that the treaty would infringe on the rights of parents (Ruck, Keating, Saewyc, Earls, & Ben-Arieh, 2016 ).

It is important to note, however, that physical punishment of children is not permitted in most US settings outside the home. It is typically not permitted in child care settings, schools, residential treatment facilities, or juvenile detention facilities (Bitensky, 2006 ). While much has been made of the fact that physical punishment is allowed in schools in some states, it is important to note that it is illegal in 31 states (Gershoff & Font, 2016 ). As a society, we appear uneasy about the value of physical punishment of children by individuals who do not hold the role of parent, yet we defer to the parent’s “right” to use physical discipline in the home. The United Nations Secretary General’s Study on Violence Against Children has called for explicit prohibition of physical punishment and other forms of “cruel or degrading punishment” in all settings, including the home (United Nations, 2006 ). Furthermore, the study report stated that “No violence against children is justifiable; all violence against children is preventable. The study marks the end of adults’ justification of violence against children, whether accepted as tradition or disguised as discipline” (United Nations, 2006 , p. 17).

If, in the USA, we hope to end the debate on whether physical punishment of children is a human rights violation, the continuing ambiguity with the United Nations Convention on the Rights of the Child must be reconciled. Because ratification of a treaty in the USA requires a two-thirds majority in Congress, it is difficult to imagine ratification any time soon. However, we can still reconcile our continuing ambiguity by acknowledging a fundamental truth: there is no such thing as a “parental right.” Humans—which includes both parents and children—have rights. And all human beings, including children, have a right not to be hit.

Physical punishment is ineffective and harmful

Decades of research has yielded more than 500 studies examining the impact of physical punishment on children (Gershoff & Grogan-Kaylor, 2016 ). Within the past 15 years, several meta-analyses have attempted to synthesize this body of research. In a highly publicized meta-analysis, Gershoff ( 2002 ) concluded that physical punishment is not only ineffective, but also harmful. Larzelere and Kuhn then conducted a meta-analysis in 2005 and concluded that physical punishment may be effective if used conditionally, such as an open-handed swat on the buttocks with 2- to 6-year-olds when other forms of discipline have been unsuccessful (Larzelere & Kuhn, 2005 ). Ferguson ( 2013 ), who also conducted a meta-analysis on the long-term impact of physical punishment, concluded that the negative effects, while statistically significant, are “trivial to small.” Researchers, he argues, “should take greater care not to exaggerate the magnitude and conclusiveness of the negative consequences.” Exaggerations “might easily backfire, decreasing the credibility of scholarly statements on parenting research overall” (Ferguson, 2013 , p. 204).In a definitive meta-analysis examining 50 years of research on outcomes associated with spanking, Gershoff and Grogan-Kaylor ( 2016 ) attempted to address two issues about the quality and interpretation of the spanking research, in particular. The first issue has to do with the potential confound between potentially abusive physical punishment and spanking. The second issue has to do with the assertion that physical punishment, including spanking, has only been linked to harmful outcomes in methodologically weak studies. Gershoff and Grogan-Kaylor analyzed 75 studies in the context of these two questions and found no evidence that nonabusive spanking is more effective than other disciplinary techniques at securing children’s immediate or long-term compliance. Indeed, they found that spanking was associated with increased risk of 13 harmful outcomes. Spanking and hitting children was a risk factor for adverse effects on such important outcomes as children’s aggressive behavior, mental health, and relationships with parents. Of all of the outcomes studied, physical abuse victimization was linked most strongly with spanking. Additionally, these researchers found no evidence that spanking is only associated with harmful outcomes in methodologically weak studies. Although not every incidence of spanking results in negative outcomes, the preponderance of evidence clearly suggests that it is ineffective and a risk factor for negative developmental outcomes.

Critics of this research argue, not unreasonably, that almost all of the research on harm and ineffectiveness is non-experimental, making causal connections difficult to establish. This research, they argue, cannot prove a causal link between spanking and harm. However, as defenders of the research remind us, much of the correlational evidence comes from studies that are statistically rigorous and use multi-variate models that attempt to control for extraneous variables. These studies have consistently documented that physical punishment increases the risk that children will experience harm or develop behavior problems, suggesting a causal pathway from parental physical punishment to negative developmental outcomes (Gershoff & Grogan-Kaylor, 2016 ; Gershoff, Sattler, & Ansari, 2017 ). Plus, defenders of the research argue it is neither feasible nor ethical, to randomly assign parents and children into experimental and control groups. As a result, pure experimental evidence on this issue will never be available. It is important to note that any number of public health and safety policy issues rest not on experimental but rather correlational evidence (e.g., see American Psychological Association, 2018 ).

Professional best practice standards suggest no physical punishment of children

In large part, the underlying cultural support for spanking and debates over the empirical evidence have undermined advocacy efforts to end physical punishment of children. As a result, advocacy and policy organizations have sometimes been reluctant to condemn, or even recommend against, spanking. For example, despite the American Psychological Association’s (APA) Code of Ethics, which obligates psychologists to “do no harm,” to safeguard vulnerable populations, and to protect individuals’ human rights (American Psychological Association, 2010 ), the organization has resisted the approval of a resolution opposing the use of physical punishment of children by parents. This is true despite the fact that the APA passed a resolution in 1975 opposing physical punishment in schools and other institutions based on far less empirical evidence than is currently available.

Of course, given the overwhelming cultural acceptance of physical punishment in the USA, such resistance on the part of professional organizations is in many ways predictable. As Straus ( 2010 ) notes, it took several years of bitter debate before the American Academy of Pediatrics was able to adopt a policy advising parents not to use physical punishment. According to Straus, the publication of this document required a compromise in wording to exclude hitting a child with an open hand, and the document carefully avoids suggesting that parents should never spank (American Academy of Pediatrics, 1998 ).

Professional attitudes, however, are changing rapidly. A survey of psychologists conducted 40 years ago found that the majority (51%) of those who worked with parents recommended spanking as a discipline technique (Anderson & Anderson, 1976 ). In contrast, 65% of a sample of APA members in 1990 reported that they had never recommended that parents spank their children (Rae & Worchel, 1991 ). By 2000, 70% of a sample of psychologists stated that they would never recommend that a parent spank a child (Schenck, Lyman, & Bodin, 2000 ). In a survey published in 2016, 86% of practicing psychologists indicated that they “never” advise a parent to spank a child with a hand (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted).

Other recent surveys suggest that the majority of mental health professionals, as well as other professionals such as physicians and child welfare personnel, do not support the use of physical punishment. In one study, three-fourths of professionals believed that spanking is a “bad disciplinary technique” (Taylor, Fleckman, & Lee, 2017 ). In Gershoff et al.’s ( 2016 ) study of medical center staff, only about 15% agreed that “sometimes the only way to get a child to behave is with a spank.” Similarly, Miller-Perrin and Rush (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted) found that only 15% of psychologists agreed that “sometimes the only way to get a child to behave is with a spank.” Furthermore, when this group of psychologists was asked whether spanking is a more appropriate part of parenting for some groups than others, such as some ethnic and religious groups, only 32% and 26%, respectively, agreed or strongly agreed. Many professionals are also changing their views about whether spanking represents an important ethical issue. In a survey of psychologists conducted in 2000, just one third of psychologists believed it was unethical to recommend that a parent use spanking. By 2016, that number had risen to 76% (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted). According to these studies, a majority of professionals who work with children believe that spanking should be avoided.

The tide of professional opinion has clearly shifted. Many US professional organizations dedicated to the welfare of children and families have issued statements in recent years recommending that parents refrain from using physical punishment with their children. These organizations include the American Academy of Child and Adolescent Psychiatry ( 2012 ), the National Association of Pediatric Nurse Practitioners ( 2011 ), and the American Professional Society on the Abuse of Children ( 2016 ), among others. The American Psychological Association may be next. Approximately 60% of APA division members believe that the APA should adopt both a policy opposing any use of spanking or physical punishment by parents/caregivers and a policy stating that its member should never recommend spanking or physical punishment (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted). This represents a significant shift in opinion from 2000 when approximately one-third of psychologists thought that APA should adopt such policies.

Over the last 50 years, the physical punishment of children has attracted considerable empirical attention from social scientists. This research suggests, overwhelmingly, that spanking does more harm than good (see Ferguson, 2013 ; Gershoff & Grogan-Kaylor, 2016 ; Gershoff, Sattler, & Ansari, 2017 ; Gromoske & Maguire-Jack, 2012 ). Physical punishment has also been acknowledged internationally as a violation of human rights (United Nations, 2015 ). In addition, many professional health organizations have called on parents to abandon physical punishment as a child disciplinary practice (e.g., American Academy of Child and Adolescent Psychiatry, 2012 ; American Academy of Pediatrics, 1998 ). Professional experts who work with children and families also overwhelmingly believe that spanking is a bad disciplinary technique, is harmful to children, is unethical to recommend to a parent, and would never advise parents to spank their child (Miller-Perrin C. & Rush, R: Attitudes, knowledge, practices, and ethical beliefs of psychologists related to spanking: A survey of American Psychological Association division members, submitted).

The time has come to move beyond contentious debates. The verdict is in: physical punishment does more harm than good and parents and professionals should act according to that which promotes children’s rights to health and well-being. The way forward will necessarily involve a number of approaches.

First, US culture can no longer hide behind euphemisms for violence. Physical punishment is hitting children and a form of violence against them.

Second, parents should be educated about the empirical research on hitting children and the merits and techniques of non-violent parenting. Several promising intervention strategies to reduce parents’ use of physical punishment have been evaluated and shown to be effective (Gershoff, Lee, & Durrant, 2017 ). One such program is ACT, created by the American Psychological Association ( www.apa.org/act/ ). The ACT program, which teaches parents and caregivers positive and non-violent parenting, has met with considerable success with research indicating that parents who participate in such programs report using physical punishment significantly less often (e.g., spanking and hitting with an object) and increasing their use of positive parenting practices (e.g., nurturing behavior) compared to parents in control groups (Knox, Burkhart, & Cromly, 2013 ; Knox, Burkhart, & Howe, 2011 ; Portwood, Lambert, Abrams, & Nelson, 2011 ).

Third, professionals need to be educated about the physical punishment research on outcomes and how to talk with parents about never using physical punishment. Professionals that should be targeted include all those who work with children and families such as health care providers, psychologists, child welfare professionals, teachers, child care providers, and religious leaders. Educating professionals on the physical punishment research has been shown to reduce positive attitudes toward it (Hornor et al., 2015 ) and increase the likelihood that medical staff would intervene if they observed physical punishment (Gershoff & Font, 2016 ).

Fourth, public health campaigns could be helpful in educating the general public about physical punishment, including media campaigns similar to those used to help prevent child abuse (public service announcements, billboard campaigns, etc.). Evidence suggests that such media campaigns can be effective at increasing awareness about the harm associated with physical punishment (Bussmann et al., 2011 ).

Fifth, increased advocacy for laws against spanking is needed. Research in countries like Sweden, which in 1979 criminalized spanking, suggests that criminalization led to large reductions in the use of physical punishment, especially severe physical punishment (Durrant, 2000 ; Durrant, Rose-Krasnor, & Broberg, 2003 ). Zolotor and Puzia ( 2010 ) studied 24 countries that have passed legislative bans and likewise concluded that both general support of physical punishment and actual use of physical punishment declined following the enactment of the ban. Such bans are effective in and of themselves in decreasing physical punishment but may be enhanced by campaigns to promote their awareness and to educate parents about alternative forms of discipline (Lansford et al., 2017 ).

Sixth, we must acknowledge the important role of unique cultural beliefs—such as religious beliefs—that create and maintain positive attitudes toward physical punishment of children. Interventions that are sensitive and respectful toward parents’ cultural views and values while attempting to change attitudes can be effective (Miller-Perrin & Perrin, 2017 ; Perrin et al., 2017 ).

Finally, researchers should continue to design studies that make causal assertions more reasonable (Gershoff & Grogan-Kaylor, 2016 ; MacMillan & Mikton, 2017 ). In addition, although the burden of proof in debates about physical punishment has typically fallen upon those who argue children should never be physically punished, perhaps it is time for a shift in perspective. Advocates opposed to physical punishment of children have been asked, essentially, to provide empirical evidence that spanking does more harm than good. Perhaps, it is time to place the burden of proof on the defenders of physical punishment and ask the defenders of physical punishment to provide empirical support that spanking does more good than harm.

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Miller-Perrin, C., Perrin, R. Physical punishment of children by US parents: moving beyond debate to promote children’s health and well-being. Psicol. Refl. Crít. 31 , 16 (2018). https://doi.org/10.1186/s41155-018-0096-x

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“Reach Out, Not Harm”: Navigating between Physical Punishment and Alternative Strategies in Addressing Student Discipline Challenges for a Positive Learning Environment

Based on the interpretivist ontological assumption that teachers and students hold unique positions regarding school discipline, this study explores their perspectives on using physical punishment and alternative strategies to address challenging discipline problems. 20 teachers (with more than 5 years of teaching experience) and 20 students (aged 16-18 years old) from a secondary school in Indonesia who were identified through purposeful snowball sampling were engaged via semi-structured interviews and an open online survey to capture their perspectives.  Data were thematically analysed following Newton’s (1980) comparison of school discipline models to reveal both parties to be in favour of alternative discipline strategies because physical punishment was deemed to have adverse effects and does not educate. The alternative disciplining strategies proposed by the teachers and students match with the characteristics of the following models:  Individual fulfilment (approach students, dialogue and negotiation), scholarly discipline (strict adherence to school rules, consistency in rule enforcement, teacher as a role model); and educational technology (reminders of school rules, progressive disciplining process).  The “fair disciplining” theme in the students’ data had no model fit. Meanwhile, no evidence suggests inclinations toward the social reconstruction model of school discipline. This study provides a glimpse into the diverse disciplining strategies which are the result of a bottom-up inquiry for addressing students’ challenging behaviours to cultivate a positive learning environment.

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Children’s experiences of corporal punishment: A qualitative study in an urban township of South Africa

Alison breen.

1 Department of Psychology, Stellenbosch University, South Africa

Karen Daniels

2 Health Systems Research Unit, South African Medical Research Council, South Africa

Mark Tomlinson

Associated data.

Exposure to violence is a serious mental and public health issue. In particular, children exposed to violence are at risk for poor developmental outcomes and physical and mental health problems. One area that has been shown to increase the risk for poor outcomes is the use of corporal punishment as a discipline method. While researchers are starting to ask children directly abouttheir experiences of violence, there is limited research with children about their perspectives on physical punishment, particularly in low-and middle-income countries (LMIC). This paper begins to address this gap by reporting on the spontaneous data that emerged during 24 qualitative interviews that were conducted with children, aged 8–12 in South Africa. The themes that emerged indicated that corporal punishment is an everyday experience, that it has negative emotional and behavioral consequences, and that it plays a role in how children resolve interpersonal conflicts. The study highlights the challenges for violence prevention interventions in under-resourced contexts.

Introduction

There is a considerable literature documenting the detrimental effects of exposure to violence on children ( Finkelhor, Turner, Shattuck, & Hamby, 2013 ; Shonkoff, Boyce, & Mcewen, 2009 ). Child maltreatment, peer victimization, and exposure to family and community violence have been repeatedly demonstrated to be associated with developmental difficulties, problem behavior, and a range of physical and mental health effects, extending throughout the lifespan ( Bensley, Van Eenwyk, & Wynkoop-Simmons, 2003 ; Danese et al., 2009 ; Sachs-Ericsson, Blazer, Plant, & Arnow, 2005 ; Widom, DuMont, & Czaja, 2007 ).

There are challenges facing preventative efforts to decrease children’s exposure to violence and abuse ( Betancourt, Meyers-Ohki, Charrow, & Tol, 2013 ). One of these areas is the use of corporal punishment as a discipline method ( Asawa, Hansen & Flood, 2008 ). The association between the use of corporal punishment at home and at school and poor child outcomes has been demonstrated ( Gershoff, 2013 ), including mental health problems and later aggressive behavior ( Hecker, Hermenau, Isele, & Elbert, 2013 ; Ma, Han, Grogan-Kaylor, Delva, & Castillo, 2012 ). The use of physical discipline methods has also been shown to increase the risk for more severe forms of abuse ( Meinck, Cluver, Boyes, & Mhlongo, 2015 ). Corporal punishment continues to be prevalent in many countries around the world, both in the home and in schools ( Akmatov, 2011 ; Hecker et al., 2013 ). In a report on corporal punishment in 35 low-and middle-income countries (LMIC), 6 of the 10 countries in which corporal punishment was found to be very prevalent are in Sub-Saharan Africa with more than 80% of children in these countries reporting being beaten at home (UNICEF, 2010).

While the use of corporal punishment is often attributed to individual causes, such as the characteristics of the child or parent/teacher, it is equally important to understand the societal enablers ( Straus, 2010 ). At a societal level, cultural norms approving violence, legality of corporal punishment in homes and schools and cultural beliefs about the necessity and effectiveness of physical punishment, can contribute to corporal punishment use. Thus the nature of the society raises or lowers the probability that a parent or teacher hits a child to correct misbehavior ( Straus, 2010 ).

Researchers who investigate corporal punishment, frequently include questions in their studies that ask parents about their attitudes and experiences ( Dawes, Kropiwnicki, Kafaar, & Richter, 2003 ), focusing on the effectiveness of discipline measures from the parent’s point of view ( Vittrup & Holden, 2010 ). Increasingly, there is a recognition of the importance of eliciting children’s views about their experiences ( James, 2007 ). This is particularly important in the case of corporal punishment, as, when children are asked about their experiences, there are often discrepancies with parental reports ( Vittrup & Holden, 2010 ). Studies where researchers investigate discipline measures solely from the parents point of view lead to an incomplete picture, as children and parents often interpret events differently ( Vittrup & Holden, 2010 ). Discrepancies have been found in how children and parents define spanking ( Dobbs & Duncan, 2004 ; Willow & Hyder, 1998 ), with parents defining it as “a gentle tap or a loving smack”, whereas children defined it as a “hard hit” or a “very hard hit” ( Dobbs & Duncan, 2004 , p. 376). Many children also report that parents usually hit when they were very angry, however the parents report that they do not hit while angry ( Dobbs & Duncan, 2004 ). In order to get a more complete picture of the context and experiences of discipline, it is important to understand children’s perspective.

When children are asked about their experiences of corporal punishment, many report being hit with objects ( Beazley, Bessell, Ennew, & Waterson, 2006 ; Dobbs, Smith, & Taylor, 2006 ). Several studies in which children were interviewed report that these children do not agree with the use of physical punishment as it causes physical and emotional pain ( Dobbs et al., 2006 ; Saunders & Goddard, 2007 ; Willow & Hyder, 1998 ) and that it is the least fair discipline method, when compared to other methods such as reasoning, time out and withdrawing privileges ( Vittrup & Holden, 2010 ). Children also show high levels of confusion in trying to make meaning of their parents actions and their own views about corporal punishment ( Dobbs, 2007 ), with some children expressing strong negative feelings toward the adult who hit them ( Gershoff, 2002 ).

There is a dearth of research from LMIC on children’s experiences in contexts of violence and adversity. The present study aimed to contribute to increasing this yield. The aim of the study was to elicit children’s experiences of daily life in South Africa, a country facing a significant burden of morbidity and mortality arising from violence and injury ( Seedat, Van Niekerk, Jewkes, Suffla, & Ratele, 2009 ). While the interview guide did not contain questions pertaining to corporal punishment, it emerged as a major content area during the analysis of the children’s narratives. In light of this, the focus of this paper is on children’s experiences of corporal punishment.

Study Setting

The study was conducted in Khayelitsha, a peri urban township near Cape Town, with an estimated population of approximately 400,000. Housing is both formal and informal (homes which consist of shacks, either in a formal dwelling backyard, or as a stand-alone structure), unemployment levels (at 38.2%) ( SDI & GIS, 2013 ) considerably higher than the national average of 24.3%. 74% of households are estimated to have a monthly income R3200/month or less (approximately $280) ( SDI & GIS, 2013 ). Many residents do not have access to running water, electricity and sanitation. There are high levels of violence and crime, however this is not the area with the highest crime rates in Cape Town ( Crime Stats SA, 2014 ). In 2014, there were 233 sexual crimes reported in Khayelitsha, 144 attempted murders, 687 assaults with intent to cause grievous bodily harm, 774 common assaults, and 1,185 reported robberies with aggravating circumstances ( Crime Stats SA, 2014 ).

Study Design and Sample

In this qualitative study, in-depth interviews were conducted with 24 Xhosa speaking children (11 boys and 13 girls), aged 8–12 years old (mean = 9.4 years) living in and attending school in the same setting. Forty six percent lived with their mothers and fathers (45.8%), 33.3% lived with their mothers but not their fathers, and 20.8% lived with other relatives such as grandparents and aunts. The children had been zero to 5 siblings (mean = 1.6) and the mean number of other children living with the children in the sample was 2.0. Sixteen percent (15.9%) lived in households where three household members were working, 29.1% had two members who worked, 20.8% had 1 household member who worked, 8% had household members on social support grants, and 25% appeared to have no means of formal income. Three primary schools, which served children from different areas of Khayelitsha were selected as sample sites. All three schools were no fee, under-resourced and overcrowded facilities, with over 1,000 children registered. There were up to 6 classes per grade and between 40 and 50 children per class to one teacher. One school primarily served an area where the children lived in informal dwellings, one where most of the children lived in formal dwellings, and the final school served children in both formal and informal dwellings. Children from these schools were invited to participate, using a purposive sampling process. Permission to do research at the schools was sought from the provincial education authority, and from the schools’ principals. The researcher and interviewer then met with the teachers of the relevant grades to explain the study aims and process. We asked the teachers to include children who they would describe as “good”, “bad” and “troubled” in the sample, in an attempt to ensure that teachers did not over select from one group. Consent forms were then sent home with the children for their caregiver’s to sign and return. However, in the end, the only sampling criteria that was relevant was the return rate of the consent forms with parental authorization. Return rates of forms sent home from school were reportedly very poor and so in order to ensure a sample of at least 20 children, 40 consent forms were sent home, 24 of which were returned by the caregivers with their signed authorization to take part in the interviews.

Ethical Approval and Issues

Ethical permission was granted by the Stellenbosch University Ethics Committee (N10/02/058). Permission to conduct research with school learners was also granted by the Western Cape Department of Education and all school principals. All of the children provided written assent in addition to written informed consent from their caregivers.

The interviewer was trained in emergency procedures in the event of children becoming upset or distressed, and in the case of abuse being reported or suspected. As reporting of suspected or confirmed abuse is mandatory in South Africa, the interviewer was to make contact with AB if she identified a case. Children were given a number of the local social services if it was suspected that it was necessary.

Data Collection

The interviews were conducted between June and July 2010. The firsttwo interviews served as a pilot and were conducted at a community support center in the setting. The remaining twenty-two interviews were conducted atthe children’s schools. The decision to conduct the interviews at school was based on both convenience and child safety, so that the children would not have to travel unescorted from the school to the venue and be exposed to risk on the way. The interview was conducted in a private room that ensured complete confidentiality. Each interview lasted between 30 and 45 min. Children were given the choice of participating in which ever language they felt comfortable. All of the children chose to have the interviews conducted in Xhosa. The interviewer was a Xhosa speaking woman in her mid-20s, with extensive experience in qualitative interviews with children. The interview guide included questions about children’s experiences at home, at school and in their communities ( Web Appendix A ). Questions were open ended, leaving room for other areas to be explored that had not been included in the interview guide.

Prior to starting the interviews, the interviewer received further training from AB in qualitative data collection techniques, interviewing children and the interview guide. AB was present during the pilot interviews. But after this it was decided that the children would feel more comfortable in the remainder of the interviews with only the interviewer present. The interviewer explained that the children were participating voluntarily, that the information was confidential, and that they could terminate the interview at any time. At the end of the interviews, the children received age-appropriate World Cup memorabilia (the interviews took place during the 2010 FIFA World Cup in Cape Town). As the sample had been predetermined, this did not affect the sample and children had not been told before the interviews that they would be receiving the incentive.

The interviewer and AB met after each data collection day to discuss the interviews and emerging themes and adjust the interview guide if necessary, using a constant comparison approach to data collection and preliminary analysis ( Glaser, 1967 ), and the data appeared to be saturated for the study purpose, as described by Bowen (2008) .

Data Analysis and Validation

With permission, the interviews were audio-taped. They were then translated and transcribed verbatim into English by an experienced bilingual translator. In order to check the accuracy of the transcripts the transcripts were reviewed by the interviewer and researcher before being analyzed. Memos (reflexive notes about interviews) and field notes were attached to the interviews. These translated transcripts were analyzed by AB using the content analysis approach ( Graneheim & Lundman, 2004 ). The analysis started with data immersion, with AB reading all of the verbatim transcripts in order to get an understanding ofthe whole, followed by further re-reading with annotations in relation to study aims and research question. The data were then illustrated diagrammatically in order to visually map the initial categories. The text was then divided into meaning units which were labeled with a code. These codes were created by staying close to text, in regular consultation between AB and KD. This was followed by the development of themes and subthemes. Data were continuously compared in order to triangulate and validate the results ( Braun & Clarke, 2006 ). The research team, with experience in qualitative health research, child development and public mental and physical health (AB, KD and MT), met regularly to organize and discuss the emerging themes, and for KD and MT to verify AB’s analysis The results are presented below using data extracts to illustrate key themes. All names have been changed to protect the children’s identity, and any names which appear in the text are made up. The number at the end of each extracts is the respondent’s gender, age and participant number.

Analysis of the content related to corporal punishment revealed 3 themes. Corporal punishment (1) is an everyday experience, (2) has negative emotional and behavioral consequences, and (3) plays a role in how children resolve interpersonal conflicts.

Corporal Punishment is an Everyday Experience

Corporal punishment emerged as an everyday reality for the children. They were either the recipient of physical discipline methods at home or school, or they witnessed the use with siblings at home or with peers at school. Other family members such as older siblings and aunts and uncles were also involved in administering corporal punishment, in most cases, in addition to the primary caregivers.

Thirteen of the children (boys = 5, girls = 8) spoke about their parents or caregivers use of corporal punishment. In three cases, children spoke about their caregiver’s use of corporal punishment as either the first thing they mentioned, or very early on in the discussion.

One children responded to the question: “Tell me about your grandmother?

“My grandmother is the kind of person who hits” (G, 10yr, 20).

Another child, when asked about what he liked about his mother, responded:

“It’s beating me…. it’s being beaten, that’s what I don’t like” (B, 9yr, 2).

The type of transgressions for which they were beaten included returning home late, not doing chores, breaking things by accident and fighting with siblings.

“She’s [mother] been beating me for a long time…[for] doing wrong…when I had played with her cosmetics and spilt them” (B, 8yr, 22). “[She beats me] when I mess up…maybe when I take her tea while she is drinking it” (G, 8yr, 5).

The use of objects in the beatings such as belts, whips, towels and shoes were common.

“If you don’t do that [arriving home by curfew] you get scolded or you get a beating…. you get beaten with a belt” (G, 12yr, 12). “I get beaten up when I bring friends home, with a towel or a belt” (G, 10yr, 20).

It was not only primary caregivers that delivered the punishment. Older siblings, aunts, uncles or grandparents, would also use physical methods, in some cases in addition to parents.

“He [grandfather] hits me on the head [when] I forget to sweep away food”. (B, 8yr, 22).

While two children denied that they themselves were beaten, they described how their siblings were. These two boys reported that their mothers would use corporal punishment with their younger siblings, but not with them.

Although most of the narratives involved children’s own experiences of being punished in the home, two spoke about their friend’s experiences. One girl described how her friend was beaten by her mother when she missed the bus and didn’t tell her teacher.

“She missed the bus, and she stayed at school and her mother went to look for her……. and she saw her and she asked her why she didn’t ride in the teacher’s car, why she didn’t tell the teachers that she missed the bus and she said, she didn’t say anything and kept quiet and then at home she got a beating” (G, 9yr, 3).

While corporal punishment was common at home, 19 children (girls = 10, boys =9) spoke about their teachers’ use of corporal punishment at school. Similar to when asked about their homes, two of the children immediately spoke about their teacher’s use of corporal punishment when asked the question “Tell me about your school, what kind of school is it?” “[At] my school, when a child doesn’t listen they get beaten up…with a stick (B, 10 yr, 14)”.

Another responded:

R: “Oh, they beat you at this school”. I: “Who is that?” R: “The teachers and the mistresses.” (B, 9yr, 17).

The type of transgressions that led to corporal punishment included coming in late from break, not doing school or homework, bringing cell phones to school, not listening to teachers, not knowing the answers or making mistakes, and making a noise during class.

“Miss came and beat me, she asked me why I hadn’t done the homework and I said that I forgot it” (G, 10yr, 15).

Teachers were also described as using objects such as sticks, planks (small thin pieces of wood), pipes, and belts in administering the punishment.

“Miss hits with anything, including a plank” (G, 9yr, 9).

When asked about teachers at school who were good or helpful, 5 children also described good teachers as not beating at all or as much as the other teachers.

“She is kind…. she doesn’t hit too much like the other Miss…… she doesn’t often do this thing of saying “hey, come here” and beat you when you do something wrong”. (B, 10yr, 14). “When they are teaching they want you to answer, but they want you to answer even if it’s the wrong answer because they say you will not be beaten” (G, 8yr, 1).

This was in contrast to other teachers.

“There is one ma’am there on some days would slap you in the face…. if you don’t write your work she will slap you” (G, 9yr, 3).

Teachers also used corporal punishment as a discipline measure to deal with children who bullied or stole things from other children.

“They took away his food… he reported to the mistress… the miss bought a stick and beat him [the one who stole the food]” (B, 8yr, 8).

Negative (Emotional and Behavioral) Consequences of Corporal Punishment

The emotional and behavioral consequences of being beaten, in many cases, were negative. Feeling sad was a common response to being beaten at home for not doing their chores.

“She [my mother] beats me and I cry and I become sad” (G, 9yr, 9).

Sometimes children would think of how they wouldn’t be beaten if the circumstances were different.

“I sit and think, and think of my mother [who had passed away], if she was here this wouldn’t happen” (G, 11yr, 7).

Children had different ways that they coped with their feelings after being beaten. Some described seeking comfort from older sisters or aunts who would comfort them, while one reported that her mother would comfort her after beating her.

“When I cry – when she beats me she also comforts me” (G, 9yr, 16).

While some children would be comforted by these people, other caregivers would respond by retaliating (or threatening to retaliate) against the parent who had administered the punishment. One girl would tell her father after her mother beat her. He father’s response was to tell her he would beat her mother, but she didn’t believe him:

“He tells me that he is going to beat her, and yet he is lying” (G, 9yr, 16).

Being left to manage their feelings alone was one consequence for children who did not have people to approach for comfort. Going to sleep, going out or just keeping quite were some of the ways they tried to cope.

“She [aunt] beats me when I didn’t sweep…. I cry and then keep quiet” (G, 10yr, 11).

Anxiety at the anticipation of being beaten was another emotional consequence of being beaten. One of the effects of this anxiety was that some children did not ask their caregivers for help when they needed to.

“If I had fought with another child I am afraid to tell my father, it’s like he will beat me or insult me” (G, 10yr, 18).

One girl described how her fear of being shouted at prevented her from asking for her grandmother, her primary caregiver, to escort her to go to the bathroom at night. The toilet was situated out of the house and therefore she stayed in bed. She reported how she had wet her bed and was then afraid of telling her grandmother for fear of being beaten. She described the incident:

“Because – because when I peed on the bed…. I was pressed and it was at night at I was afraid…. I was unwilling to wake her [grandmother] up…. I was unwilling because she would shout at me. Q. Okay so what happened then, when you woke up having wet your bed, what did she do to you? She beat me” (G, 9yr, 3).

While sadness was the most common described emotional response to being beaten at home, anxiety at the prospect of being beaten was more prevalent at school. When asked about what worried them in their lives in general, many children reported worrying about being punished at school.

“It sometimes happens when someone is going to get beaten, I become anxious as if I am the one who is going to be beaten”. (G, 8yr, 5). “When I do not do my homework I fear that I will be beaten” (G, 10yr, 15).

Although sadness was reported far less commonly, a few children did describe feeling sad after being beaten at school.

“I cry and then keep quiet…… because no one will comfort me” (G, 10yr, 15).

Copying each other’s homework was one of the strategies that children described as a means of avoiding being beaten.

“We say, “hey did you write the English homework?” and she says no, and we then say “we are going to get a beating” and she says “please help me copy it” and we help her copy” (G, 10yr, 6).

Corporal Punishment by Parents and Teachers Plays a Role in How Children Solve Interpersonal Problems

Corporal punishment use by teachers and caregivers played a role in how children solved their interpersonal difficulties. At home, disputes between siblings over possessions such as toys or school books could end with the older sibling telling the parent. The parent would then beat the younger sibling.

“Siya [5 year old brother] takes my school things and throws them away……I report him [to mother]……She beats him up” (B, 8yr, 22).

There were far more examples of this relationship at school. Monitors (children who were appointed by the teacher to report children who made a noise in class) would threaten making false allegations which would lead to their classmates being beaten if they did not do what the monitor asked of them. One girl described an incident at school where her friend who was a monitor forbade her from sharing her apple with another one of her friends. The monitor threatened that she would write her name on the board so she would be beaten if she shared her apple with the other friend.

“When we fight sometimes she writes me down… then she said I will see, I will also write you [write your name on the board], I will show you” (G, 9yr, 3).

Reporting peers to teachers for bullying was another way that children used to solve problems.

“We were playing skip and rope where you count and then whisper to someone else, and then we were playing with another child, now I was counting and then he beats me and says I should not count, I am making noise. I went to report him to the teacher and the teacher beat him with a pipe” (G, 9yr, 3). “I do not fight, I let a person hit me and then report him …. I don’t feel hurt, I just laugh at them because I know I am going to report him” (B, 10yr, 14).

Finally, the wish to be able to beat other children the way they had been beaten emerged. One child expressed the wish to be a teacher when she grew up.

“I also want to beat the children, because I too was beaten when I was young” (G, 9yr, 16).

Despite not being an area specifically addressed by the interview guide questions, the use of corporal punishment by teachers and caregivers emerged as a key experience in these children’s lives, and in some cases, was the first thing that they spoke about when asked broad questions about their caregivers and schools. The ubiquity of corporal punishment by parents in these children’s lives is in line with global findings (UNICEF, 2003). The prevalence of our participants’ experience of corporal punishment at school is also in line with findings from rural and poor schools in South Africa ( Kipperberg, 2007 ; Ward, 2007 ), as well as other countries in Africa ( Hecker et al., 2013 ; Slonim-Nevo & Mukuka, 2007 ).

Many of the children in this study report commonly being hit with objects like belts, whips and planks, both at home and at school for minor transgressions, similar to reports in other studies ( Hecker et al., 2013 ; Sanapo & Nakamura, 2011 ). This places them at an increased risk for physical abuse ( Zolotor, Theodore, Chang, Berkoff, & Runyan, 2008 ), in a country where the rates of child physical abuse are already very high (Meinck et al., 2014), with some studies indicating prevalence rates as high as 19% ( Madu, 2003 ) and 43% for orphan and other vulnerable children ( Thurman & Kidman, 2011 ).

While the children in this study did not disclose experiences of injury as a result of beatings, it is possible that physical abuse and injury as a result of beatings are only reported in severe cases ( DSD, DWCPD & UNICEF, 2012 ). Beliefs about the necessity and appropriateness of corporal punishment play a key role in determining whether any resulting injury is perceived as abuse ( Gracia & Herrero, 2008 ). The children in this study did not express their views about whether they believed that it was necessary or appropriate, but many did highlight a sense of responsibility for having beating beaten, the result of them having done something wrong or in the very least as their own fault. This may reflect that, despite them not liking being beaten, they see it as appropriate similar to views reported in previous studies ( Simons & Wurtele, 2010 ). While the children did not report physical injury as a result of corporal punishment, they did report what might be described as emotional injury. The sadness and anxiety that they experienced when exposed to corporal punishment at home and at school, as reported in others studies ( Dobbs, 2007 ; Sanapo & Nakamura, 2011 ), often led to children in the study avoiding asking their caregivers for help. Children’s attachment relationships are key protective factors for positive outcomes in adverse contexts ( Masten, 2011 ). Damage to the parent–child relationship is a well-established outcome of exposure to corporal punishment ( Gershoff, 2002 ), and our data showed how this impacts on how children make use of potential resources. Previous research has shown that the painful nature of corporal punishment can evoke feelings of fear, anxiety, anger in children, which, if generalized to the parent can lead the child to avoid and be fearful of their parent ( Gershoff, 2002 ). As reported above, in some cases, punishment was as the first thing that came to mind when discussing their relationship with the adults in their lives. This has implications for children’s brain development in contexts of chronic stress. When children’s stress response systems are frequently activated without the buffering protection of adult support, the resulting experience of toxic stress disrupts their brain architecture, placing them at risk for stress-related disease and cognitive impairment ( Shonkoff et al., 2009 ).

At school, children were more trusting of teachers who did not make use of, or were less frequent users of corporal punishment. The accounts given by the children in this study shows that children may even put themselves at risk to avoid corporal punishment, like going to the toilet unaccompanied in the middle of the night, as for many children, toilet facilities are either on their property in a separate building, or in a communal area. If these children were able to feel safe in their relationships with their primary caregivers, and able to ask for help when they needed it, this could help mediate the effects of their exposure to violence in other areas such as their neighborhoods ( Shields, Nadasen, & Pierce, 2008 ).

Children who are exposed to corporal punishment are more likely to use aggressive conflict resolution strategies with the siblings and peers ( Simons & Wurtele, 2010 ). The children’s narratives showed how they would use their parents’ and teachers’ use of corporal punishment as a way of resolving interpersonal conflict, at times even fabricating problems so that others would be beaten. This is consistent with social cognitive theory which highlights the role of observational learning, through both direct and vicarious experiences ( Bandura, 1986 ). When children see the adults in their lives using physical methods, they are more likely to view it as normative ( Vittrup & Holden, 2010 ).

Implications for Interventions and Future Research

South Africa illustrates the complexity of implementing policy changes in the absence of other structural changes. The SouthAfrican SchoolsAct of 1996 outlawed corporal punishmentin schools. Yet, the practice of corporal punishment persists. South Africa is a highly inequitable society and this inequality is reflected in the education system ( Spaull, 2013 ). The middle class, formerly white schools no longer use corporal punishment as a discipline method ( Morrell, 2001 ). However, in poor and rural schools its use is still common practice ( Maphosa & Shumba, 2010 ). In these schools, classrooms are overcrowded and under-resourced, and teachers are often under-qualified and overworked ( Makgato & Mji, 2006 ). There are also huge problems with violence by learners toward other learners and teachers, and teachers feel ill-equipped with viable alternative discipline methods to maintain a safe and secure environmentto facilitate learning ( Maphosa & Shumba, 2010 ). Other factors which have been indicated to play a role in the on-going use of corporal punishment include the legacy of authoritarian education practices and parental use and support of its use at school ( Morrell, 2001 ).

Campaigns for the prohibition of corporal punishment in the home are ongoing in South Africa, as well as other African countries including Angola and Tanzania ( PAN: Children, 2012 ). Corporal punishment in both the home and school are prohibited in five African countries (South Sudan, Kenya, Tunisia, Tongo and the Democratic Republic of Congo) ( PAN: Children, 2012 ).

Child rearing attitudes are rooted in cultural discipline practices, which either favor corporal punishment as appropriate or not ( Bell & Romano, 2012 ). Where corporal punishment is seen as appropriate it may also be deemed necessary and viewed as a way to protect children from danger ( LeVine et al., 1996 ). Many of the children in our study reported being beaten when they came home after their curfew. Being out after dark places them at high risk for exposure to other forms of violence, and parents may believe that using corporal punishment is what they need to do to keep children safe. Parental use of corporal punishment is also associated with lower economic status and large household number ( Vittrup & Holden, 2010 ).

Parents are also more likely to use corporal punishment if they themselves were exposed during their own childhood ( Gage & Silvestre, 2010 ). While we did not interview these children’s parents, we can hypothesize based on our experience as authors, of growing up in vastly different South African settings, that it is likely that they also were recipients of corporal punishment. Mothers who have been exposed to physical and emotional violence in their current relationship or with someone else, also have a significantly increased risk of using corporal punishment with their children ( Gage & Silvestre, 2010 ). Again, we can hypothesize, given the high levels of interpersonal violence in South Africa ( Kaminer, Grimsrud, Myer, Stein, & Williams, 2008 ) that many of these mothers have at some stage experienced some form of abuse, and that within cramped living conditions their children are likely to have been witness to this.

Advocates of ending corporal punishment suggest policies which make the use of corporal punishment illegal ( Lansford & Dodge, 2008 ; Zolotor & Puzia, 2010 ). However, as this study illustrates, the case is more complex. While programs that help parents and teachers develop alternative methods of discipline are effective and needed, given the prevalence of the practice, it is unlikely that these will have much impact in the absence of policy changes and interventions targeting change of a broader societal level (A Dawes, Kropiwnicki, Kafaar, & Richter, 2005 ; Lansford & Dodge, 2008 ). Potential interventions need to target the people who influence parents around corporal punishment use such as religious leaders, and educate parents, teachers and the general public around the high risk/benefit ratio of using corporal punishment, in order to have an impact on social and cultural norms ( Lansford & Dodge, 2008 ; Taylor, Hamvas, Rice, Newman, & DeJong, 2011 ).

Our study has a balance of strengths and limitations. The children were purposively sampled and we may therefore not have accessed children who were severely abused. The interviews were also conducted with an adult interviewer in the school environment. We took care to create an environment where the children would feel comfortable, with the interviewer being sensitive to the children’s needs. Our choice of interviewer had advantages and disadvantages. As a young women, who spoke the same language and lived in the same area as the children, she was more likely to have been seen as an older sister figure than a teacher or parental authority figure, and therefore facilitated trust. However, in spite of training and experience in interviewing children, she came across at times as judgmental. For example, in one case a girl spoke about being beaten by her father for breaking something from his car. Her response could have given the child the message that it was appropriate for her to be beaten as she had been the one to take the item from the car. Another potential limitation was the translation from Xhosa into English. Although measures were taken as described in the methods section, language nuance and specific meanings may have been lost. For instance, the word “beating” may cover a wide range of behaviors, however, in discussion with the interviewer and translator, the English word beating does have resonance with the Xhosa words the children used. Despite these limitations, the children were able to express themselves and share their experiences openly, giving us insight into their world from a perspective that is not commonly accessed. The research team brought different perspectives, and engaged in a process of constantly questioning interpretations. During the data analysis, it was easy to become overwhelmed by the sadness of these stories, but having three people to work with, two of who were more distant from the data, helped bring perspective so that we could consider the public health implications and not be drowned by the narratives.

The study highlights the importance of speaking to children directly about their experiences. This methodology also has potential in being used as part of advocacy and change interventions.

It is suggested that future research is needed to develop sensitive methods to explore and measure trends of corporal punishment in South Africa.

There is a dearth of good quality data on the prevalence of corporal punishment in South Africa, and this knowledge gaps weaken efforts to develop viable interventions to address this form of violence against children ( Dawes et al., 2005 ). Given that discrepancies exist between adult and child reports of corporal punishment( Vittrup & Holden, 2010 ), eliciting children’s experiences helps provide a more complete picture of what is happening in their everyday lives. Further research is needed to build on this study, to understand more about children’s experiences in other contexts as well as develop child-centered, sensitive methodologies to explore these issues. Research with parents, teachers and other key role players is also needed to understand their experiences and the beliefs that maintain this practice.

Supplementary Material

Acknowledgments.

This research was supported by NIH/NIAAA (R24 AA022919), the National Research Foundation, South Africa, the Harry Crossley Foundation and the South African Medical Research Council.

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