Physical punishment and lifelong outcomes in low‑ and middle‑income countries: a systematic review and multilevel meta-analysis

Abstract

Research from high-income countries has found negative outcomes associated with physical punishment. Yet, the extent to which such research evidence generalizes to children in low- and middle-income countries (LMICs) is largely unknown. The objective of the current pre-registered study (PROSPERO: CRD42022347346) was to conduct a meta-analysis of the associations between childhood physical punishment and individual outcomes in LMICs. We identified eligible articles by searching for keywords related to physical punishment in six languages across 11 databases, with search periods from April to August 2021 and June to July 2024. This process yielded 5,072 unique records, of which 189 studies, comprising 1,490 unique effect sizes and representing 92 LMICs, met our inclusion criteria. Findings from random-effects multilevel meta-analyses indicated that physical punishment was associated with detrimental outcomes, including mental health problems, worse parent–child relationships, substance use, impaired social–emotional development, negative academic outcomes and heightened externalizing behaviour problems, among others. Despite some variation by contextual and study-level characteristics, all subgroup estimates were consistent in direction. Sensitivity checks indicated that these findings were not typical of other non-violent methods of discipline but were specific to physical punishment and psychological aggression. The analysis confirmed that physical punishment is associated with detrimental outcomes for individuals in LMICs. Additional research is needed to inform the design, implementation, and evaluation of policies and interventions to prevent the physical punishment of children and adolescents worldwide.