Adolescent childbearing and women's attitudes towards wife beating in 25 sub-Saharan African countries

Factors Associated with Adolescent Pregnancy in Sub-Saharan Africa during the COVID-19 Pandemic: A Review of Socioeconomic Influences and Essential Interventions

Objective: A literature review was conducted to analyze the impact of COVID-19 on documented preexisting determinants of adolescent pregnancy in sub-Saharan Africa such as poverty, inequitable gender norms, low access to education, and reproductive health services. Methods: The terms "sub-Saharan Africa," "Gender Norms," "Poverty," and "Adolescent Pregnancy" were used to search the literature for preexisting determinants of adolescent pregnancy in academic and grey literature. "COVID-19" was added to investigate the potential consequences of the pandemic. The literature revealed similar experiences in adolescent girls during the Ebola outbreak, which lead to the analysis of government and healthcare official responses to previous epidemics. Results: The literature review revealed that the relationship between identified micro (inequitable gender norms, transactional sex, sexual and gender-based violence, early marriage, and menstruation) and macro (poverty, education, and healthcare) factors contributing to adolescent pregnancy were exacerbated by the COVID-19 pandemic. Conclusion: Three realistic targets including, expanding and communicating available reproductive health resources, prioritizing the role of women in the economy, and ensuring return to school should be included as part of current COVID-19 mitigation programs. Additionally, these interventions should be incorporated in future public health preparedness plans to reduce the risk of adolescent pregnancy during public health emergencies.

Tuition-free secondary education and women's attitudes toward intimate partner violence: Evidence from Sub-Saharan Africa

Intimate partner violence against women (IPVAW) is devastatingly common around the world. It rose further during the pandemic, increasing the urgency of finding interventions to prevent IPVAW and supporting women's ability to exit violent situations. Interventions that prevent violence and eliminate views among perpetrators that violence is acceptable should be top priority. It is also critical to study women's attitudes toward IPVAW as these shape women's responses to the abuse and their exit options. Moreover, research shows that these attitudes have a direct impact on women's health outcomes. We examine the effect of tuition-free secondary education on women's attitudes toward IPVAW across 29 Sub-Saharan African countries using data from the Demographic and Health Surveys conducted between 2000 and 2019. Using the difference-in-difference-in-differences strategy, we estimate the change in women's attitudes toward IPVAW in countries that implement tuition-free secondary policy compared with countries with tuition-free primary alone and those without any tuition-free policy during the study period. We find that while tuition-free primary education policy alone did not reduce the probability of IPVAW being perceived as justified, tuition-free secondary reduced it significantly. The probability that IPVAW was perceived as justified under at least one circumstance declined by 5.3 percentage points more on average in countries that adopted tuition-free policy up to the secondary level relative to those that adopted only up to the primary level. Tuition-free secondary affects four of the five circumstances under which IPVAW was perceived as justified — if she goes out without telling the husband, argues with him, neglects children or refuses sex. We observed no declines for when she burns food, suggesting different factors affecting this outcome. Our findings underscore the importance of making a stronger commitment toward policies that make secondary education more accessible to not only benefit education outcomes but also advance population health.

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Intimate Partner Violence against women (IPVAW) is on the rise globally.

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We examine tuition-free education policy's effect on women's attitudes toward IPVAW.

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Our study exploits variation in the timing of policy rollout in Sub-Saharan Africa.

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Tuition-free primary policy alone did not affect women's attitudes toward IPVAW.

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Tuition-free secondary reduced the probability of IPVAW being perceived as justified.

"A Slap of Love": A Way of Showing Love and Resolving Conflict Among Young People in South Kivu, Democratic Republic of Congo

This article draws on qualitative study to examine Congolese male and female high school students' attitudes toward intimate partner violence. A total of 56 boys and girls aged 16-20 years from two urban and two rural high schools in South Kivu province took part in focus groups, and 40 of these were subsequently interviewed individually. To the majority of male and female participants, when the man or boy beats his wife or girlfriend that means he loves her and he wants her to change. They believed that if a boy does not love her, he may let her go on making mistakes. Some male participants viewed women and girlfriend beating as a way to let her realize her inferiority. However, some female participants disagreed with these assumptions but they concomitantly accepted a "slap of love." There is a strong need to re-educating both males and females to address the problem, and particularly train men to treat women respectfully and non-violently.

Intimate Partner Violence and Sexually Transmitted Infections Among Women in Sub-Saharan Africa

Intimate partner violence (IPV) is a serious public health issue that increases risk for sexually transmitted infections (STIs). Data was obtained from women (n = 32,409) who completed the Demographic Health Survey's (DHS) domestic violence module in 7 countries in sub-Saharan Africa between 2011 and 2015. DHS questions assessed lifetime physical, emotional and sexual IPV, cumulative exposure to IPV as well as the presence of a STI in the past 12 months. Multivariate logistic regression examined the association between IPV and STIs adjusting for potentially influential covariates. Data were weighted and analyzed using STATA Software (version 14.0). Women who had experienced physical, emotional sexual and cumulative IPV were significantly more likely to have had a STIs in the past 12 months. In order to reduce the burden of STIs, initiatives may need to address underlying mechanisms such as gender norms and power inequalities which perpetuate IPV.

Individual and community-level risk factors of women's acceptance of intimate partner violence in Ethiopia: multilevel analysis of 2011 Ethiopian Demographic Health Survey

BACKGROUND

The prevalence of Intimate partner violence (IPV) is higher in societies with higher acceptance of norms that support IPV. In Ethiopia, the proportion of women's acceptance of IPV was 69%, posing a central challenge in preventing IPV. The main objective of this study was to assess the individual and community-level factors associated with women's acceptance of IPV.

METHODS

Two-level mixed-effects logistic regression was applied to the 2011 Ethiopia Demographic and Health Survey data. A total of 16,366 women nested in the 596 clusters were included in the analysis.

RESULTS

The acceptability of the IPV was estimated to be 69%. Among the individual-level factors: women's education with secondary and above (AOR = 0.38; 95% CI 0.29-0.52), partner's education secondary and above (AOR = 0.71; 95% CI 0.54-0.82), women aged 35-49 years (AOR = 0.67; 95% CI 0.54-0.82), fully empowered in household level decision making (AOR = 0.67; 95% CI0.54-0.81), literate (AOR = 0.76; 95% CI 0.62-0.92), and perceived existence of law that prevents IPV (AOR = 0.56; 95% CI 0.50-0.63) were significantly associated with women's acceptance of IPV. Similarly, rural residence (AOR = 1.93; 95% CI 1.53-2.43) and living in the State region (AOR = 2.37; 95% CI 1.81-3.10) were significantly associated with the women's acceptance of IPV among the community-level factors.

CONCLUSION

Both individual and community-level factors were significant risk factors for the acceptability of intimate partner violence. Women's education, women's age, women's empowerment, partner education level, perceived existence of the law, and literacy were among individual factors. State region and residence were among community-level risk factors significantly associated women's acceptance of IPV.

Controlling Behavior and Lifetime Physical, Sexual, and Emotional Violence in sub-Saharan Africa

Intimate partner violence (IPV), commonly accompanied by controlling behavior, is a serious public health concern in sub-Saharan Africa. Data from women (n = 37,115) aged 15 to 49 years who completed the Demographic Health Survey's (DHS) domestic violence module in eight countries in sub-Saharan Africa (Cameroon, Democratic Republic of the Congo [DRC], Côte d'Ivoire, Namibia, Rwanda, Sierra Leone, Togo, and Zambia) between 2011 and 2015 were obtained. DHS questions assessed lifetime physical, emotional, and sexual violence (ever vs. never). Controlling behavior was measured by a revised Conflict Tactics Scale. Multivariate logistic regression examined the association between controlling behavior and IPV adjusting for all covariates, including age, education, marital status, wealth, urban/rural setting, and occupation. An interaction term was included to evaluate the consistency of effect estimates across countries. In all, 45.60% of women reported experiencing one or more forms of IPV (physical, sexual, or emotional violence) in their lifetime, ranging from 31.16% in Côte d'Ivoire to 57.37% in Cameroon. Women who reported controlling behavior by a spouse/partner were more likely to have experienced lifetime physical (adjusted odds ratio [AOR] = 3.57, 95% confidence interval [CI] = [3.31, 3.85], sexual (AOR = 3.98, CI = [3.47, 4.57]) or emotional (AOR = 3.52, CI = [3.22, 3.85]) violence than women who did not report controlling behavior. Women who reported controlling behavior were also more likely to have experienced one (AOR = 2.57, CI = [2.36, 2.81]) or two/three types (AOR = 5.34, CI = [4.80, 5.94]) of violence. AORs did not significantly differ across countries. Further research is needed to evaluate whether policies, programs, and education aimed at preventing or modifying controlling behavior may reduce IPV.

Understanding the endorsement of wife beating in Ghana: evidence of the 2014 Ghana demographic and health survey

Background

Domestic violence (DV) has become a global burden. The high occurrence of intimate partner violence (IPV) across the globe has implications for the socioeconomic wellbeing and health of children and women.

Methods

Data for the study was from the 2014 Ghana Demographic and Health Survey (GDHS). The association between approval of wife-beating and background characteristics of women was examined by the use of a Binary Logistic Regression model.

Results

A higher proportion of respondents were from urban areas (53.7 and 52.2% women and men respectively). The ages of women ranged from 15 to 49 (mean = 30, SD = 9.7) whilst the age range of men was 15–59 (mean = 32, SD = 12.5). Twenty-four percent of the men and 23% of the women were within the richest wealth category. The results showed that few women (6.3%) and men (11.8%) had attained higher education. Both women (AOR = 1.3; CI = 1.01–1.24) and men (AOR = 2.2; CI = 1.72–2.76) aged 15–24 had higher odds of approving wife-beating than those aged 35–49 (reference category). Poorest women (AOR = 2.7; CI = 2.14–3.38) and men (AOR = 1.7; CI = 1.11–2.69) alike had higher odds of approving wife-beating, as compared with those in the richest wealth status (reference category). As compared to research participants with higher/tertiary education, both women (AOR = 5.1; CI = 3.52–7.51) and men (AOR = 4.2; CI = 2.37–7.16) without any formal education were found to be at higher odds to approve wife-beating; however, this observation seems to decline as one’s educational status advances.

Conclusion

Age, wealth status, level of education, frequency of listening to radio, frequency of reading newspaper/magazine, frequency of watching television, ethnicity, and religion were found to be significantly associated with Ghanaian men and women’s approval of wife-beating. Policies, interventions, and campaigns must target Ghanaians without formal education and young adults on the need to uphold human rights in order to dissuade them from endorsing intimate partner violence. Mass media has also proven to be a protective factor against domestic violence approval and, as such, much progress can be made if utilised by human rights activists, especially through radio, magazine and television broadcasting.

Gender Norms and HIV Testing/Treatment Uptake: Evidence from a Large Population-Based Sample in South Africa

How does the endorsement of different dimensions of gender norms by men and/or women influence their use of HIV testing and antiretroviral treatment? This question was examined using data from a 2014 population-based survey of 1053 women and 1004 men, ages 18–49, in rural South Africa. We used a global measure for views toward gender norms (the GEM Scale), plus four subsets of scale items (all reliabilities ≥ 0.7). In multivariate analyses using the global measure, endorsement of inequitable gender norms was associated with more testing (AOR 2.47, p < 0.01) and less treatment use (AOR 0.15, p < 0.01) among women but not men. When examining specific subsets of inequitable norms (e.g., endorsing men as the primary decision-maker), decreased odds of treatment use was found for men as well (AOR 0.18, p < 0.01). Careful attention to the role specific gender norms play in HIV service uptake can yield useful programmatic recommendations.

Women's attitude and reasons toward justifying domestic violence in Ethiopia: a systematic review and meta-analysis

Background

Domestic violence (DV) is a global public problem that touches all levels of society and socio-economic status. Identifying women's attitudes towards domestic violence is an important first step in the prevention and control of its consequence. Thus, this systematic review and meta-analysis aimed: (i) to synthesize women's reasons for justifying domestic violence and (ii) to determine the pooled prevalence of women's attitude towards domestic violence in Ethiopia.

Methods

Pub-Med and google scholar data bases searched for quantitative cross-sectional studies. The study quality was assessed with the Newcastle-Ottawa quality assessment tool. Heterogeneity test and evidence of publication bias were assessed. Pooled prevalence of women's attitude was calculated with 95%CI using random effects model.

Results

A total of 15 articles were included in the study. The pooled prevalence of women's attitude towards justifying domestic violence was found to be 57% (95% CI; 47.0%-67.2%). Reasons for justifying were: burning food, argues with husband, goes out without telling, neglects children, refuses sex, unfaithful, disobeys and suspects infidelity.

Conclusion

More than half of women accept domestic violence. Authors' suggest strengthening of women's awareness toward norms that justify wife beating.

Justification of Wife Beating in Adolescents: Associated Beliefs and Behaviors

Socioeconomically disadvantaged adolescents who are exposed to social norms related to violence against women are more likely to experience or be perpetrators of intimate partner violence. This study evaluated factors hypothesized to be associated with acceptance of wife beating among 240 male and female adolescents aged 10-16 years participating in a World Vision program in Armenia. Acceptance of wife beating was associated with relational victimization, perceived social support, and parent and community boundaries and expectations, but was not associated with overt victimization or aggression. These findings highlight several areas that may be important for violence prevention research.

Developing strategies to address contraceptive needs of adolescents: exploring patterns of use among sexually active adolescents in 46 low- and middle-income countries

OBJECTIVE

We explore the patterns of adolescents' need for contraception in 46 low- and middle-income countries.

METHODS

Using data from the Demographic and Health Surveys, we estimate the prevalence of never-use, ever-use and current contraceptive use of sexually active adolescent girls ages 15-19. We use weighted fixed-effects meta-analytic techniques to estimate summary measures. Finally, we highlight country profiles of adolescent contraceptive use.

RESULTS

More than half (54.4%) of sexually active or girls in unions report never using contraception, while 13.3% report having used contraception but not currently doing so. Nearly a third report currently using a contraceptive method: 24.6% are using a modern short-term method, 2.5% are using a most effective method, and 5.2% are using a traditional method.

CONCLUSIONS

We find significant heterogeneity across countries as well as within countries based on adolescents needs for spacing, limiting and method preference. With more than half of sexually active adolescents having never used contraception, the potential for unwanted pregnancies is high.

IMPLICATIONS

While there is no single strategy to address adolescents' contraceptive needs, country programs may want to consider the heterogeneity of adolescents' risks for unintended pregnancy and tailor programs to align with the profile of adolescents in their settings.

Timing of abortion among adolescent and young women presenting for post-abortion care in Kenya: a cross-sectional analysis of nationally-representative data

Background

Complications of unsafe abortion are a leading cause of maternal mortality in sub-Saharan Africa. Adolescents and young women are disproportionately represented among those at risk of these complications. Currently, we know little about the factors associated with young women’s timing of abortion. This study examined the timing of abortion as well as factors influencing it among adolescents and young women aged 12–24 years who sought post-abortion care (PAC) in health facilities in Kenya.

Methods

We draw on data from a cross-sectional study on the magnitude and incidence of induced abortion in Kenya conducted in 2012. The study surveyed women presenting with a diagnosis of incomplete, inevitable, missed, complete, or septic abortion over a one-month data collection period in 328 health facilities (levels 2–6). Survey data, specifically, from adolescents and young women were analyzed to examine their characteristics, the timing of abortion, and the factors associated with the timing of abortion.

Results

One thousand one hundred forty-five adolescents and young women presented for PAC during the data collection period. Eight percent of the women reported a previous induced abortion and 78% were not using a modern method of contraception about the time of conception. Thirty-nine percent of the index abortions occurred after 12 weeks of gestation. A greater proportion of women presenting with late abortions (more than 12 weeks gestational age) (46%) than those presenting with early abortions (33%) presented with severe complications. Controlling for socio-demographic and reproductive history, timing of abortion was significantly associated with place of residence (marginal), education, parity, clinical stage of abortion and level of severity.

Conclusions

Late-term abortions were substantial, and may have contributed substantially to the high proportion of women with post-abortion complications. Efforts to reduce the severity of abortion-related morbidities and mortality must target young women, particularly those living in rural and other remote areas. Interventions to reduce unintended pregnancies in this population are also urgently needed to improve early pregnancy detection and timely care seeking.

Early adolescent childbearing in low- and middle-income countries: associations with income inequity, human development and gender equality

Objective

Reducing unwanted adolescent childbearing is a global priority. Little is known about how national-level economic and human development indicators relate to early adolescent childbearing. This ecological study evaluates associations of Gross Domestic Product (GDP), GINI index, Human Development Index (HDI) and Gender-related Development Index (GDI; i.e. the HDI adjusted for gender disparities) with early adolescent childbearing in 27 low- and middle-income countries (LMICs) across three time periods.

Methods

Among women ages 18–24, prevalence estimates for early birth (<16 years) were calculated by nation, and weighted linear regressions evaluated associations between national indicators and early childbearing. To examine temporal trends, analyses were stratified by year groupings.

Findings

Early adolescent childbearing declined over time, with the greatest change observed in Bangladesh (31.49% in 1996/7 to 19.69% in 2011). In adjusted models, GDI was negatively associated with early childbearing, i.e. early childbearing prevalence decreased as GDI increased. In the most recent time period, relative to the lowest GDI group, the average prevalence of early childbearing was significantly lower in the middle (-12.40, P < 0.00) and upper (-10.96, P = 0.03) tertiles after adjustment for the other indicators. These other indicators showed no consistent association with early childbearing.

Conclusion

As national-level GDI increased, early adolescent childbearing declined. The GDI, which reflects human development adjusted for gender disparities in educational and economic prospects, was more consistently related to early adolescent childbearing than the absolute development prospects as given by the HDI. While creating gender equality is an important goal in and of itself, the findings emphasize the potential for improved national-level gender equitable development as a means to improve adolescents’ sexual and reproductive health.

Sexual violence as a risk factor for family planning-related outcomes among young Burundian women

OBJECTIVES

The study aimed to examine associations between experience of sexual violence and family planning-related outcomes.

METHODS

A multi-stage cluster survey was conducted among a representative sample of 744 young women aged 15-24 in eight provinces in Burundi.

RESULTS

The prevalence of young women who reported having ever been physically forced to have sexual intercourse was 26.1%. Young women who had experienced sexual violence (ever) were 2.5 times more likely not to have used any modern contraceptives in the 12 months preceding the survey. They were also 2.3 times more likely to report that their last pregnancy was unplanned. Higher odds of not being able to negotiate contraceptive use with their partners were only reported by young women having experienced sexual violence in the 12 months prior to the survey when adjusted for confounders.

CONCLUSIONS

Sexual violence was found to be significantly associated with contraceptive negotiation and use as well as unplanned pregnancy. Weak perceived ability to negotiate contraceptive use highlights gender inequalities leaving young women vulnerable to unprotected sex and thus unplanned pregnancies.

A national survey of attitudes toward intimate partner violence among married women in Kazakhstan, Kyrgyzstan, and Tajikistan: Implications for health prevention and intervention

Attitudes toward intimate partner violence (IPV) can affect the prevalence of IPV, response of victims' to IPV (e.g., whether to seek help), and the response of professionals (e.g., police, social workers, health care professionals) to IPV. Knowledge about IPV-related attitudes is essential for developing effective social work and violence-related programs. Using data from the 2005-2006 Multiple Indicator Cluster Surveys, this study examines attitudes toward IPV and socio-demographic predictors of these attitudes among married women in Kazakhstan, Kyrgyzstan, and Tajikistan. Women were asked whether they approved of a husband beating his wife: if she goes out without telling him, neglects their children, argues, refuses to have sex, and burns food. The prevalence of IPV acceptance for at least one of the five reasons varied from 12.3% in Kazakhstan to 45.3% in Kyrgyzstan and 74.5% in Tajikistan. Women who were less educated, members of Asian ethnic groups, resided in middle-class urban areas, and lived in specific regions were more likely to accept IPV. Few age differences that emerged indicated that young women were more approving of IPV. Proactive efforts are needed to confront attitudes about gender roles and IPV in Tajikistan and Kyrgyzstan.

Women's approval of domestic physical violence against wives: analysis of the Ghana demographic and health survey

Background

Intimate partner violence (IPV) has serious consequences for the physical, psychological, and reproductive and sexual health of women. However, the factors that make women to justify domestic violence against wives in many sub-Saharan African countries have not been explored. This study investigates factors that influence women approval of domestic physical violence among Ghanaian women aged 15–49.

Method

A nationally representative sampled data (N = 10,607) collected in the 2003 and 2008 Ghana Demographic and Health Survey were used. Multivariate logistic regression was used to study the associations between women’s economic and socio-demographic characteristics and their approval of domestic physical violence against wives.

Results

Women aged 25–34 and 15–24 were 1.5 and 1.3 times, respectively, more likely to approve domestic physical violence against wives compared to those aged 35 years and above. Furthermore, women with no education (OR = 3.1, CI = 2.4–3.9), primary education (OR = 2.6, CI = 2.1–3.3) and junior secondary education (OR = 1.8, CI = 1.4–2.2) had higher probability of approving domestic physical violence compared to a woman who had secondary education or higher. Compared to women with Christian belief, Moslems (OR = 1.5, CI = 1.3–1.8) and Traditional believer (OR = 1.7, CI = 1.2–2.4) were more likely to approve domestic physical violence of wives. Women who were in the richest, rich and middle wealth index categories were less likely to approve domestic physical violence of wives compared to the poorest.

Conclusion

These findings fill a gap in understanding economic and socio-demographic factors associated with approval of domestic physical violence of wives. Interventions and policies should be geared at contextualizing intimate partner violence in terms of the justification of this behaviour, as this can play an important role in perpetration and victimization.

Women's Status and Intimate Partner Violence in the Democratic Republic of Congo

Women's greatest risk of violence in the Democratic Republic of Congo (DRC) may come from an intimate partner, but few studies have analyzed context-specific risk and protective factors for intimate partner violence (IPV) in the DRC. This study analyzed data from the most recent Demographic and Health Survey (DHS) in Congo to assess risk and protective factors for IPV and the role of women's status, a factor implicated in prior IPV research. Using a sample of 1,821 married or cohabiting women between the ages of 15 and 49, four logistic regression models tested relationships between physical, sexual, emotional, or any violence and independent variables of interest. Results indicated that 68.2% of respondents had experienced at least one of the three types of IPV. An attitude of acceptance toward spousal violence was associated with increased risk for physical and emotional IPV. Women who were the only wife of their husband were half as likely to experience IPV compared with women whose husbands had other wives or women who did not know their husbands' marital status. Partner's use of alcohol was associated with nearly doubled risk for both physical and sexual IPV. The study's results indicate that IPV occurs frequently and is justified as acceptable by many women in the DRC. Findings suggest that awareness-raising campaigns may be a helpful intervention and that partner characteristics should be considered when assessing women's risk for IPV.