Intimate partner violence against women and its association with pregnancy loss in Ethiopia: evidence from a national survey

Interparental Coercive Control and Child and Family Outcomes: A Systematic Review

Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person. Although the adverse impacts of childhood exposure to interparental IPV have been well documented, the outcomes of childhood exposure to interparental CC have not been systematically examined. This study aimed to address this gap by reviewing available empirical evidence on interparental CC and child and family outcomes. Articles were identified by searching electronic databases using keywords relating to CC, children and parents, and child wellbeing outcomes. The final review included 51 studies that reported on adverse outcomes pertaining to parenting and family relationships (k = 29), child internalizing and externalizing problems (k = 7), social-emotional development (k = 5), and physical/health development (k = 17). Specifically, studies reported that CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly. Results indicated that the impacts of childhood exposure to CC are complex, far reaching, and, in some cases, devastating. The limitations of the findings, as well as implications for practice, policy, and research are discussed.

Intimate partner violence and its associated factors among reproductive-age women in East Africa:-A generalized mixed effect robust poisson regression model

BACKGROUND

The World Health Organization (WHO) has published estimates revealing that around one out of every three women across the globe has been a victim of either physical and/or sexual violence from an intimate partner or non-partner throughout their lifetime. The available evidence on intimate partner violence in East Africa is limited Consequently, the objective of this study was to evaluate the occurrence and factors linked to intimate partner violence in East Africa.

METHODS

The study utilized the most recent data from the Demographic and Health Surveys (DHS) conducted between 2011 and 2018/19 in 11 countries in Eastern Africa. A total of 59,000 women were included in the study. Descriptive and inferential statistics were used to exmine factors associated with IPV. A mixed effect robust Poisson regression model was fitted to identify factors associated with intimate partner violence. The adjusted prevalence ratio (aPR) and its corresponding 95% confidence interval (CI) were employed to determine the presence of a significant association between intimate partner violence and the independent variables.

RESULTS

In this study, the prevalence of intimate partner violence in East Africa was 43.72% with 95% CI 43.32% to 44.12%. In the mixed effect robust Poisson regression model:-Marital status, working status, parity, sex of household headed, wealth index, community poverty, and residence, were significantly associated with intimate partner violence.

CONCLUSION

The prevalence of intimate partner violence in East Africa is high as compared to the global prevalence 30%, which hinders The Sustainable Development Goals (SDGs), specifically goal 5, aim to attain gender equality and empower women and girls worldwide by the year 2030 Women being previously married and cohabitated, working, having a high number of children, rural residents were positively associated with IPV and household and community wealth index and sex of household headed were negatively related with IPV in East Africa. Therefore, we recommend establishing effective health and legal response using an integrated policy approach and Special attention should be given to women who live rural and poorest to reduce IPV and to achieve Sustainable Development Goals (SDGs) goal 5.

Exploring the relationship between intimate partner violence during pregnancy and stillbirths

INTRODUCTION

The relationship between intimate partner violence (IPV) in pregnancy and stillbirths is poorly understood. We aimed to determine if there was any association between stillbirths and IPV during pregnancy.

METHODS

A community-based, matched, case-control study was conducted in 2014, nested within the Maternal and Newborn Health Registry of the Global Network for Women's and Children's Health Research in Pakistan. Using a WHO questionnaire, IPV in pregnancy was ascertained from 256 cases (women with stillbirths) and 539 controls (women with live births), individually matched on parity. Multivariable conditional logistic regression analysis assessed the association of IPV in pregnancy ending in stillbirths compared to those with live births.

RESULTS

The effect of physical and psychological IPV was modified by maternal age. Among women 25-34 years old with stillbirths, the odds of experiencing physical IPV in pregnancy were four times greater than those with live births, after controlling for confounders [odds ratio 4.1 (95% CI: 1.5, 11.2)]. A negative association was observed between psychological IPV in pregnancy and stillbirths among women younger than 25 years, and no association was observed between sexual IPV during pregnancy and stillbirths.

CONCLUSION

Study results show that women 25-34 years of age with stillbirths were four times more likely to experience physical IPV during pregnancy. Further studies replicating the effect modification of IPV by maternal age are warranted.

Intimate partner violence as a determinant factor for spontaneous abortion during pregnancy: an unmatched case-control study

Background

Intimate partner violence affects a significant portion of women worldwide throughout their lifetimes. Ethiopia lacks data that policymakers could utilize to develop context-specific policies for handling intimate partner violence during pregnancy.

Objectives

To identify the determinants of spontaneous abortion among women survivors of intimate partner violence during pregnancy in Adigrat General Hospital, Northern Ethiopia, in 2020.

Methods

A facility based, case-control study design was employed to recruit 371 women (124 cases and 247 controls) attending maternal health services in Adigrat General Hospital, Northern Ethiopia, from March 13 to June 12, 2020. Cases and controls were selected using a consecutive sampling technique. A multivariable binary logistic regression model was carried out to identify potential factors, and a p-value of <0.05 was used to declare statistical significance.

Results

The proportion of any form of intimate partner violence during pregnancy among cases and controls was 53.23 and 34.82%, respectively. Any form of intimate partner violence (AOR = 3.66; 95% CI 1.69-7.95), physical intimate partner violence (AOR = 3.06; 95% CI 1.69-7.95), and an interpregnancy interval of <24 months (AOR = 4.46; 95% CI 1.65, 12.07), were the independent determinants of spontaneous abortion among survivors.

Conclusion

Spontaneous abortion was significantly associated with exposure to any form of intimate partner violence, including physical intimate partner violence, and a shorter inter-pregnancy interval.

The association of intimate partner violence and contraceptive use: a multi-country analysis of demographic and health surveys

BACKGROUND

Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries.

METHODS

The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors.

RESULT

Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35-49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods.

CONCLUSION

Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.

The Relationship Between Intimate Partner Violence and Unintended Pregnancy: Eastern Sub Saharan African Countries' Analysis of Demographic and Health Surveys

Intimate partner violence (IPV) adversely affects female reproductive health in various ways. Similarly, it plays a critical role in women's unintended pregnancy. This study examines the relationship between IPV and unintended pregnancy in Eastern Sub-Saharan Africa (SSA) countries. This study uses data from the nationally representative Demographic and Health Surveys (DHS) in six Eastern African SSA countries. The original sample size was restricted to ever married (or cohabitating) women of reproductive age who completed the survey's Domestic Violence Module and had a pregnancy in the previous 5 years. Svyset proportion was used to estimate the prevalence and 95% confidence intervals (CI) of the study outcomes and multiple logistic regression was used to compare outcomes of last pregnancy by exposure to lifetime IPV committed by the most recent partner. The prevalence of unintended pregnancy in Eastern SSA was 38% [36.4, 40.34] among married women with high disparity among countries. This prevalence was 45% [42.05, 48.15] and 55% [50.0, 59.87] among women who had experienced any form of IPV and sexual violence, respectively. After adjusting for potential confounding factors, women with a history of sexual violence had a higher risk of unintended pregnancy [AOR: 1.80, 95% CI: 1.39, 2.33] and increased odds of unintended pregnancy for women who had more than five living children [AOR: 4.93, 95% CI: 3.40, 7.15], women who lived in rural residences [AOR: 1.42, 95% CI: 1.07, 1.90], and women who reported they had financial barriers for health care [AOR: 1.36, 95% CI: 1.13, 1.64]. Our findings suggest that IPV, particularly sexual violence, is a key player for higher risk of unintended pregnancy in Eastern SSA countries. This study highlights the need for developing programs and implementation of policies that integrate sexual reproductive health and IPV to reduce unintended pregnancy among married and single women.

Intimate partner violence and child loss: an evaluation of 7 sub-Saharan African countries

Purpose

Intimate partner violence (IPV) and child loss disproportionately affect women in sub-Saharan Africa (SSA). Little research has examined the relationship between IPV and child loss in SSA.

Methods

We used data from Demographic Health Surveys in 7 countries in SSA (Côte d'Ivoire, Democratic Republic of the Congo, Namibia, Sierra Leone, Togo, Zambia, and Rwanda). Women's Health Module questions assessed lifetime physical, sexual, and emotional IPV. Child loss was calculated as the difference between the number of child births and the number of living children. Logistic regression was conducted adjusting for age, marital status, educational attainment, location of residence, wealth, sexually transmitted infections, and country of origin. Data were weighted and analysed using STATA Software (14.0).

Results

Among women who gave birth, approximately one third (31.7%) reported that they lost 1 or more children. Nearly half (44.3%) reported that they experienced physical IPV during their lifetime. Women who had experienced physical, emotional, or sexual IPV were significantly more likely to report a loss of 1 or more children (OR=1.20, 95% confidence interval (CI)= [1.08, 1.33]; OR=1.30, 95% CI= [1.16, 1.45]; OR=1.42, 95% CI= [1.23, 1.65], respectively) in comparison with women who had not experienced IPV controlling for potentially influential covariates. Women who were older, married, had lower educational attainment, and had lower income were more likely to have lost 1 or more children.

Conclusion

These results suggest that women who experienced all types of and cumulative exposure to IPV may be more likely to lose a child in SSA.

Physical Violence during Pregnancy and Its Implications at Birth: Analysis of a Population Survey, 2019

Physical partner violence is widely recognized as a global health problem, especially in pregnant women. This study determines the association between physical violence during pregnancy in Peruvian women aged 15 to 49 years with low birth weight and abortion according to the Demographic and Family Health Survey (ENDES) 2019. An analytical cross-sectional observational study was carried out based on the data from the ENDES 2019. Two dependent variables referring to birth outcomes were included: abortion and low birth weight. The independent variable was physical violence during pregnancy by her current or former husband/partner. A total of 15,305 women were included in the study. The prevalence of physical violence during pregnancy was 6.43%. Regarding the adverse outcomes of pregnancy, the prevalences of abortion and low birth weight were 20.84% and 6.01%, respectively. Women suffering physical violence during pregnancy were more likely to have an abortion but not low birth weight. In conclusion, it was found that 6 in 100 Peruvian women of childbearing age were victims of violence during pregnancy. Likewise, it was observed that women who were victims of violence during pregnancy had a higher probability of having an abortion but not low birth weight.

Troubling Trade-offs Between Women's Work and Intimate Partner Violence: Evidence From 19 Developing Countries

The empirical link between women's employment status and their experience of different types of intimate partner violence (IPV) is not very apparent. Using Demographic and Health Surveys (DHS) data from 19 developing countries in South Asia, Sub-Saharan Africa, and the Middle East, we found that working women were significantly more likely to experience IPV than their stay-at-home counterparts. Given the great diversity in women's employment with respect to economic returns and working conditions, we disaggregated women's employment into three categories vis-à-vis agriculture jobs (AJ), blue-collar jobs (BJ), and white-collar jobs (WJ). The disaggregated analysis revealed that women engaged in all three job categories were significantly more likely to experience IPV. After controlling for potential endogeneity of women's employment, we found that women's work increased the risk of less severe physical violence (LSPV) and emotional violence (EV) but reduced the risk of sexual violence (SV). Endogeneity-adjusted disaggregated analysis showed that women engaged in BJ and WJ faced an increased risk of LSPV but reduced risk of SV. In contrast, women undertaking AJ faced a smaller risk of severe physical violence (SPV) and SV. This study contradicts some long-held beliefs that women's work is a sufficient condition for protecting them from IPV. The public policy should not assume that women's earnings automatically protect them against the risk of IPV. While encouraging a greater female labor force participation rate is important in its own right, women's risk of IPV is context-specific.

Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey

Background

Women exposed to Intimate Partner Violence (IPV) often do not utilize maternal health care optimally both because of stigma and other social problems. The current study aims to explore an association between maternal healthcare seeking and violence exposure among Ethiopian women and to assess if educational attainment and wealth status moderate this association.

Methods

The analyses included 2836 (weighted) currently married women with one live birth. We focus on the five years preceding the 2016 Ethiopian Demographic and Health Survey (EDHS) who participate, in the domestic violence sub-study. Exposure was determined by maternal reports of physical, emotional, sexual IPV or any form of IPV. The utilization of antenatal care (ANC) and place of delivery were used as proxy outcome variables for uptake of skilled maternal healthcare utilization. Women’s education attainment and wealth status were selected as potential moderators, as they can enable women with psychological and financial resources to counteract impact of IPV. Multilevel logistic regression analyses were used to explore the association between spousal IPV and maternal health outcomes. Moderation effects by education and wealth status were tested, and the data stratified. Using statistical software Stata MP 16.1, the restricted maximum likelihood method, we obtained the model estimates.

Results

About 27.5% of the women who reported exposure to any form of IPV had a health facility delivery. While 23.4% and 22.4% visited four or more antenatal care services among mothers exposed to emotional IPV and sexual IPV, respectively. After adjusting for potential confounding factors, only the association between maternal exposure to emotional IPV and adequate use of ANC was statistically significant (OR = 0.73, (95% CI:0.56–0.95)). But we found no significant association between IPV and utilization of health facility delivery. Some moderation effects of education and wealth in the association between IPV and maternal healthcare service utilization outcome were found.

Conclusion

Exposure to emotional IPV was associated with poor uptake of maternal health care service utilization for married Ethiopian women. While developing interventions to improve women’s maternal healthcare service use, it is crucial to consider the effects of socio-economic variables that moderate the association especially with the intersection of IPV.

Association Between Girl-child Marriage and Intimate Partner Violence in Sub-Saharan Africa: Insights From a Multicountry Analysis of Demographic and Health Surveys

While considerable attention has been given to the health consequences of child marriage in Sub-Saharan Africa (SSA), limited studies exist on its impact on intimate partner violence (IPV) in the region. We address this gap by examining the link between child marriage and IPV. We tested our study hypothesis using demographic and health survey data of 28,206 young women aged 20-24 years from 16 SSA countries with recent surveys (2015-2019). Binary logistic regression models were used to examine the effect of child marriage on IPV. Child marriage prevalence ranged from 13.5% in Rwanda, in East Africa, to 77% in Chad, in Central Africa, while IPV ranged from 17.5% in Mozambique in Southern Africa to 42% in Uganda, in East Africa. Past year experience of IPV was higher among young women who married or begun cohabiting before the age of 18 (36.9%) than those who did at age 18 or more (32.5%). This result was consistent for all forms of violence: physical violence (22.7% vs 19.7%), emotional violence (25.3% vs 21.9%), and sexual violence (12% vs 10.4%). After controlling for covariates, we found that young women in SSA who married before 18 years were more likely to experience IPV than those who married as adults (AOR: 1.20; 95% CI [1.12, 1.29]). Significant heterogeneity was observed in the country-level results, with a higher likelihood of IPV found in 14 of the 16 countries and lower in Angola and Chad. Child marriage is associated with a higher likelihood of IPV in most SSA countries, suggesting that ending child marriage will result in a substantial reduction in IPV. There is a need to institute policies to support and protect women who marry as children from abusive relationships in SSA.

Health Workers’ Knowledge and Attitude Towards Intimate Partner Violence: A Descriptive Study in Sidama Region, Southern Ethiopia

Background

It is important that health workers understand intimate partner violence (IPV) and its link with ill health. Increasing their awareness will help them play a stronger role in identifying survivors and providing appropriate health care. We assessed the knowledge and attitude of health workers towards IPV survivors taking into account their professional roles.

Methods

Data was collected in 2018 in 12 health centers and 55 health posts located in 3 districts of the former Sidama zone using a self-administered questionnaire. The main outcome variable was proportion of wrong responses of the knowledge questions. We also calculated scores from the 10 knowledge questions and 10 Likert items of attitude. Proportions of wrong responses were compared between health post and health center staff. Mean knowledge score was compared using an independent samples t-test and a one-way analysis of variance. A Tukey’s honestly significant difference test was performed to determine significant analysis of variance results.

Results

There were 139 participants. Most (78%) of them were females. Nurses and midwives accounted for 54% of the total. Few (13%) of the participants had received previous training regarding IPV. More than half of the participants were not confident about how to care for women exposed to IPV. “Wrong responses” (incorrect or “don’t know”) ranged from 5.8% to 30.9%. The mean knowledge score was higher for women older than 30 years (p = 0.03). Negative attitudes ranged from 4 to 47%. One-third of the participants believed that they could not suspect IPV unless they saw physical injuries. More knowledge about IPV was associated with better attitude scores.

Conclusion

Around half of the health workers felt unprepared to provide care to IPV survivors, and a third would not consider IPV unless they saw physical evidence. Increasing knowledge may improve attitudes and support for IPV survivors.

Intimate Partner Violence and Pregnancy Termination among Tajikistan Women: Evidence from Nationally Representative Data

Intimate partner violence is the most common kind of violence and a significant public health issue. The relationship between intimate partner violence and pregnancy termination among Tajikistan women was investigated in this study. The data for this research was collected from the Tajikistan Demographic and Health Survey 2017. This research has used the data of married women aged between 15 to 49 years. The findings from the study indicate that around 23.2% of married women in Tajikistan have experienced physical violence. The respondent’s age, region, and employment status was significantly associated with pregnancy termination (p < 0.05). Similarly, women who can refuse sex with their partner and ask their partner to use a condom are more likely to terminate pregnancy (p < 0.05). The characteristics of the husband or partner that had a significant positive association with pregnancy termination of married women in Tajikistan are age, educational level, and alcohol drinking status of their husbands (p < 0.05). This study also establishes the significant relationship between pregnancy termination and physical or emotional violence experienced by women (p < 0.05). The dynamics of domestic abuse need to be understood by healthcare providers to aid women in making decisions on whether or not to terminate their pregnancy.

Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: Evidence from demographic and health surveys

Intimate partner violence has been associated with numerous consequences for women, including pregnancy termination. This study aimed to examine the association between intimate partner violence and pregnancy termination among adolescent girls and young women in 25 sub-Saharan African countries. Data for this study was obtained from the demographic and health surveys of 25 countries in sub-Saharan Africa, published between 2010 and 2019. A total of 60,563 adolescent girls and young women were included in this study. Binary logistic regression models were used in analyzing the data and the results were presented as crude odds ratios (CORs) and adjusted odds ratios (AORs) at 95% confidence interval (CI). The prevalence of intimate partner violence and pregnancy termination among adolescent girls and young women in the 25 countries in sub-Saharan Africa were 19% and 10.1% respectively. In all these countries, the odds of pregnancy termination was higher among adolescent girls and young women who had ever experienced intimate partner violence, compared to those who had never experienced intimate partner violence [COR = 1.60, 95% CI = 1.51-1.71], and this persisted after controlling for confounders [AOR = 1.58, 95% CI = 1.48-1.68]. However, across countries, intimate partner violence had significant association with pregnancy termination among adolescent girls and young women in Angola, Chad, Congo DR and Gabon (Central Africa); Benin, Burkina Faso, Cote D'lvoire, Gambia and Mali (West Africa); Comoros, Rwanda and Uganda (East Africa); and Malawi and Zambia (Southern Africa). The findings imply that reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa depends on the elimination of intimate partner violence. Thus, policies and programmes aimed at reducing pregnancy termination among adolescent girls and young women in sub-Saharan Africa, should pay particular attention to those who have history of intimate partner violence.