Intimate partner violence and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

Multilevel analysis of intimate partner violence and associated factors among reproductive-age women: Kenya demographic and health survey 2022 data

INTRODUCTION

Intimate partner violence is a human rights violation that often involves violence against women, which appears to be the most prevalent type of abuse. Intimate partner violence is a major global public health issue that includes physical, emotional, and sexual violence. The prevalence of intimate partner violence in Africa is high. The burden of intimate partner violence among reproductive-age women is high in Kenya. Therefore, the main aim of this study is to determine the associated factors of intimate partner violence among reproductive-age women at the individual and community level from the recent Demographic and Health Survey (DHS) 2022 data of Kenya.

METHODS

The Kenya National Demographic and Health Survey data of 2022 was used for this study. The overall sample size for this study was 14,612, which focused on women aged 15 to 49 years who had ever been partnered and responded to the domestic violence module. Multilevel logistic regression models to determine the prevalence and associated factors at the individual and community level with intimate partner violence with a 95% Confidence Interval (CI) and Adjusted Odds Ratio (AOR).

RESULT

The overall prevalence of intimate partner violence was 41.1% with a 95% CI (40.07%, 42.60. Male-headed households, poorest and middle wealth status, partner alcohol use, separated/widowed current marital status, and low education of women were statistically significantly associated with intimate partner violence at the individual level variables in this study.

CONCLUSIONS

The prevalence of intimate partner violence was high. Educating women, reducing partner alcohol use, and improving the economic status of women, were crucial in mitigating the burden of intimate partner violence. The intimate partners are supposed to respect the rights of women.

Intimate partner violence during pregnancy against adolescents in sub-Saharan Africa: a systematic review

BACKGROUND

Adolescent pregnancy and intimate partner violence (IPV) are major public health issues that are linked to poor health outcomes particularly during pregnancy. In sub-Saharan Africa (SSA), previous studies on IPV during pregnancy have primarily focused on adults. This review examines the available evidence on adolescents' experience of IPV during pregnancy in SSA.

DESIGN

Systematic review.

METHODS

We searched multiple databases for articles that met our inclusion criteria. Included studies investigated IPV during pregnancy, including prevalence, risk factors and health outcomes among ever-pregnant adolescents aged 10-19 years old or younger in SSA. Studies were peer-reviewed studies from SSA, quantitative and/or qualitative; and published in English regardless of the year of publication.

RESULTS

Nine studies out of 570 abstracts screened, published between 2007 and 2020, met the inclusion criteria. The prevalence of IPV during pregnancy among adolescents in SSA ranged from 8.3% to 41%. Mental health symptoms, particularly depression, and anxiety, were associated with adolescent IPV during pregnancy and qualitatively linked to poor coping strategies when dealing with IPV.

CONCLUSION

This review found evidence of a linkage between pregnancy and IPV during pregnancy among adolescents. Given the long-term negative effects of IPV during pregnancy on adolescents and children, this conclusion points to the critical need for developing interventions to improve IPV detection during pregnancy in SSA among adolescents to interrupt its continuation into adulthood.

Magnus J, Assefa N, Wordofa MA. The protocol for a cluster randomized controlled trial to evaluate couple-based violence prevention education and its ability to reduce intimate partner violence during pregnancy in Southwest Ethiopia

BACKGROUND

A significant proportion of women in Ethiopia suffer from violence by their intimate partner during pregnancy, which has adverse maternal and newborn outcomes. Couple-focused interventions are effective in reducing and/or controlling violence between women and their intimate partners. However, interventions addressing intimate partners of the victims are not well studied, particularly in the Ethiopian setting. This study aims to assess the effect of couple-based violence prevention education on intimate partner violence during pregnancy.

METHODS

We will use a cluster randomized controlled trial to evaluate the effectiveness of couple-based violence prevention education compared to routine care in reducing intimate partner violence during pregnancy. Sixteen kebeles will be randomly assigned to 8 interventions and 8 control groups. In the trial, 432 couples whose wife is pregnant will participate. Health extension workers (HEWs) will provide health education. Data will be collected at baseline and endline. All the collected data will be analyzed using Stata version 16.0 or SPSS version 25.0. We will use the McNemar test to assess the differences in outcomes of interest in both intervention and control groups before and after the intervention for categorical data. A paired t-test will be used to compare continuous outcome of interest in the intervention and the control groups after and before the intervention. The GEE (Generalized Estimating Equation), will be used to test the independent effect of the intervention on the outcome of the interest. Data analysis will be performed with an intention-to-treat analysis approach. During the analysis, the effect size, confidence interval, and p-value will be calculated. All tests will be two-sided, and statistical significance will be declared at p < 0.05.

DISCUSSION

We expect that the study will generate findings that can illuminate violence prevention strategies and practices in Ethiopia.

TRIAL REGISTRATION

It has been registered on ClinicalTrials.gov as NCT05856214 on May 4, 2023.

Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia

OBJECTIVE

To adapt an evidence-based psychological intervention for pregnant women experiencing depressive symptoms and intimate partner violence (IPV) in rural Ethiopia.

METHOD

We conducted a desk review of contextual factors in Sodo, Ethiopia, followed by qualitative interviews with 16 pregnant women and 12 antenatal care (ANC) providers. We engaged stakeholders through participatory theory of change (ToC) workshops, to select the intervention and articulate a programme theory. We used "ADAPT" guidance to adapt the intervention to the context, before mapping potential harms in a "dark logic model".

RESULTS

Brief problem-solving therapy developed for South Africa was the most contextually relevant model. We adapted the delivery format (participants prioritised confidentiality and brevity) and training and supervision (addressing IPV). Consensus long-term outcomes in our ToC were ANC providers skilled in detecting and responding to emotional difficulties and IPV, women receiving appropriate support, and emotional difficulties improving. Our dark logic model highlighted the risk of more severe IPV and mental health symptoms not being referred appropriately.

CONCLUSION

Although intervention adaptation is recommended, the process is rarely reported in depth. We comprehensively describe how contextual considerations, stakeholder engagement, programme theory, and adaptation can tailor psychological interventions for the target population in a low-income, rural setting.

The prevalence of intimate partner violence among Iranian pregnant women: a systematic review and meta-analysis

BACKGROUND

Intimate partner violence against pregnant women is an important public health concern and human rights issue. According to the various findings of previous studies, this study was conducted to assess the pooled prevalence of intimate partner violence against Iranian women.

METHODS

In this systematic review and meta-analysis, a literature search was conducted in databases such as PubMed, Scopus, Web of Science, MagIran, and Scientific Information Database without a time limit. Heterogeneity was assessed by Cochrane Q test statistics and the I2 test, and the results were incorporated into a random effects model to estimate the prevalence of intimate partner violence. Data analysis was performed using R software version 4.3.2.

RESULTS

The overall prevalence of intimate partner violence was reported to be 51.5% (95% confidence interval (CI) 45.0-58.1), and the prevalence rate of physical, sexual, and psychological intimate partner violence was 18.0% (95% CI 15.1-20.9), 22.1% (95% CI 17.7-26.60) and 43.2% (95% CI 36.6-49.8), respectively. The lowest level of physical, sexual, and emotional intimate partner violence rate was observed in district 1 of Iran (includes Tehran, the capital of Iran and the surrounding provinces). The rate of physical and sexual intimate partner violence prevalence decreased with the increased mean age of the husband (P=0.005) and the mean age of the wife (P=0.035), respectively.

CONCLUSIONS

Studies included in this review report that more than half of Iranian women experience violence during pregnancy. In order to prevent adverse maternal and neonatal consequences, it is necessary to identify these women and introduce them to support centres.

Health providers readiness in managing intimate partner violence in public health institutions, Ethiopia

INTRODUCTION

Intimate Partner Violence (IPV) is a worldwide public health problem and major human and legal rights abuses of women. It affects the physical, sexual, and psychological aspects of the victims therefore, it requires complex and multifaceted interventions. Health providers are responsible for providing essential healthcare services for IPV victims. However, there is a lack of detailed information on whether or not health providers are ready to identify and manage IPV. Therefore, this study aimed to assess health providers' readiness and associated factors in managing IPV in public health institutions at Hawassa, Ethiopia.

METHOD

Institutional based cross-sectional study was conducted through a simple random sample of 424 health providers. Data was collected with an anonymous questioners using physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) tool. Linear regression analysis was used to examine relationships among variables. The strength of association was assessed by using unstandardized β with 95% CI.

RESULTS

The mean score of perceived provider's readiness in managing IPV was 26.18± 6.69. Higher providers age and providers perceived knowledge had positive association with provider perceived readiness in managing IPV. Whereas not had IPV training, absence of a protocol for dealing with IPV management, and provider attitude had a negative association with provider perceived readiness in managing IPV.

CONCLUSION AND RECOMMENDATION

This study reviled that health providers had limited perceived readiness to manage IPV. Provision of training for providers and develop protocol for IPV managements have an important role to improve providers readiness in the managements of IPV.

An Umbrella Review of the Literature on Perinatal Domestic Violence: Prevalence, Risk Factors, Possible Outcomes and Interventions

Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for, potential effects of, and promising interventions to reduce P-DV is essential for informing policies to tackle P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of worldwide research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of and interventions to reduce and prevent P-DV. 13 reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e. English systematic reviews and/or meta-analyses that were from recent 10 years, focused on women exposed to P-DV, assessed risk factors, possible outcomes and/or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has thus far not been translated well into effective interventions. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance reliability.

The Association Between Domestic Violence and Adverse Pregnancy Outcomes in Pregnant Women Seeking Antenatal Care at Public Hospitals in Gedeo Zone: A Prospective Cohort Study

Background

Domestic violence is any harmful behavior by an intimate partner, such as physical, sexual, or psychological abuse. In Ethiopia, domestic violence is a serious and widespread problem. It affects two-thirds (64.6%) of pregnant women and increases the risk of maternal and perinatal morbidity and mortality. Domestic violence during pregnancy is a growing public health problem that may contribute to maternal and perinatal mortality, especially in low- and middle-income countries. This study aims to assess the association between domestic violence during pregnancy and the risk of adverse pregnancy outcomes in Gedeo Zone Public Hospitals, Southern Ethiopia.

Material and Methods

We conducted a prospective cohort study on 142 pregnant women in their third trimester who attended public health institutions in Gedeo Zone for antenatal care. We compared 47 women who were exposed to domestic violence with 95 who were not and followed them until 24 hours after delivery or drop-out. We used SPSS version-24 to analyze data and logistic regression to examine the association between domestic violence and pregnancy outcomes. We reported the results using an adjusted odds ratio with 95% confidence interval and P-value.

Results

Out of 142 women, who completed the follow-up, 47 were exposed to domestic violence and 95 were not. We found a strong link between domestic violence and preterm birth. Women exposed to domestic violence had a four-fold higher risk of preterm birth (AOR= 4.392, 95% CI: 1.117, 6.588) than those who were not. They also had a 2.5-fold higher risk of perinatal death (AOR= 2.562, 95% CI: 1.041, 6.308).

Conclusion

Domestic violence during pregnancy affects many pregnant women in southern Ethiopia and harms their babies. It leads to preterm birth and perinatal death, which can be prevented. The Ethiopian government and other stakeholders need to protect pregnant women from intimate partner violence urgently.

Physical violence during pregnancy in sub-Saharan Africa: why it matters and who are most susceptible?

OBJECTIVE

The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA).

DESIGN

We analysed cross-sectional data of 108971 women in sexual unions from the most recent Demographic and Health Surveys of 26 countries in SSA. The predictors of physical violence were examined using a multilevel binary logistic regression. All the results were presented as adjusted odds ratios (aORs) with their corresponding 95% confidence intervals (CIs).

SETTING

Twenty-six countries in SSA.

PARTICIPANTS

108 971 women who had ever been pregnant.

OUTCOME MEASURE

Physical violence during pregnancy.

RESULTS

Physical violence was identified in 6.0% of pregnant women in SSA. The highest prevalence (14.0%) was reported in South Africa, while Burkina Faso recorded the lowest (2.1%). Women who had primary (aOR=1.26, 95% CI=1.15, 1.38) and secondary education (aOR=1.15, 95% CI=1.01,1.32); those who were cohabiting (aOR=1.21, 95% CI=1.11, 1.32); those who were working (aOR=1.17, 95% CI=1.08, 1.28); and those whose partners had primary (aOR=1.15, 95% CI=1.04, 1.28) and secondary education (aOR=1.14, 95% CI=1.01, 1.28) were more likely to experience physical violence during pregnancy compared with those who had no formal education; those who were married; those who were not working, and those whose partners had no formal education, respectively. Moreover, women whose partners consumed alcohol (aOR=2.37, 95% CI=2.20, 2.56); those who had parity of four or more (aOR=2.06, 95% CI=1.57, 2.72); and those who perceived intimate partner violence (IPV) as a culturally accepted norm (aOR=1.55, 95% CI=1.44, 1.67) had higher odds of experiencing physical violence during pregnancy compared to those whose partners did not consume alcohol, those with parity zero, and those who did not perceive IPV as culturally accepted, respectively. On the contrary, women who were aged 35-39, those who were of the richest wealth index, and those in rural areas had reduced odds of experiencing physical violence during pregnancy.

CONCLUSION

Based on the findings, community leaders are encouraged to liaise with law enforcement agencies to strictly enforce laws on gender-based violence by prosecuting perpetrators of IPV against pregnant women as a deterrent. Also, intensifying education on what constitutes IPV and the potential consequences on the health of pregnant women, their children, and their families will be laudable. Improving the socioeconomic status of women may also help to eliminate IPV perpetration against women at their pregnancy stage.

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.

Needs and unmet needs for support services for recently pregnant intimate partner violence survivors in Ethiopia during the COVID-19 pandemic

BACKGROUND

Globally, 2-14% of women experience intimate partner violence (IPV) during pregnancy. Timely response to IPV is critical to mitigate related adverse health outcomes. Barriers to accessing limited IPV support services are pervasive in low- and middle-income countries (LMICs), such as Ethiopia; key barriers include mistrust, stigmatization, and self-blame, and discourage women from disclosing their experiences. Infection control measures for COVID-19 have the potential to further disrupt access to IPV services.

METHODS

In-depth qualitative interviews were undertaken from October-November 2020 with 24 women who experienced IPV during recent pregnancy to understand the needs and unmet needs of IPV survivors in Ethiopia amid the COVID-19 pandemic. Trained qualitative interviewers used a structured note-taking tool to allow probing of experiences, while permitting rapid analysis for timely results. Inductive thematic analysis identified emergent themes, which were organized into matrices for synthesis.

RESULTS

Qualitative themes center around knowledge of IPV services; experiences of women in seeking services; challenges in accessing services; the impact of COVID-19 on resource access; and persistent unmet needs of IPV survivors. Notably, few women discussed the violence they experienced as unique to pregnancy, with most referring to IPV over an extended period, both prior to and during COVID-19 restrictions. The majority of IPV survivors in our study heavily relied on their informal network of family and friends for protection and assistance in resolving the violence. Though formal IPV services remained open throughout the pandemic, restrictions resulted in the perception that services were not available, and this perception discouraged survivors from seeking help. Survivors further identified lack of integrated and tailored services as enduring unmet needs.

CONCLUSIONS

Results reveal a persistent low awareness and utilization of formal IPV support and urge future policy efforts to address unmet needs through expansion of services by reducing socio-cultural barriers. COVID-19 impacted access to both formal and informal support systems, highlighting needs for adaptable, remote service delivery and upstream violence prevention. Public health interventions must strengthen linkages between formal and informal resources to fill the unmet needs of IPV survivors in receiving medical, psychosocial, and legal support in their home communities.

Multilevel analysis of factors for intimate partner violence during pregnancy in Gammo Goffa Zone, South Ethiopia: A community based study

Background

Intimate partner violence during pregnancy is a public health problem that can affect both maternal and fetal life. However, its prevalence and associated factors have not been well studied and understood in Ethiopia. Hence, this study was conducted to assess the individual and community-level factors associated with intimate partner violence during pregnancy in Gammo Goffa Zone, South Ethiopia.

Methods

A community-based cross-sectional study was conducted among 1,535 randomly selected pregnant women from July to October 2020. Data were collected using an interviewer-administered, standardized WHO multi-country study questionnaire and analyzed using STATA 14. A two level mixed-effects logistic regression model was used to identify factors associated with intimate partner violence during pregnancy.

Results

The prevalence of intimate partner violence during pregnancy was found to be 48% (95% CI: 45–50%). Factors affecting violence during pregnancy were identified at the community and individual levels. Access to health facilities (AOR = 0.61; 95% CI: 0.43, 0.85), women feeling isolated from the community (AOR= 1.96; 95% CI: 1.04, 3.69), and strict gender role differences (AOR= 1.45; 95% CI: 1.03, 2.04) were among higher-level factors found to be significantly associated with intimate partner violence during pregnancy. Low decision-making power was found to increase the odds of experiencing IPV during pregnancy (AOR= 2.51; 95% CI: 1.28, 4.92). Similarly, maternal education, maternal occupation, living with the partner's family, current pregnancy intended by the partner, dowry payment, and presence of marital conflict were among the individual- level factors found to increase the odds of experiencing intimate partner violence during pregnancy.

Conclusions

The prevalence of intimate partner violence during pregnancy was high in the study area. Both individual and community-level factors had significant implications on maternal health programs related to violence against women. Socio-demographic and socio-ecological characteristics were identified as associated factors. Since it is a multifaceted problem, special emphasis has to be given to multi-sectoral approaches involving all responsible bodies to mitigate the situation.

Intimate partner sexual violence during pregnancy and its associated factors in Northwest Ethiopian women

Background

Violence against women is a global problem. In pregnant women, it is a particular concern as a virtue of the additional risks to the unborn child. Of different acts of violence, sexual violence shares the major contribution that results in short and long-term physical, sexual, reproductive, and mental health problems of pregnant women. Little is known about sexual violence during pregnancy in Ethiopia.

Objective

this study aimed to assess the proportion and factors associated with intimate partners' sexual violence against pregnant women in Northwest Ethiopia.

Methods

A cross-sectional study was conducted among 409 pregnant women in Debre Markos town from March to April 2018. The study participants were selected using a systematic random sampling technique. A pre-tested and validated questionnaire was used. Binary logistic regression analyses were done to identify associated factors and the adjusted odds ratio (AOR) with its 95 % confidence interval (CI) at a p-value of <0.05 was used to declare a significant association.

Result

Of 409 pregnant women, 19.8% have experienced sexual violence by their intimate partner during their current pregnancy. Accordingly, the major intimate partner sexual violence during pregnancy was having unwanted sexual intercourse due to fear from the partner (13.4%), being forced to do something sexual that is degrading or humiliating (13.0%), and being physically forced to have sexual intercourse (9.8%). Living with her partner/husband (AOR: 3.73, 95% CI: 1.30, 10.69), uneducated educational status of partner (AOR: 2.43, 95% CI: 1.06, 5.56), and frequency of alcohol consumption (AOR: 3.20, 95% CI: 1.24, 8.26) were factors associated with increased occurrence of intimate partner sexual violence during pregnancy.

Conclusion

The proportion of sexual violence against pregnant women by their intimate partner(s) was found to be common in our study. Socio-demographic and behavioral-related factors were risk factors for sexual violence. As a result, preventive strategies and interventions centering on the empowerment of those facing the greatest barriers to reproductive freedom require a shift from traditional ways of thinking.

Intimate partner violence against women of reproductive age and associated factors during COVID-19 pandemic in Northern Ethiopia, 2021: A community-based cross-sectional study

Background

Intimate partner violence (IPV) is a major public health concern that affects more than one-third of all women globally. Assessing the prevalence of intimate partner violence and associated factors during the COVID-19 pandemic in various localities is crucial for intervention actions. So far, a few studies have been done in Ethiopia during the current COVID-19 pandemic.

Objective

This study aimed to assess the prevalence of intimate partner violence in women of reproductive age and associated factors during the COVID-19 pandemic in Debre Berhan town, Ethiopia, 2021.

Methodology

A community-based cross-sectional study was done. A total of 809 ever-partnered women of reproductive age were selected randomly via a multistage sampling method. Crude and adjusted odds ratios (AOR) with the resulting 95% confidence interval (CI) were used to verify the strength of associations. Significant associations were declared at p-values <0.05.

Result

Among the 796 women who successfully participated in the study, 337 (42.3%) experienced at least one type of intimate partner violence. Prevalence of psychological, physical, and sexual violence was 35.3% (281), 15.3% (122), and 15.2% (121), respectively. Multivariate analysis revealed that women with no formal education [AOR (95% CI): 3.66 (1.91-6.98)], having no own income [AOR (95% CI): 1.78 (1.24-2.56)], and attitude of IPV were acceptable [AOR (95% CI): 4.02 (1.33-12.14)]; a male partner with no formal education [AOR (95% CI): 3.06 (1.53-6.14)], with "level of religious beliefs" [weak-AOR (95% CI): 4.17 (1.45-12.03); and medium-AOR (95% CI): 1.64 (1.13-2.39)], who is alcoholic [AOR (95% CI): 5.91 (4.03-8.67)], and with smoking habits [AOR (95% CI): 2.04 (1.10-3.77)] and >5 [AOR (95% CI): 1.83 (1.01-3.39)] was significantly associated with the presence of intimate partner violence.

Conclusion and recommendation

This study revealed a high prevalence of IPV in the study participants. The high intimate partner violence prevalence was due to multiple factors, thus demanding empowering women and tailored health education for male partners.

Pregnant women and health workers' perspectives on perinatal mental health and intimate partner violence in rural Ethiopia: a qualitative interview study

BACKGROUND

Mental health conditions are common during the perinatal period and associated with maternal, foetal, and neonatal morbidity and mortality. There is an established bidirectional relationship between mental health conditions and intimate partner violence (IPV), including during and after pregnancy. Mean lifetime prevalence of physical, sexual or emotional IPV exposure among women in rural Ethiopia is estimated to be 61% and may be even higher during the perinatal period. We aimed to explore the perspectives of women and antenatal care (ANC) health workers on the relationship between all types of IPV and perinatal mental health, to inform the adaptation of a psychological intervention for pregnant women experiencing IPV in rural Ethiopia.

METHODS

We conducted in-depth qualitative interviews with 16 pregnant women and 12 health workers in the Gurage zone of the Southern Nations, Nationalities and People's Region of Ethiopia, between December 2018 and December 2019. We conducted thematic analysis of English-translated transcripts of audio-recorded Amharic-language interviews.

RESULTS

Participants contextualised IPV as the primary form of abusive treatment women experienced, connected by multiple pathways to emotional and bodily distress. Patriarchal norms explained how the actions of neighbours, family, community leaders, law enforcement, and government agents in response to IPV often reinforced women's experiences of abuse. This created a sense of powerlessness, exacerbated by the tension between high cultural expectations of reciprocal generosity and severe deprivation. Women and health workers advocated a psychological intervention to address women's powerlessness over the range of difficulties they faced in their daily lives.

CONCLUSIONS

Women and health workers in rural Ethiopia perceive multiple, interconnected pathways between IPV and perinatal emotional difficulties. Contrary to expectations of sensitivity, women and health workers were comfortable discussing the impact of IPV on perinatal mental health, and supported the need for brief mental health interventions integrated into ANC.

Intimate Partner Violence and Pregnancy Termination Among Women in Sub-Saharan Africa

Intimate partner violence (IPV) is predominant in sub-Saharan Africa (SSA) and has serious adverse effects on the physical, psychological, and reproductive health of those who experience it. For reproductive health outcomes, experiencing IPV has been linked to higher odds of unintended pregnancies that can result in abortion. Hence, we examined the association between IPV and pregnancy termination among women in SSA. This study used data from the Demographic and Health Surveys (DHSs) of 25 countries in SSA, which adopted a cross-sectional study design. Bivariable and multivariable binary logistic regression models were used to examine the association between IPV and pregnancy termination. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95% confidence intervals (CIs). The prevalence of IPV and pregnancy termination were 40.8% and 16.5%, respectively. The odds of pregnancy termination was higher among women who had experienced IPV [cOR = 1.57, 95% CI = 1.52-1.61] compared to those who had never experienced IPV. This persisted after controlling for potential confounders [aOR = 1.56, 95% CI = 1.51-1.61]. At the country level, IPV had a significant association with pregnancy termination in all the countries considered, except Sierra Leone and Namibia. These findings highlight the need for laws and policies to protect women from IPV in SSA, especially in the countries that recorded higher odds of IPV and pregnancy termination.

Perinatal intimate partner violence during COVID-19 and its associated factors among postpartum mothers attending newborn immunization in southern Ethiopia, 2021: A cross-sectional study

Objective:

This study aimed to assess the prevalence of perinatal intimate partner violence during COVID-19 and its associated factors among postpartum mothers attending newborn immunization in southern Ethiopia, 2021.

Method:

A facility-based cross-sectional study was conducted among 657 postpartum mothers from 1 to 30 March 2021 in southern Ethiopia. All postpartum mothers who visited the selected hospitals or health centers for newborn immunization and met the inclusion criteria were included in this study. Data were cleaned, coded, entered into Epidata manager version 4.2 and then exported into SPSS version 26 for analysis. Binary and multivariate logistic regression analysis was used.

Results:

The prevalence of perinatal intimate partner violence was 62.4%. In this study, income loss due to COVID-19 (adjusted odds ratio: 12.00, 95% confidence interval: 5.60, 25.71, p < 0.001) was the strongest factor associated with perinatal intimate partner violence. Young age women (adjusted odds ratio: 5.82, 95% confidence interval: 2.72, 12.46, p < 0.001), partner alcohol use (adjusted odds ratio: 2.21, 95% confidence interval: 1.37, 3.56, p = 0.001), partner substance use (adjusted odds ratio: 2.07, 95% confidence interval: 1.12, 3.83, p = 0.021), and partner relationships (cohabited) (adjusted odds ratio: 1.88, 95% confidence interval: 1.06, 3.34, p = 0.032) were also strongly associated with perinatal intimate partner violence.

Conclusion:

The prevalence of perinatal intimate partner violence was relatively high. The health of the women should be maintained through empowerment of women and provision of health education in order to minimize prevalence of perinatal intimate partner violence associated with low income, young age, substance use, and cohabited marital status. Future qualitative studies are required to identify the underlying multifactorial reasons for intimate partner violence.

Nearly Half of Women Have Experienced Intimate Partner Violence During Pregnancy in Northwest Ethiopia, 2021; The Role of Social Support and Decision-Making Power

Background

In developing countries, intimate partner violence is increasing alarmingly, though attention to this issue is rarely given. It has devastating effects on the general wellbeing of women, pregnancy outcomes, and the long-term health of children, and this needs to be addressed. Hence, this study was designed to assess intimate partner violence and associated factors in northwest Ethiopia.

Methods

A community-based cross-sectional study was conducted from July 1^st to August 30^th, 2021, among 858 postpartum women in Gondar city. A cluster sampling technique was employed to select the study participants. EPI DATA version 4.6 and SPSS 25 were used for data entry, cleaning and analysis, respectively. A bivariable and multivariable logistic regression model was fitted to identify factors associated with intimate partner violence. The level of significant association was declared using the adjusted odds ratio (AOR) with 95 % confidence interval (CI) and a p-value of ≤ 0.05.

Results

In this study, 48.6% of women indicated having experienced intimate partner violence during pregnancy (95% CI: 45.3, 51.7). The odds of intimate partner violence during pregnancy were significantly higher among women who were not able to read and write (AOR = 4.96; 95% CI: 2.15, 11.41), were private workers (AOR = 1.78; 95% CI: 1.05, 3.02), and had low decision-making power (AOR = 1.43; 95% CI: 1.06, 1.95), a poor social support (AOR = 1.99; 95% CI: 1.32, 3.02), and unsupported pregnancy by family (AOR = 2.32; 95% CI: 1.26, 4.24). Whereas a family size of ≥ 5 (AOR = 0.73; 95% CI: 0.54, 0.98) appeared to be a protective factor for intimate partner violence.

Conclusion

The magnitude of intimate partner violence was unacceptably high in the study area and connected to poor women's empowerment and social determinants of health. Thus, it is important to focus on interventions that improve women's access to social support and allow them to participate in all aspects of household decision-making through community-based structures and networks. It is also important to encourage women to improve their educational status and arrange risk-free employment opportunities.

Intimate partner violence and associated factors among reproductive age women in Liberia: a cross-sectional study using a recent Liberian demographic and health survey

Background

Intimate partner violence (IPV) is a major public health problem and a violation of women's human rights. Almost one third of women aged 15–49 years who have been in a relationship have experienced to some form of physical and/or sexual violence by their intimate partner worldwide.

Objective

The study aimed to assess the prevalence of intimate partner violence within the last 12 months and associated factors among reproductive aged women in Liberia.

Method

This study was based on a large community-based cross-sectional survey, Liberia Demographic Health Survey (LDHS), conducted From October 16, 2019, to February 12, 2020, in Liberia. The 2019–20 LDHS used a stratified two-stage cluster design. Multivariable logistic regression was used to identify independent intimate partner violence among reproductive age women in Liberia and to control confounders. Adjusted odds ratio and confidence interval (CI) were used to declare statistical significance in the final model. Those variables with p value < 0.05 were considered as statistically significant.

Result

The overall prevalence of IPV within the last 12 months was 44.74% (42.73–46.77). age of the women 41% (AOR = 0.59, 95%CI 0.37–0.93), 42% (AOR = 0.58, 95%CI 0.35–0.94), and 59% (AOR = 0.41, 95%CI 0.25–0.68) among women with in the age group of 35–39, 40–44 and 45–49 respectively, south central region (AOR = 0.71, 95%CI 0.52–0.96), women’s primary education (AOR = 1.28, 95%CI 1.01–1.63), female household head (AOR = 0.77, 95%CI 0.61–0.97), husbands higher education (AOR = 0.62, 95%CI 0.39–0.99), positive wife beating attitude (AOR = 1.57, 95%CI 1.29–1.90), husband drinks (AOR = 2.59, 95%CI 2.14–3.15) and Women’s decision making autonomy (AOR = 0.75, 95%CI 0.61–0.93) were significantly associated with IPV.

Conclusion

The prevalence of IPV in Liberia was high. Socio-demographic characteristics of women, husbands education, sex of household head, having a positive attitude towards wife-beating, partner’s alcohol drinking habit and women empowerment was significantly associated with IPV in Liberia. Policymakers and program designers have to take into account those factors when they design interventions to reduce IPV in Liberia.

Violence against Pregnant Women in Indonesia

BACKGROUND

Generally, violence against women, especially during pregnancy, can increase the risk of pregnancy and childbirth complications. Besides, multiple trauma may occur because it affects not only the woman but also the fetus. The present study analyzed the factors associated with violence against pregnant women in Indonesia.

METHODS

This cross-sectional study involved participants consisted of 2,553 pregnant women (aged 15-49) from the 2017 Indonesian Demographic and Health Survey data. The dependent variable was violence, while the independent variables included the characteristics of the households, respondents, and husbands/partners. In the final stage, the author calculated determinants using binary logistic regression.

RESULTS

The higher the wealth status of pregnant women, the lower the likelihood of domestic violence. The pregnant women who jointly owned a house with their husbands/partners were more likely to be violated than those who did not. Pregnant women in the high parity category were at greater risk of experiencing violence than those in the primiparous category. A husband/partner at a younger age increased the likelihood of violence among pregnant women. Finally, the pregnant women whose husbands/partners had primary/secondary education were more likely to experience violence than those whose husbands/partners had no education.

CONCLUSION

The study concluded five variables were statistically and significantly associated with violence against women in Indonesia: wealth status, homeownership, parity, husband/partner' age, and the education level of the husbands/partners.

Prevalence and Associated Factors of Intimate Partner Violence Among Married Women During COVID-19 Pandemic Restrictions: A Community-Based Study

Ethiopia has taken unprecedented preventive measures, such as confinement to home and closure of schools and offices to halt the spread of Corona virus pandemic in the country. Unfortunately, such orders may have been associated with intimate partner violence (IPV) against women but there is no study conducted to assess the magnitude of IPV during the lock-downs in the country. Thus, this study intended to investigate the prevalence and associated factors of IPV against women during the COVID-19 pandemic restrictions. A community-based cross-sectional study was conducted on sample of 617 married or cohabited women. A systematic random sampling technique was employed to identify and enroll women who are married. A logistic regression analysis was used to identify the predictors of IPV among women and all statistical analyses were carried out using STATA 14.2. In this study, amongst the 589 married women who were included in the analysis, 22.4% [95% CI: 19.1%, 25.9%] were experienced at least one form of IPV. Additionally, 11.0%, 20.0%, and 13.8% of women also experienced physical, psychological, and sexual IPVs respectively. After adjusting for covariate; being illiterate [AOR=2.37: 95% CI 1.29, 4.35], having illiterate husband [AOR=2.67: 95% CI 1.36, 5.21], having substance user husband (alcohol, chat or cigarettes) [AOR=2.75: 95% CI 1.42, 5.34], and community tolerant attitude to violence [AOR=2.97: 95% CI 1.17, 7.61] were the independent predictors of IPV amongst married women. In conclusion, the prevalence of IPV among married women was comparable to the national pre-COVID figure of IPV. Therefore, national and regional governments should work toward enhancing gender equality, coupled with addressing risk factors at multiple levels, using community- and institution-based approaches to prevent IPV and to specifically achieve SDG5 of eliminating violence against women by 2030.

Determinants of Intimate Partner Violence against Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis

Background. Intimate partner violence (IPV) against pregnant women is a recognized global public health problem affecting all spheres of women and unborn infants. In Ethiopia, although inconsistent, individual studies avail; there is a dearth of systematic reviews and meta-analysis about the prevalence and associated factors of intimate partner violence. Thus, the present study was aimed at determining the pooled prevalence of IPV and its determinant factors during pregnancy. Methods. The report of meta-analysis follows the Preferred Reporting Items for Systematic Review and Meta-Analysis 20 guideline (PRISMA 20). Databases including PubMed/Medline, CINAHL, SCOPUS, HINARI (research4life), AJOL, IRIS, and AIM were searched. Heterogeneity test was assessed by the Cochrane chi-square ( $\chi 2$ ) and quantified by $I^2$ statistics test. Publication bias was tested by funnel plots and Egger’s test. Sensitivity test and subgroup analysis were also performed. Effect size was calculated by random effects model. Results. A total of 26 studies, including data from 13, 912 participants, were included in the analysis. The prevalence of IPV ranged from 7% to 81% with overall estimated pooled prevalence of 37% (30% -44%, $I^2=96.5$ %, $p\le 0.001$ ). Of this, the prevalence of physical, sexual, and psychological violence was 24% (95% CI; 19%-30%), 21% (95% CI; 16%-26%), and 27% (95% CI; 22%-32%), respectively. Factors such as lack of formal education, childhood violence, rural residency, low decision-making power, family history of violence, attitude, unplanned and unwanted pregnancy by women and partners, late initiation of antenatal care, partner alcohol, and khat use were associated with IPV. Conclusion. More than one-third of pregnant women experienced IPV. The most prevalent form of IPV was psychological violence followed by physical and sexual violence. The identified risk for IPV including victim, pregnancy, and perpetrator-related factors indicated the need of a holistic approach in the promotion, prevention, and treatment of IPV. The finding of this study suggests the need of strengthening women empowerments (capacity building) against traditional beliefs, attitudes, and practices. This study also suggests the need of evaluation and strengthening the collaborative work among different sectors such as policy-makers, service providers, administrative personnel, and community leaders, including the engagement of men partners.

Prevalence and its predictors of intimate partner violence against pregnant women amid COVID-19 pandemic in Southwest Ethiopia, 2021: A cross-sectional study

OBJECTIVES

Preventive measures like staying-at-home and social distancing are among the top strategies on the list to avert the spread of coronavirus disease 2019 and its consequences. However, this strategy brings off another shadow pandemic of intimate partner violence against women, and no study has been done to assess the magnitude of intimate partner violence against pregnant women during the pandemic in Ethiopia. Therefore, this study was aimed to determine the prevalence of intimate partner violence and its predictors in Southwest Ethiopia amid the coronavirus disease 2019 pandemic.

METHODS

A community-based cross-sectional study was conducted, from 15 June 2021 to 15 August 2021, on a total of 590 pregnant women recruited by systematic random sampling techniques. Pretested structured questionnaires were used to collect data, and the data were entered using EpiData version 3.1 and analyzed by SPSS version 24. Logistic regression analysis was used to identify predictors of intimate partner violence. Finally, statistical significance was declared at a p-value <0.05.

RESULTS

The prevalence of intimate partner violence was 39.2%. Of this, 29.8%, 26.8%, and 22.2% of the pregnant women had experienced physical, sexual, and emotional intimate partner violence, respectively. Being illiterate (adjusted odds ratio = 2.36, 95% confidence interval: 1.33-4.19), having illiterate husbands (adjusted odds ratio = 4.79, 95% confidence interval: 2.69-8.55), household decisions made by the husband alone (adjusted odds ratio = 4.91, 95% confidence interval: 3.74-9.33), and pandemic-induced economic downturns (adjusted odds ratio = 9.03, 95% confidence interval: 5.18-15.98) were the predictors that were significantly associated with intimate partner violence.

CONCLUSION

The prevalence of intimate partner violence against pregnant women during the coronavirus disease 2019 pandemic has been found to be high in the study area. Thus, more efforts should be tried to integrating intimate partner violence screening in maternal and child healthcare services, and early identification of high-risk individuals, and continuous community-based awareness creation activities are recommended.

Magnitude and factors associated with intimate partner violence against pregnant women in Ethiopia: a multilevel analysis of 2016 Ethiopian demographic and health survey

Background

Intimate partner violence (IPV) is defined as acts of physical aggression, sexual coercion, psychological/emotional abuse, or controlling behaviors by a current or former partner or spouse. IPV has a special concern for pregnant women since it leads to higher rates of miscarriage, several complications including adverse birth outcomes. So far, the effect of contextual factors on IPV was largely overlooked. Therefore, this study aimed to assess the magnitude and factors associated with IPV among pregnant women in Ethiopia.

Method

Data from the 2016 Ethiopian Demographic and Health Survey was used for this study. A total of 4167 (weighted sample) pregnant women were included in the analysis. The multi-level logistic regression model was fitted to identify factors associated with IPV. Finally, the adjusted odds ratio (AOR) with 95% CI and random effects for the multilevel logistic regression model was reported.

Results

In this study, the overall magnitude of IPV among pregnant women was 28.74 (95% CI 27.38, 30.13) with emotional violence being the most common (24.09%) type. In the multi-level analysis, women with no education (AOR = 2.07; 95%CI 1.23, 3.48), primary education (AOR = 2.04; 95%CI:1.24, 3.38), and secondary education (AOR = 1.53; 95%CI:1.29.2.62), women from households with poorest (AOR = 1.72; 95%CI: 1.16, 2.56), poorer (AOR = 1.62;95% CI:1.09, 2.41), middle (AOR = 1.74;95%CI:1.17, 2.56), and richer (AOR = 1.58;95%CI: 1.08, 2.33) wealth index, women aged 35–39 years (AOR = 1.28;95%CI:1.01, 1.63) and 40–49 years (AOR = 1.78;95%CI:1.28, 2.45) and those from pastoral (AOR = 1.47;95%CI:1.04, 1.93) and agrarian regions (AOR = 1.32;95%CI 1.02, 1.88) had a higher likelihood of having IPV. Of the partner-related factors, women with husbands who drink alcohol (AOR = 2.94; 95%CI: 2.36, 3.42) and secondary educational level (AOR = 1.47; 95%CI 1.02, 2.12) had higher odds of experiencing IPV during pregnancy.

Conclusion

Intimate partner violence during pregnancy is a public health problem in Ethiopia. Therefore, improving the educational status of women and their husbands, improving the economic capacity of women, and promoting the healthy behavior of husbands by reducing the alcohol consumption in those agrarian and pastoral regions of Ethiopia is vital to reduce the magnitude of IPV.

Prevalence and associated factors of intimate partner violence among pregnant women attending health care facilities, Northern Ethiopia: comparative cross-sectional study

Intimate partner violence (IPV) is a major public health problem. While it is high among pregnant women in Ethiopia, the cases are under-reported, and the true extent of the issue is uncertain. The study is intended to determine the prevalence and determinants of IPV among pregnant women seeking antenatal care (ANC). A comparative cross-sectional survey was conducted in healthcare facilities, Northern Ethiopia, in 2019. A sample of 324 pregnant women visiting ANC service was selected by systematic sampling. Binary logistic regression was conducted to identify significant determinants. The prevalence of IPV during pregnancy was 36.3%. Lack of formal schooling, rural life, husband's additional sexual partners, lack of shared decisions, and partners' alcohol intake were identified as a predictor of IPV. It is important to consider raising awareness, enhancing women's decision-making abilities, and educating women. Furthermore, partner involvement should be addressed to minimize violence against women in the community.IMPACT STATEMENTWhat is already known on this subject? Intimate partner abuse (IPV) is a global public health problem as well as a significant violation of human rights, and Ethiopia has the world's highest rates of physical and sexual IPV. The immediate effect of IPV during pregnancy (sexually transmitted infections (STI), intrauterine growth retardations (IUGR), preterm labour, miscarriage, abortion, antepartum haemorrhage, perinatal death) was known.What do the results of this study add? Even though the outcome of IPV among pregnant women was recognised, the underlying factors of the violence were not well understood. As a result, this research will contribute to our understanding of the determinants of IPV among pregnant women.What are the implications of these findings for clinical practice and/or further research? In this research, we revealed that the majority of the determinants of IPV among pregnant women were linked to their husband's behaviour, and that women's decision-making capacity and educational level were also root causes of the violence. Therefore, Women empowerment and partner participation during antenatal care would offer outstanding feedback to reduce partner violence. Aside from that, more research in family health would provide in-depth knowledge about the root cause of the violence.

Magnitude and associated factors of antenatal depression among mothers attending antenatal care in Arba Minch town, Ethiopia, 2018

BACKGROUND

Depression is a common mental disorder. The burden of antenatal depression is higher in developing countries which is 20% as compared to developed ones 10% to 15%. In Ethiopia around one-fifth of pregnant mothers are depressed. Despite the severity of the problem, only a few studies have been done in Ethiopia, and there is no study done in Arba Minch on the problem.

OBJECTIVE

To assess the magnitude and associated factors of antenatal depressive symptoms among pregnant women attending Public Health facilities in Arba Minch town Southern Nations and Nationalities Peoples Region, Ethiopia 2018.

METHODS

Health Institution based, cross-sectional study design was used to assess the magnitude and associated factors of antenatal depression among 323 pregnant mothers who came for antenatal care follow-up in all public health facilities in Arba Minch town. The systematic random sampling technique was applied. Interviewer administered, pretested structured Questionnaire containing Edinburgh postpartum depression scale was utilized. EPI INFO was used to enter data and then the data were analyzed by logistic regression using SPSS. Variables with P-value less than 0.2 in the bivariate logistic regression were inserted in for multivariable analysis to see their independent effect and those with P-value less than 0.05 were used to determine the significant association between dependent and independent variables.

RESULT

The magnitude of antenatal depression was 35.4%. Variables that were significantly associated with antenatal depression on multivariate analysis were anxiety (AOR = 5.49, 95%CI: 2.56, 11.77), un-planned pregnancy (AOR = 2.71, 95%CI: 1.21, 6.07), and Primigravida (AOR = 2.96, 95%CI: 1.28, 6.8). Similarly, uneducated mothers and those who attend only elementary school had AOR 4.92, 95% CI 1.36,17.73 and AOR 4.04955CI 1.23, 13.39 respectively.

CONCLUSION

The magnitude of antenatal depression, intimate partner violence, and threatening life event in Arba Minch town was high. Anxiety, unplanned pregnancy, educational status, and Primigravida were significantly associated factors with depression. There should be a mechanism for routine screening and management of antenatal depression and intimate partner violence during antenatal care follow-up.

Is preterm birth associated with intimate partner violence and maternal malnutrition during pregnancy in Ethiopia? A systematic review and meta analysis

BACKGROUND

Despite remarkable progress in the reduction of under-five mortality, preterm birth associated mortality and morbidity remains a major public health problem in Sub-saharan Africa. In Ethiopia, study findings on the association of preterm birth with intimate partner violence and maternal malnutrition have been inconsistent. Therefore, this systematic review and meta-analysis estimates the pooled effect of intimate partner violence and maternal malnutrition on preterm birth.

METHODS

International databases including PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library, were systematically searched. All identified observational studies and/or predictors were included. I2 statistics and Egger's test were used to assess the heterogeneity and publication biases of the studies. A random-effects model was computed to estimate the prevalence and its determinants of preterm birth.

RESULTS

The random effects meta-analysis showed that a pooled national prevalence of preterm birth was 13% (95% CI: 10.0%, 16.0%). The highest prevalence of preterm birth was 25% (95% CI: 21.0%, 30.0%) in Harar, and the lowest prevalence was 8% in Southern Nations Nationalities People of Representatives. The meta-analysis suggested a decrease in preterm birth of up to 61% among women receiving antenatal care [POR = 0.39 (95% CI: 0.21, 0.72)]. Women who experienced intimate partner violence [POR = 2.52 (95% CI: 1.68, 3.78)], malnutrition during pregnancy [POR = 2.00 (95% CI: 1.16, 3.46)], and previous preterm birth [POR = 3.73 (95% CI: 2.37, 5.88)] had significantly higher odds of preterm birth.

CONCLUSION

One in every eight live births in Ethiopia were preterm. Women who experienced intimate partner violence, malnutrition, and had previous preterm exposure were significantly associated with preterm birth. Thus, improving antenatal care visits and screening women who experience previous preterm birth are key interventions. The Federal Ministry of Health could be instrumental in preventing intimate partner violence and improving the nutritional status of pregnant women through proper and widespread implementation of programs to reduce preterm birth.

Intimate partner violence among pregnant women attending antenatal care services in the rural Gambia

Background

Intimate partner violence (IPV) refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It is the most common form of violence in women’s lives. According to a World Health Organization report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life. In the Gambia, about 62% of pregnant women experience at least one form of violence from an intimate partner. IPV has severe physical and mental health consequences on a woman ranging from minor bodily injury to death. It also increases the risk of low birth weight, premature delivery, and neonatal death.

Methods

A health facility-based cross-sectional study design was carried out to assess the magnitude and factors associated with intimate partner violence among pregnant women seeking antenatal care in the rural Gambia. The study enrolled 373 pregnant women, and a multi-stage sampling technique was used to select the respondents. An interviewer-administered structured questionnaire was used to obtain information from the study participants. The collected data were analyzed using SPSS Ver.22. Bivariate and multivariate logistic regression were used to determine the association between dependent and independent variables. Odds ratio with 95% confidence interval (CI) was computed to determine the presence and strength of associated factors with IPV.

Result

The study reveals that the prevalence of IPV in The Gambia is 67%, with psychological violence (43%) being the most common form of IPV reported by the respondents. The multivariate logistic regression result reveals that being aged 35 years or older [AOR 5.1(95% CI 1.5–17.8)], the experience of parents quarreling during childhood [AOR 1.7(95% CI 1.0–2.75)], and having cigarette smoking partners [AOR 2.3 (95% CI 1.10–4.6)] were significantly associated with IPV during pregnancy.

Conclusion

This study has demonstrated that all forms of IPV in rural Gambia are frequent. Women older than 35 years, had experienced parents quarreling, had a partner who smoked, and a partner who fight with others were more likely report IPV compared to other pregnant women in the study. We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in rural Gambia.

Intimate partner violence against reproductive-age women and associated factors in Peru: evidence from national surveys, 2015-2017

PURPOSE

We aimed to evaluate the factors associated with intimate partner violence (IPV) against reproductive-age women in Peru.

METHODS

Secondary analysis of the ENDES 2015-2017. ENDES is a multi-stage survey with a probabilistic sampling design for the urban and rural areas of the 25 regions of Peru. A total of 62,870 women of reproductive age (15-49 years) were included. IPV was defined as any report of violence (physical, psychological or sexual) committed by the last partner of the women. Categorical variables were described using absolute frequencies and weighted proportions. We used generalized linear models with Poisson family and log link function to calculate prevalence ratios (PR) for the associated factors with their respective 95% confidence intervals.

RESULTS

The overall IPV was 38.7%. The prevalence of sexual, psychological and physical IPV was 6.9%, 26.8%, and 31.2%, respectively. The frequency of any IPV was lower in younger women, those living with their intimate partners or married, and those living in a coastal region different from Lima. IPV was more frequent among women with a low educational level, or with a partner with low educational level, with children, with a partner with alcohol habit, in women with a history of violence by the father against the mother and living in the highlands or the jungle.

CONCLUSIONS

In Peru, IPV affects nearly four in ten women (physical and psychological types were the most frequent). The factors associated with IPV can be useful markers to identify the most vulnerable groups for implementing interventions intended to decrease the prevalence of IPV.

Effects of rural-urban residence and education on intimate partner violence among women in Sub-Saharan Africa: a meta-analysis of health survey data

Background

Intimate Partner Violence (IPV) against women is a major public health and human rights problem worldwide. Sub-Saharan Africa (SSA) has one of the highest prevalence of IPV against women in the world. This study used meta-analysis to obtain pooled rural–urban and education attainment differences in the prevalence of IPV among ever-partnered women in SSA, and assessed whether the differences in IPV depended on the SSA region or period or women’s age.

Methods

We analysed IPV data on 233,585 ever-partnered women aged 15–49 years from 44 demographic and health surveys conducted between 2000 and 2018 in 29 SSA countries. Random-effects meta-analyses were used to estimate overall rural–urban residence and educational differences in IPV rates among the women in SSA. Subgroup analyses were also done to investigate the sources of heterogeneity in the overall meta-analysis findings.

Results

The pooled prevalence of intimate partner violence was estimated to be 41.3% (37.4–45.2%). Regionally, the highest prevalence of IPV was in Middle Africa (49. 3%; 40.32–58.45), followed by East Africa (44.13%; 36.62–51.67), Southern Africa (39.36%; 34.23–44.49), and West Africa (34.30%; 27.38–41.22). The risks of experiencing IPV were significantly higher if the women had less than secondary education (RR = 1.12; 95% CI  1.07–1.22) compared to those with at least a secondary education. Generally, women who resided in a rural area had their risks of experiencing IPV increased (RR = 1.02; CI 0.96–1.06) compared to those who resided in urban areas, but the IPV increases were only significant in East Africa (RR = 1.13; CI 1.07–1.22).

Conclusion

In sub-Saharan Africa, intimate partner violence against women is widespread, but the levels are much higher among women with lower levels of education and residing in rural areas. Our findings have provided additional support to policies aimed at achieving SDG goals on the elimination of all forms of violence against women and girls in sub-Saharan Africa. For example, policies that advocate improved educational attainment, especially among women and communities in rural areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01286-5.

Spatial distribution and determinants of intimate partner violence among reproductive-age women in Ethiopia: Spatial and Multilevel analysis

BACKGROUND

Intimate partner violence is a serious global public health problem particularly in low-and middle-income countries such as Ethiopia where women's empowerment is limited. Despite the high prevalence of intimate partner violence in Ethiopia, there is limited evidence on the spatial distribution and determinants of intimate partner violence among reproductive-age women. Exploring the spatial distribution of intimate partner violence is crucial to identify hotspot areas of intimate partner violence to design targeted health care interventions. Therefore, this study aimed to investigate the spatial distribution and determinants of intimate partner violence among reproductive-age women in Ethiopia.

METHODS

A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 6090 reproductive-age women were included in the study. The spatial scan statistical analysis was done to identify the significant hotspot areas of intimate partner violence. A multilevel binary logistic regression analysis was fitted to identify significant determinants of intimate partner violence. Deviance, Intra-cluster Correlation Coefficient (ICC), Median Odds Ratio, and Proportional Change in Variance (PCV) were used for model comparison as well as for checking model fitness. Variables with a p-value less than 0.2 were considered in the multivariable analysis. In the multivariable multilevel analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were reported to declare statistical significance and strength of association between intimate partner violence and independent variables.

RESULTS

The spatial analysis revealed that the spatial distribution of intimate partner violence was significantly varied across the country (Moran's I = 0.1007, p-value < 0.0001). The SaTScan analysis identified a total of 192 significant clusters, of these 181 were primary clusters located in the Benishangul-Gumuz, Gambella, northwest Amhara, and west Oromia regions. In the multivariable multilevel analysis; women aged 45-49 years (AOR = 2.79, 95% CI 1.52-5.10), women attained secondary education (AOR = 0.61, 95% CI 0.38-0.98), women in the richest household (AOR = 0.58, 95% CI 0.35-0.97), > 10 family size (AOR = 3.85, 95% CI 1.41-10.54), and high community women empowerment (AOR = 0.66, 95% CI 0.49-0.8)) were significantly associated with intimate partner violence.

CONCLUSIONS

Intimate partner violence among reproductive-age women had significant spatial variation across the country. Women's age, education status, family size, community women empowerment, and wealth status were found significant determinants of intimate partner violence. Therefore, public health programs should design targeted interventions in identified hot spot areas to reduce the incidence of intimate partner violence. Besides, health programmers should scale up public health programs designed to enhance women's autonomy to reduce the incidence of intimate partner violence and its consequences.

Intimate partner violence among prenatal care attendees amidst the COVID-19 crisis: The incidence in Ethiopia

Objective

To assess the incidence and predictors of intimate partner violence (IPV) during pregnancy amidst the coronavirus disease 2019 pandemic.

Methods

This cross‐sectional study was conducted at the prenatal care clinic of St. Paul's Hospital Millennium Medical College (SPHMMC), Addis Ababa, Ethiopia, among pregnant women from 31 August to 2 November 2020. Participants were interviewed using Open Data Kit. Logistic regression was used to assess predictors.

Results

Among the 464 pregnant women, 33 (7.1%) reported IPV during pregnancy, and among these 24 (72.7%) reported emotional violence, 16 (48.5%) reported sexual violence, and 10 (30.3%) reported physical violence. Among the study participants, only 8 (1.7%) were screened for IPV. IPV was reported 3.27 times more often by women who reported that their partner chewed Khat compared with those women whose partner did not (adjusted odds ratio [aOR] 3.27; 95% confidence interval [CI] 1.45–7.38), and 1.52 times more often women who reported that their partner drank alcohol compared with those women whose partner did not (aOR 1.52; 95% CI 1.01–2.28).

Conclusion

Very few women were screened for IPV. Partners drinking alcohol and chewing Khat are significantly positively associated with IPV during pregnancy. IPV screening should be included in the national management protocol of obstetric cases of Ethiopia.

Very few women were screened for intimate partner violence during pregnancy, a finding that has implications for policy moving forward.

Prevalence of Intimate Partner Violence in Pregnancy: An Umbrella Review

BACKGROUND

Intimate partner violence (IPV) is a public health concern, especially during pregnancy, and needs to be urgently addressed. In order to establish effective actions for the prevention of IPV during pregnancy, authorities must be aware of the real burden of IPV. This review aimed to summarize the existing evidence about IPV prevalence during pregnancy worldwide.

METHODS

A review of reviews was carried out. All published systematic reviews and meta-analyses published until October 2020 were identified through PubMed, Scopus, and Web of Science. The main outcome was the IPV prevalence during pregnancy.

RESULTS

A total of 12 systematic reviews were included in the review, 5 of them including meta-analysis. The quality of the reviews was variable. Physical IPV during pregnancy showed a wide range (1.6-78%), as did psychological IPV (1.8-67.4%).

CONCLUSIONS

Available data about IPV prevalence during pregnancy were of low quality and showed high figures for physical and psychological IPV. The existing evidence syntheses do not capture the totality of the worldwide disease burden of IPV in pregnancy.

Postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia: a systematic review and meta-analysis

BACKGROUNDS

Despite remarkable progress in the reduction of maternal mortality, postpartum depression remains a major public health problem among vulnerable populations. In Ethiopia, study findings regarding postpartum depression and its association with intimate partner violence and social support have been inconsistent. Therefore, this systematic review and meta-analysis estimate the pooled prevalence of postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia.

METHODS

We systematically searched international databases like PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library. All identified observational studies reporting the postpartum depression and or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. The I² statistics were used to assess the heterogeneity of the studies. A random-effects model was computed to estimate the pooled prevalence of postpartum depression and its associations with the selected predictors.

RESULTS

The random effect meta-analysis of thirteen studies showed a pooled prevalence of postpartum depression was 21.55% (95% CI: 17.89, 25.94). The highest prevalence of postpartum depression occurred in Addis Ababa, 23.3% and the lowest was in Harar, 13.11%. Our meta-analysis indicated a 5.46 folds increased risk of postpartum depression among women exposed to intimate partner violence (POR = 5.46 (95%CI: 3.94, 7.56, I²=38.8%) and 6.27 folds increased risk postpartum depression among women who had inadequate social support (POR = 6.27 (95%CI: 4.83, 8.13, I2=0) relative to those who had adequate social support. The meta-analysis further revealed that marital dissatisfaction (POR = 2.6%; 95%CI: 1.48-4.65), previous postpartum depression (POR = 2.03%; 95%CI: 1.72-2.4), and substance abuse (POR = 2.03%; 95%CI: 1.72-2.4) were associated with postpartum depression.

CONCLUSIONS

Our study indicates that two in every ten postpartum women in Ethiopia are suffering from postpartum depression. Intimate partner violence and social support should be a major focus to improve women's mental health during postpartum period with the reduction of substance abuse. There is an urgent need for concerted efforts in the reduction of postpartum depression through prevention efforts of intimate partner violence and substance abuse.

Associations between intimate partner violence and pregnancy complications: A cross-sectional study in India

BACKGROUND

The high prevalence rates of violence of the intimate partner affects the maternal health of the woman that sometimes ends in maternal mortality as well as the possibility of an adverse effect on the newborn. The purpose of this study was to assess the prevalence and determinants of intimate physical and sexual intimate partner violence (IPV) on mothers and examine the association between IPV and pregnancy complications.

MATERIALS AND METHODS

Data for the present study were retrieved from the National Family Health Survey-IV (2015-2016). In total, 79,729 women completed the domestic violence questions, but 24,882 were considered for this analysis. The study was restricted to currently married women aged 15-49 who had given birth to at least one child in the 5 years preceding the survey. The association between self-reporting pregnancy complications with the experience of IPV was examined using Chi-square test, followed by multivariate logistic regression.

RESULTS

The study findings show that IPV, specifically physical and sexual violence, are associated with pregnancy complications. The results show that 31.6% of the women had experienced some form of IPV. The factors associated with IPV included husband's alcohol habit, women who had witnessed parental violence, and women whose husbands had shown high marital controlling behavior. The high level of pregnancy complications was reported by women who had experienced sexual violence, emotional violence, and women whose husbands display three or more specific behaviors.

CONCLUSION

Confidential screening for IPV and prompt referral to support services could be crucial in improving women's reproductive health.

Prevalence, Risk Factors and Effects of Domestic Violence Before and During Pregnancy on Birth Outcomes: An Observational Study of Literate Omani Women

BACKGROUND

Domestic violence against women before and/or during pregnancy is a concerning public health issue. It has a deleterious impact on both the mother and the baby.

AIM

The aim of this study is to identify the prevalence and predictors of emotional and physical domestic violence during three periods (lifelong, one year before pregnancy and during pregnancy). Moreover, it evaluates the effects of domestic violence on the outcomes of pregnancy, including miscarriages, birth weight of the baby, gestational age at delivery, and mode of delivery.

METHODOLOGY

This is a prospective observational study of literate pregnant women, attending four primary health-care centers in Muscat, from 1st April 2019 to 31st March 2020. Subjects with twin pregnancies were excluded from the study. The validated Arabic NorVold Domestic Abuse Questionnaire (NORAQ) was used to determine the prevalence of emotional and physical domestic violence. The recruited subjects were re-evaluated for birth outcomes at 2-4 weeks postpartum.

RESULTS

A total of 960 women participated in the study, with the mean age of 30.3 ± 5.4 years. Overall, experiences of lifelong domestic violence were reported by 161 women (16.8%), and the prevalence rate declined substantially in the one-year period preceding pregnancy and during pregnancy, 2.7% and 1.6%, respectively. Women who reported any type of domestic violence one year before pregnancy were at a higher risk of experiencing it again during pregnancy. A multivariate analysis of the obtained data revealed a strong association between physical domestic violence one year before pregnancy and unplanned pregnancy. Subjects with lifelong domestic violence reported higher rates of depression, insomnia, and somatic symptoms. No significant association was found between domestic violence, across any periods, and birth outcomes.

CONCLUSION

The rates of domestic violence are relatively lower during pregnancy and one year before pregnancy compared to those of the lifelong period among Omani women. A significant association was found between domestic violence and depression, insomnia, somatic symptoms, and unplanned pregnancy. Screening for domestic violence during the perinatal period, using high-quality surveys, is of utmost importance.

Violence against pregnant women in the experience of the rape centre of Turin: Clinical and forensic evaluation

Pregnant women can be victims of violence: as a matter of fact, far from being a protective factor, pregnancy can trigger or worsen episodes of abuse. Studies conducted by the WHO highlight that its incidence fluctuates between 1% and 28%. Therefore violence during pregnancy is endemic all over the world and involves all social strata. We analysed 113 medical records concerning pregnant women (average age 27.9 ± 6.0 years, 80 foreigners), who turned to the Centro Soccorso Violenza Sessuale, one of the two Italian Rape Centre, in Turin between January 1st, 2005 and December 31st, 2017. Fifty-three women were visited in the first trimester, 41 in the second, and 16 in the third, while 3 during the puerperium. The current partner was accused to be the abuser by the 84.4% of the Italian women and by the 69.2% of the foreigners. Sixty-eight women suffered multiple forms of violence, while 98 suffered only physical violence, and 3 reported only sexual abuse. According to 20 women, violent episodes increased during pregnancy. The clinical history of these women was characterized by some recurrent physical symptoms, such as pelvic pain, abdominal pain, facial pain and headache and 54 women presented injuries (abrasions and ecchymosis). Our results confirm that violence in pregnancy is a social and public health problem. Therefore it is important that the health personnel should be prepared not only to care for women seeking help, but above all its better preparation could also identify victims of violence, which do not report abuse.

High rate of partner violence during pregnancy in eastern Ethiopia: Findings from a facility-based study

INTRODUCTION

Intimate partner violence during pregnancy can contribute to maternal mortality and morbidity by limiting women's ability to receive maternal health services including antenatal care and skilled delivery care. In Ethiopia, evidence regarding intimate partner violence during pregnancy is limited, and no previous studies have been conducted in the Harari region. Therefore, this study aimed to investigate the prevalence and associated factors of intimate partner violence during pregnancy among women who had given birth in public hospitals in Harari regional state, eastern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted from November 2018 to April 2019 among women who had given birth in public hospitals in Harari regional state, East Ethiopia. A systematic random sampling method was employed to select 648 participants. Data were collected using an interviewer-administered standardized questionnaire based on the World Health Organization Multi-Country Study on Women's Health and Domestic Violence against Women survey. Crude and adjusted odds ratios with respective confidence intervals were computed. Variables with a p-value of ≤0.05 were considered to have a significant association with intimate partner violence during pregnancy.

RESULTS

The prevalence of intimate partner violence during the most recent pregnancy was found to be 39.81%. Furthermore, the prevalence of physical, emotional and sexual violence were found to be 25.93%, 25.62% and 3.7%, respectively. Longer duration of marriage (adjusted odds ratio = 1.68, 95% confidence interval = 1.01-2.79), most recent pregnancy being unplanned (adjusted odds ratio = 1.55, 95% confidence interval = 1.03-2.34), experiencing controlling behaviour by a partner, (adjusted odds ratio = 2.23, 95% confidence interval = 1.46-3.40) and having an attitude that justifies intimate partner violence (adjusted odds ratio = 1.60, 95% confidence interval = 1.09-2.36) were associated with experiencing intimate partner violence.

CONCLUSION

The prevalence of intimate partner violence during pregnancy was found to be high. Pregnancy monitoring programs, which can detect and intervene with regard to partner's controlling behaviors and women's perception regarding justification of intimate partner violence, especially in those women with an unplanned pregnancy, could help to reduce intimate partner violence during pregnancy. Further, changing social norms that condone violence through advocacy and awareness creation might help in preventing partner violence.

Ethiopian Health Care Workers' Insights into and Responses to Intimate Partner Violence in Pregnancy-A Qualitative Study

Violence against women is a global pandemic, with the potential to spread through generations. Intimate partner violence has impacts on women’s sexual, reproductive, and psycho-social health. It can occur during pregnancy and adversely affect the health of both mother and child. Health care workers involved in antenatal care can have a unique role in identifying intimate partner violence and in intervening, preventing, and mitigating its consequences. In this study, the objective was to explore Ethiopian health care workers’ insights of and responses to intimate partner violence in pregnancy. Using an exploratory design, this qualitative study includes ten semi-structured interviews of health care workers representing different antenatal care centers in Jimma, Ethiopia. The content analyses of translated interview notes were conducted with Atlas.ti7 software, (Atlas.ti Scientific Software Development Gmbh, Berlin). The health care workers shared their insights of the consequences of intimate partner violence during pregnancy in addition to their experience with and responses to the victims. There was a limited understanding of the extent of the adverse impacts of intimate partner violence on pregnancy outcomes, as well as the potential long-term health implications. The informants described how they only gave medical treatment for obstetric complications or visible trauma during pregnancy. There was no formal referral to or linkages with other resources. Women’s empowerment and systemic changes in the health care, including training and capacity building, clear guidelines addressing management of intimate partner violence in pregnancy, and inclusion of intimate partner violence screening tools in the Ethiopian antenatal care chart/card, were recommended by the informants. The adverse impacts of intimate partner violence on pregnancy outcomes were poorly understood by the Ethiopian health care workers in this study. They offered limited assistance to the victims and recommended changes in the routine antenatal care (ANC) and health care systems. They identified various policy initiatives focusing on women’s empowerment to reduce intimate partner violence and its complications especially during pregnancy.

Perinatal mental distress in a rural Ethiopian community: a critical examination of psychiatric labels

BACKGROUND

Perinatal mental distress poses a heavy burden in low- and middle-income countries (LMICs). This study investigated perceptions and experiences of perinatal mental distress among women in a rural Ethiopian community, in an effort to advance understanding of cross-cultural experiences of perinatal mental distress.

METHODS

We employed a sequential explanatory study design. From a population-based cohort study of 1065 perinatal women in the Butajira Health and Demographic Surveillance Site, we purposively selected 22 women according to their scores on a culturally validated assessment of perinatal mental distress (the Self-Reporting Questionnaire). We examined concordance and discordance between qualitative semi-structured interview data ('emic' perspective) and the layperson-administered fully-structured questionnaire data ('etic' perspective) of perinatal mental distress. We analysed the questionnaire data using summary statistics and we carried out a thematic analysis of the qualitative data.

RESULTS

Most women in this setting recognised the existence of perinatal mental distress states, but did not typically label such distress as a discrete illness. Instead, perinatal mental distress states were mostly seen as non-pathological reactions to difficult circumstances. The dominant explanatory model of perinatal mental distress was as a response to poverty, associated with inadequate food, isolation, and hopelessness. Support from family and friends, both emotional and instrumental support, was regarded as vital in protecting against mental distress. Although some women considered their distress amenable to biomedical solution, many thought medical help-seeking was inappropriate. Integration of perspectives from the questionnaire and semi-structured interviews highlighted the important role of somatic symptoms and nutritional status. It also demonstrated the differential likelihood of endorsement of symptoms when screening tools versus in-depth interviews are used.

CONCLUSIONS

This study highlights the importance of the wider social context within which mental health problems are situated, specificially the inseparability of mental health from gender disadvantage, physical health and poverty. This implies that public health prevention strategies, assessments and interventions for perinatal distress should be developed from the bottom-up, taking account of local contexts and explanatory frameworks.

Prevalence and Associated Factors of Intimate Partner Violence During Pregnancy in Eastern Ethiopia

BACKGROUND

Intimate partner violence is a major public health problem and a gross violation of human rights. The consequences of this violation are severe during pregnancy as the fetus/newborn could also be affected negatively. The aim of this study was to assess the prevalence and associated factors of intimate partner violence during pregnancy (IPVP) in Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 3015 postpartum mothers in Eastern Ethiopia. Data were collected using the WHO Violence Against Women questionnaire. Factors associated with IPVP were assessed by a log-binomial regression model using Stata version 14.

RESULTS

The overall prevalence of IPVP was 30.5% (95% CI: 28.8, 32.1); the prevalence for psychological violence was 24.4% (95% CI: 22.9, 26.0), physical violence was 11.9% (95% CI: 10.8, 13.2) and sexual violence was 11.0% (95% CI: 9.9, 12.2). About 95% of acts of sexual violence were in the form of forced sex. In multivariable analysis, women's education was associated with a decreased prevalence of all forms of IPVP. Previous experience of infant loss and not drinking alcohol were associated with lower prevalence of all IPVP types, except for the physical form. Working for cash and having medium household decision-making autonomy increased the prevalence of all forms of IPVP. Being older, living in an extended family, husband's/partner's habitual khat chewing and discordant pregnancy intentions increased the prevalence ratio (PR) of all forms of IPVP, except for sexual violence. Compared to being urban, being rural decreased the PR of sexual IPVP by 59% (adjusted prevalence ratio [APR]=0.41; 95% CI: 0.27, 0.60) and psychological IPVP by 32% (APR=0.68; 95% CI: 0.53, 0.87). Husband's/partner's support for antenatal care use decreased the PR of physical IPVP by 56% (APR=0.44; 95% CI: 0.25, 0.78).

CONCLUSION

Nearly one-third of pregnant women experienced IPVP. The great majority of them were subjected to forced sex by their husband/partner. This calls for urgent attention at all levels of societal organization, requiring stakeholders and policy makers to tackle the situation.

Prevalence, determinants, and effects of violence during pregnancy: A maternity-based cross-sectional study in Luanda, Angola

Information on the extent of violence against women is scarce in Angola. This study aims to estimate the prevalence of violence against pregnant women in Angola and to identify its sociodemographic determinants and effects on pregnancy outcomes. A cross-sectional study was conducted between December 2012 and February 2013, involving 995 women who delivered at a Maternity in Luanda, Angola. Information was collected through questionnaires administered by interviewers. The prevalence of violence during pregnancy was 13.0%. Exclusively physical, psychological or sexual violence was reported by 4.3%, 7.7% and 0.2% of the women, respectively. After adjustment, the occurrence of physical violence decreased with increasing age and education, and was more common among women who consumed alcohol during pregnancy, while psychological violence was significantly more frequent among women aged 20 to 24 years and those who had their first sexual intercourse before the age of 15, and less frequent among those who were married or in cohabitation. This first study describing violence against pregnant Angolan women showed that violence is a frequent event, supporting that violence assessment should be considered in antenatal care.

Community Stakeholders' Perspectives on Intimate Partner Violence during Pregnancy-A Qualitative Study from Ethiopia

Intimate partner violence (IPV) in pregnancy adversely affects the health of women and unborn children. To prevent this, the community responses, societal systems, and structures to support victims of IPV in pregnancy are vital. Objectives: to explore community stakeholders’ perspectives related to IPV in pregnancy in Jimma, Ethiopia, and if needed, create the knowledge base for interventions. Methods: using an exploratory design, this qualitative study had a maximum-variation (multiple spectrum sources) sampling strategy with 16 semi-structured interviews of purposively selected key informants representing different community institutions. Guided by Connell’s theory of gender and power, a content analysis of the translated interviews was conducted using Atlas.ti 7 software. Results: reconciliation between IPV victims and their abusers was the solution promoted by almost all the respondents. There was limited awareness of the adverse impacts IPV in pregnancy has on the health of the woman and the foetus. Despite regular encounters with victims, there is no organized or structured operational response to support IPV victims between the participating institutions. Conclusion: the potential danger of IPV for the mother or the unborn child was not well understood by the members of the studied Ethiopian community. Neither coordinated efforts to support IPV victims nor links among relevant agencies existed. The study demonstrated the dire need of coordinated practical action, changes in current socio-cultural norms, formal training and capacity building, awareness creation, clear intervention guidelines, and facilitation of support networks among relevant institutions in Ethiopian communities.

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review

BACKGROUND

Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH.

METHODS

A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls.

RESULTS

A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out.

CONCLUSION

This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD  42017063856 .

Intimate partner violence and its associated factors among pregnant women in Bale Zone, Southeast Ethiopia: A cross-sectional study

BACKGROUND

Intimate partner violence (IPV) against women is a major public health concern in low income countries. Violence against pregnant women has adverse effects on maternal and newborn outcomes. This study aimed to assess the prevalence and associated factors of intimate partner violence in Southeast Ethiopia pregnant women.

METHODS

Institutional based cross-sectional study was conducted on pregnant women who were attending antenatal care (ANC) in Bale Zone health institution during study period. Face to face interviews were conducted using a pre-tested structured questionnaire. Data related to socio-demographic characteristic, pregnancy and reproductive history, intimate partner behavior and IPV encountered during recent pregnancy was gathered for this study. Descriptive analysis and logistic regression were used for the data analysis. Odds ratio with 95% CI was computed to determine the presence and strength of associated factors with IPV.

RESULTS

A total of 612 pregnant women participated in the study. Of these, 361 (59.0%) pregnant women faced at least one type of IPV during the recent pregnancy. Physical violence (20.3%), sexual violence (36.3%), psychological/emotional violence (33.0), controlling behavior violence (30.4%) and economic violence (27.0) were the type of IPV encountered by participants. An intimate partners who were drank alcohol [AOR = 2.9; 95% CI: (1.5-5.4)], partners who were chewed Khat [AOR = 1.7; 95% CI: (1.1-2.6)], partners who were smoked cigarette [AOR = 2.6; 95% CI: (1.4-4.9)], partners who had aggressive behavior [AOR = 2.8; 95% CI: (1.7-4.6)], having partner age ≥30 year old [AOR = 1.8; 95% CI: (1.2-2.9)], unwanted pregnancy [AOR = 3.3; 95% CI: (1.9-5.5)] and history of adverse pregnancy outcome [AOR = 2.1; 95% CI: (1.2-3.6)] that were the factors that significantly associated with IPV of the pregnant women.

CONCLUSION

The prevalence of IPV during pregnancy was high among the study participants. Intimate partners' use of substance, intimate partners' aggressive behavior, older intimate partners, unwanted pregnancy and history of adverse birth outcome were identified as associated factors for IPV. IPV needs to be considered during ANC service and integrated into the sexual and reproductive health education. Community-based interventions should be advocated as a way of health promotion. Counseling, awareness creation, service provision and program design on IPV is mandatory to minimize the victim.