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

The study assessed the prevalence of physical violence against pregnant women and its associated factors in sub-Saharan Africa (SSA). 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). Twenty-six countries in SSA. 108 971 women who had ever been pregnant. Physical violence during pregnancy. 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. 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.

Ahinkorah BO ，Aboagye RG ，Seidu AA ，Boadu Frimpong J ，Hagan JE Jr ，Budu E ，Yaya S ... -  《BMJ Open》

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

Lencha B ，Ameya G ，Baresa G ，Minda Z ，Ganfure G ... -  《PLoS One》

Partner alcohol consumption and intimate partner violence against women in sexual unions in sub-Saharan Africa.

Intimate partner violence is increasingly gaining attention as the leading form of violence against women globally, particularly sub-Saharan Africa. Given that substance abuse, especially alcohol consumption has long been associated with aggressive behaviour, emotional abuse, and sexual misconduct, it is surprising that studies on the potential association between partner's alcohol consumption and intimate partner violence are scarce. The current study seeks to fill this gap in the literature by examining the association between partner's alcohol consumption and intimate partner violence among women in sub-Saharan Africa. Cross-sectional survey data of 89,229 women aged 15 to 49 in sexual unions from 21 sub-Saharan African countries were pooled from the Demographic and Health Surveys. Percentages with their corresponding confidence intervals (CIs) were used to present the results of the prevalence of partner's alcohol consumption and intimate partner violence. Multivariable binary logistic regression analysis was used to examine the association between partner's alcohol consumption and intimate partner violence. The regression analysis results were presented using adjusted odds ratio (aOR) with 95% CI. Statistical significance was set at p<0.05. The pooled prevalence of partner alcohol consumption was 36.3% [36.0-36.6]. The highest prevalence of partner alcohol consumption was found in Burundi (67.1%) with Mali (3.9%) recording the lowest prevalence. Similarly, the overall prevalence of physical violence, emotional violence, and sexual violence among the women were 19.7% [19.2-20.2], 25.0% [24.5-25.5], and 9.7% [9.3-10.1], respectively. In the pooled data, women whose partners consumed alcohol were more likely to experience physical violence [aOR = 2.37, 95% CI = 2.24-2.50], emotional violence [aOR = 1.96, 95% CI = 1.86-2.07], and sexual violence [aOR = 2.03, 95% CI = 1.89-2.18] compared to those whose partners did not consume alcohol. In all the 21 countries, women whose partners consumed alcohol had higher odds for physical and emotional violence. The odds of sexual violence was higher among women whose partners consumed alcohol compared to their counterparts whose partners did not in 20 countries, except Namibia. We found that partner's alcohol consumption increases women's likelihood of experiencing physical, emotional, and sexual violence in sub-Saharan Africa. There is the need to implement behavioural change interventions targeted at male partners to reduce alcohol consumption. The findings call for the need to effectively create and organize support networks in addressing intimate partner violence among married and cohabiting women.

Aboagye RG ，Ahinkorah BO ，Tengan CL ，Salifu I ，Acheampong HY ，Seidu AA ... -  《PLoS One》

Intimate partner violence against married and cohabiting women in sub-Saharan Africa: does sexual autonomy matter?

Literature shows that women's sexual autonomy, which refers to women's capacity to refuse sex and ask a partner to use condom, has significant implications on the sexual and reproductive health outcomes and sexual-and-gender based violence. Nevertheless, there is scarcity of empirical evidence to support the association between women's sexual autonomy and intimate partner violence (IPV) in sub-Saharan Africa. Data for the study were extracted from the recent Demographic and Health Surveys in 24 countries in sub-Saharan Africa between 2010 and 2019. Bivariable and multivariable binary logistic regression analyses were performed to examine the association between sexual autonomy and IPV in all the studied countries. Statistical significance was set at p < 0.05. The pooled prevalence of IPV and sexual autonomy in the 24 countries were 38.5% and 73.0% respectively. Overall, the odds of exposure to IPV were higher among women with sexual autonomy, compared to those without sexual autonomy even after controlling for covariates (age, level of education, marital status, current working status, place of residence, wealth quintile and media exposure). At the country-level, women from Angola, Cameroon, Chad, Gabon, Cote d'lvoire, Gambia, Mali, Nigeria, Kenya, Comoros, Zambia, and South Africa who had sexual autonomy were more likely to experience IPV whilst those in Burundi were less likely to experience IPV. The study showed that sexual autonomy increases women's exposure to IPV and this occurred in many countries except Burundi where women with sexual autonomy were less likely to experience IPV. The findings highlight the need for serious programs and policies to fight against IPV in the sub-region. Additionally, laws need to be passed and implemented, with law enforcement agencies provided with the necessary resources to reduce intimate partner violence among women with sexual autonomy.

Aboagye RG ，Dadzie LK ，Arthur-Holmes F ，Okyere J ，Agbaglo E ，Ahinkorah BO ，Seidu AA ... -  《Reproductive Health》

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

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. 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. 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. 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.

Liyew AM ，Alem AZ ，Ayalew HG 《BMC PUBLIC HEALTH》