The shadow of violence
How intimate partner violence shapes contraceptive and maternal health service use across 25 African countries
Bibliographic Data
| ID | 19591404 |
|---|---|
| Authors | Alex Bawuah (0000-0003-4603-5789, University of Sussex, corresponding author), Linus Baatiema (0000-0002-8668-4671, Ministry of Health, corresponding author), Michael Sarfo (0000-0001-7380-1608, University of Huddersfield, corresponding author), Francis Appiah (0000-0003-1465-5211, Kwame Nkrumah University of Science and Technology, corresponding author), Sanni Yaya (0000-0002-4876-6043, The George Institute for Global Health, corresponding author) |
| Editors | Dvora Joseph Davey (0000-0001-6290-9293) |
| Year | 2025 |
| Volume | 5 |
| Issue | 11 |
| Pages | e0005470 |
| Publication date | 2025-11-20 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | PLOS Global Public Health (JOURNAL) |
| Journal identifiers | ISSN: 2767-3375 • E-ISSN: 2767-3375 |
| Publisher | Public Library of Science (PLoS) (PUBLISHER) |
| DOI | 10.1371/journal.pgph.0005470 |
| PMID | 41264586 |
| OpenAlex | W4416430255 |
| Language | EN |
| References cited | 28 |
Despite increasing efforts to improve reproductive health outcomes in sub-Saharan Africa (SSA), disparities persist in the use of modern contraceptives and maternal health services (MHS). Evidence suggests that exposure to intimate partner violence (IPV) may influence women’s health-seeking behaviours, yet few studies have examined this relationship across multiple SSA countries. Using cross-sectional data from the most recent Demographic and Health Surveys (2015–2024) in 25 SSA countries, we analyzed 122,144 women aged 15–49 with complete information on IPV, contraceptive use, and MHS utilization. The primary outcome variables were current use of any modern contraceptive method and adequate MHS use. IPV exposure was measured using standardized DHS indicators for emotional, physical, and sexual violence. Multivariable logistic regression models adjusted for socio-demographic covariates and survey design were used to examine associations. Overall, 29.2% of women used modern contraceptives, and 39.2% received adequate MHS. About 34.3% of women had experienced at least one form of IPV. Women who experienced emotional (AOR = 1.15; 95% CI: 1.11–1.20), physical (AOR = 1.14; 95% CI: 1.07–1.20), or sexual violence (AOR = 1.09; 95% CI: 1.03–1.15) were significantly more likely to use modern contraceptives than those who had not. However, they were less likely to receive adequate MHS: emotional (AOR = 0.95; 95% CI: 0.91–0.99), sexual (AOR = 0.88; 95% CI: 0.83–0.95), and at least one form of IPV (AOR = 0.94; 95% CI: 0.90–0.98). Key predictors such as parity, education, household wealth, residence, distance to a health facility, employment, and media exposure significantly influenced the outcomes. While exposure to IPV may increase contraceptive use, possibly as a protective strategy, it simultaneously reduces uptake of comprehensive maternal healthcare. Integrating IPV screening, counselling, and support services into reproductive and maternal health programs is critical for improving women’s health outcomes
Domestic violence · Family planning · Logistic regression · Poison control · Population · Public health · Reproductive health · Sexual violence · Suicide prevention · Adolescent Sexual and Reproductive Health · Global Maternal and Child Health · Intimate Partner and Family Violence
Demographic and health surveys
A Systematic Review of Risk Factors for Intimate Partner Violence
The health-systems response to violence against women
A Caution Regarding Rules of Thumb for Variance Inflation Factors
Prevalence and severity of physical intimate partner violence during pregnancy among adolescents in eight sub-Saharan Africa countries
Violence against women in relation to literacy and area of residence in Ethiopia
Socioeconomic inequalities in uptake of HIV testing during antenatal care
The association of intimate partner violence and contraceptive use
Intimate partner violence among adolescents and young women
Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa
Intimate partner violence and maternal health services utilization
Domestic violence and its determinants among reproductive-age women in Sub-saharan Africa
What factors are associated with recent intimate partner violence? findings from the WHO multi-country study on women's health and domestic violence
Prevalence and Associated Factors of Intimate Partner Violence Among Pregnant Women Attending Kisumu District Hospital, Kenya
Intimate Partner Violence and Women's Contraceptive Use
Exposure to Intimate Partner Violence Amongst Women of Reproductive Age in Lagos, Nigeria
| Citation velocity | historical |
|---|---|
| Highly cited | No |