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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 1st to August 30th, 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.
A community-based cross-sectional study was conducted in Gondar city from July 1st to August 30th, 2021. This study was conducted in Gondar city. The city is located in Central Gondar Zone, Amhara national regional state, northwest Ethiopia. It is located 750 km from Addis Ababa, the capital city of Ethiopia. There are 1 governmental referral hospital, 8 governmental health centers, 22 health posts, 1 private primary hospital, and 1 general hospital serving the city and other populations outside of the city. The recent estimated total population of the city is 432,191, of whom 224,508 females about 133, 477 (30.88%) of these females are in the reproductive age group (unpublished data by Amhara regional state, 2021). All women who gave birth in the 6 months prior to data collection were the study population. All women residing for at least 6 months before the data collection period were included in the study. The single population formula was used to calculate the necessary sample size for the current study by considering the following assumptions: the proportion of IPV-44.5% (27), level of confidence-95%, and margin of error-5%. Therefore, the sample size (n) =(Zα2)2*p(1-p)d2 = (1.96)2*0.455(1-0.5)(0.05)2 = 380. Based on a design effect of 2 (since cluster sampling used) and a non-response rate of 10 %, a total sample size of 836 women needed. In Gondar city, there are 22 kebeles (the smallest administrative unit in the government structure), from which 30% of the total kebeles (seven kebeles) were randomly selected by the lottery method. To reach out to the eligible women, a house-to-house visit was carried out in the selected kebeles (clusters). All women found to be eligible for the study were interviewed. Finally, due to the nature of cluster sampling, 858 women were included in the study. Intimate partner violence was the outcome variable, whereas women’s age, women’s occupation, monthly income, religion, women’s educational status, marital status, family size, parity, antenatal care (ANC) visit, the number of ANC visits, whether the pregnancy was supported or not by family, pregnancy was planned or not, husband’s educational status, husband’s occupation, woman’s household decision-making power, media exposure, and social support were the independent variables. Intimate partner is considered as a current spouse, co-habited partner, current boyfriends, or former partner or spouse. If the respondent said “Yes” to any one of the ranges of sexual, psychological, and physical or any combination of the three coercive acts regardless of the legal status of the relationship with current/former intimate partner, it was considered as intimate partner violence (28). The ability of women to act self-sufficiently about the household activities including their health, children’s health, freedom of movement, and control over finance without needing permission from another person (29). Eight questions were prepared to assess the household decision-making power of women. The women’s responses were coded 2 (if women decided independently), 1 (if women decided with their husbands), and 0 (if the decision was made by the husband or somebody else). The total score ranged from 0 to16. Thus, based on the summative score of variables designed to assess household decision-making power, women who were answered above the mean value were considered as having higher decision-making power (29, 30). The Oslo-3 Social Support Scale (OSSS-3) was used to measure social support. The scale consists of 3 items addressing the number of close intimates to the woman, perceived level of concern from others, and perceived easiness of getting support from neighbors. Accordingly, the level of social support was categorized as “poor” with a score of 3–8; “moderate” with a score of 9–11; and “strong” with a score of 12–14 (31). Study participants were asked how often they watched television, read a newspaper, or listened to the radio. Respondents who responded at least once a week are considered to be regularly exposed to that form of media (21). After reviewing related literature and WHO multi country study on women’s health and domestic violence (5, 8, 27, 28) the data collection instrument was developed to elicit required information on IPV. The English version of the questionnaire was prepared first and translated to the local language (Amharic) and back English to ensure its consistency. Data were collected using a structured and interviewer-administered questionnaire through face-to-face interviews. The questionnaire contains socio-demographic characteristics, obstetric and maternal health services-related characteristics, decision-making power, social support, and intimate partner violence-related questions. A total of 14 BSc and 4 MSc in Midwifery holders were involved in the data collection and supervision process, respectively. The one-day training was provided about the interview technique and information-handling techniques. The pretest was done on 5% (n = 42) of the calculated sample size outside of the study site. The language clarity and validity of the tool were checked and necessary revisions were made after the pretest. The supervisors checked for questionnaire completeness daily. Data were checked, coded, and entered into EPI DATA version 4.6 and further cleaning and analysis were done using SPSS version 25. Binary logistic regression analysis was performed to identify candidate predictors. Predictors with a p-value of < 0.25 were included in the multivariable logistic regression analysis to address the possible effect of confounders. In the last model (multivariable logistic regression analysis,) a p-value of ≤ 0.05 with 95% CI for the AOR was used to decide the level of association. The variance inflation factor (VIF) was used to check the multicollinearity assumption and was acceptable with a value of < 10. The Hosmer Lemeshow goodness-of-fit was performed to check the model fit.
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