OBJECTIVE: To estimate the extent to which intimate partner violence (IPV), at the levels of the individual and the community, is associated with shortened interbirth intervals among women in sub-Saharan Africa.
METHODS:We analyzed demographic and health survey data from 11 countries in sub-Saharan Africa. Only multiparous women were included in the analysis. Interbirth interval was the primary outcome. Personal history of IPV was measured using a modified Conflict Tactics Scale. Community prevalence of IPV was measured as the proportion of women in each village reporting a personal history of IPV. We used multilevel modeling to account for the hierarchical structure of the data, allowing us to partition the variation in birth intervals to the four different levels (births, individuals, villages, and countries).
RESULTS: Among the 46,697 women in the sample, 11,730 (25.1%) reported a personal history of physical violence and 4,935 (10.6%) reported a personal history of sexual violence. In the multivariable regression model, interbirth intervals were inversely associated with personal history of physical violence (regression coefficient b,06.0؊؍ 95% confidence interval ؊0.91 to ؊0.28) and the community prevalence of physical violence (b,14.1؊؍ 95% confidence interval ؊2.41 to ؊0.40). Estimated associations with sexual violence were of similar statistical significance and magnitude.
CONCLUSION: Both personal history of IPV and the community prevalence of IPV have independent and statistically significant associations with shorter interbirth intervals.
LEVEL OF EVIDENCE: IIV iolence against women, including intimate partner violence (IPV), is a grave violation of human rights and is highly prevalent worldwide. The highest rates have been reported in resource-limited settings, although wide variations exist. 1,2 Personal history of IPV has been associated with numerous adverse sexual and reproductive health consequences for women, including low self-efficacy for condom use, 3 inconsistent condom use, 4,5 unplanned pregnancies, 6 and a range of other perinatal outcomes. 7 The specific mechanisms underlying these associations are not well-understood, but previous work suggests at least two hypotheses. First, at the individual level, IPV may lead to, or may be a marker for, direct controlling behaviors perpetrated by male partners to promote pregnancy. 8 Second, even when their male partners do not directly engage in coercive behaviors, women may fear violent reprisals if they live in communities where IPV is highly prevalent or where IPV is culturally sanctioned. This latter hypothesis suggests that context may exert an effect independent of direct victimization at the individual level, ie, a "culture of terror" 9 may indirectly compromise women's sexual decision-making. Studies that explicitly model the pattern of violence against other women in the community would help