- Title
- Intimate partner violence against women in Ethiopia: determinants, impacts, and health sector response
- Creator
- Tiruye, Tenaw Yimer
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Being a female is difficult in Ethiopia where boys are privileged over girls, girls have less access to school and healthcare, and girls suffer from harmful practices such as early marriage, female genital mutilation, abduction and rape. For those who pass through childhood and reach womanhood, intimate partner relationships are not necessarily safe either—there is a high prevalence of violence against women by their intimate partners. Previous studies have suggested that intimate partner violence (IPV) could be affected by many factors and IPV, in turn, affects the overall health of affected women and their babies. At the time of commencing this thesis, only individual-level determinants of IPV had been investigated within small geographic areas in Ethiopia. There was no study that assessed the hierarchical multilevel predictors of IPV. National-level evidence regarding the adverse impacts of IPV on women’s reproductive health and the survival of their neonates was lacking, and the Ethiopian health system responses to IPV were largely unknown. Therefore, this study investigated the individual, relationship, community, and societal-level determinants of IPV directed against women; it examined the adverse reproductive outcomes (unintended pregnancy, pregnancy loss and neonatal mortality) of IPV in Ethiopia; and explored the perceptions of, and attitudes towards, IPV within the Ethiopian health system. The thesis used a multimethod approach incorporating retrospective analyses of nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS) and qualitative in-depth interviews. In analyses of EDHS data, the determinants and impacts of IPV were invesigated in a subsample of married women of reproductive age (15–49 years) who participated in the domestic violence sub-study of the survey. In addition, a qualitative study was conducted among thirteen purposively selected in-depth interview participants (nine healthcare providers and five health managers) to explore perceptions to IPV. Analyses of EDHS data showed that about one in every three women reported experiencing IPV (a composite measure of physical, sexual and emotional abuse) and three in every five women experienced partner controlling behaviours. Lifetime IPV experience was higher among women who were older, married before the age of 18 years, had witnessed inter-parental violence during their childhood, had a partner who drank alcohol, and lived in a community with high IPV accepting norms. Alternatively, experiences of IPV were lower among women who had decision-making autonomy in the household, who had the same or lower educational attainment as their partner, and lived in a community with low proportions of educated women. These findings reveal that although individual-level factors were significant determinants of IPV, higher level factors including female education and IPV acceptance in the community were also important influences on this major public health issue in Ethiopia. This thesis further revealed that women’s IPV experience, including partner controlling behaviours, were significantly associated with the risk of unintended pregnancy, pregnancy loss and neonatal mortality in Ethiopia, with the impact on unintended pregnancy being partly mediated by women’s autonomy. Qualitative interviews with healthcare providers and health managers in the Ethiopian health sector further suggest that the existing health system responses were insufficient, with several barriers and challenges identified as hindering the health system from providing consolidated IPV services. Taken together, these findings suggest combined interventions at different levels may reduce IPV in Ethiopia. Women’s health and neonatal survival strategies should focus beyond the direct causes and target IPV as an underlying factor in maternal and neonatal ill health and mortality. Reproductive health programs should be sensitive to the relational aspects of fertility control, and the need to improve women’s decision-making power to reduce the negative reproductive health effects of IPV. Overall, there is a clear need to incorporate IPV services into the Ethiopian healthcare setting and should be provided as a key component of maternal reproductive health service. This requires policy frameworks and clear guidelines, training of healthcare workers, community education and sensitization, and sectoral collaborations.
- Subject
- intimate partner violence; reproductive coercion; women’s health; neonatal mortality; Ethiopian health system; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1450078
- Identifier
- uon:43822
- Rights
- Copyright 2021 Tenaw Yimer Tiruye
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 3 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 372 KB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT04 | Errata | 24 KB | Word Microsoft Office Open XML Format document | View Details Download |