Prevalence, severity, and health outcomes associated with intimate partner violence during pregnancy among adolescents in sub-Saharan Africa

BACKGROUND: Intimate partner violence (IPV) is a pervasive and deeply entrenched global public health issue that transcends geographic, cultural, and socioeconomic boundaries. IPV encompasses various forms, including physical, sexual, and psychological violence, each leaving indestructible marks on the lives of those affected. Adolescents, particularly those residing in sub-Saharan Africa (SSA), are at elevated risk of experiencing IPV, particularly during pregnancy. In SSA, where cultural norms, gender inequalities, and economic disparities intersect, understanding the complex landscape of IPV during pregnancy among this vulnerable group is paramount. Although the issue is urgent, there has not been any systematically conducted rigorous research analysing the evidence about the prevalence, severity, and effects of physical IPV during pregnancy among adolescents (15-19) in SSA. By analysing the multidimensional nature of physical IPV during pregnancy within the context of SSA, this study aims to close this important information gap. I intend to shed light on the difficulties experienced by adolescents, with an emphasis on the severity and health effects, by appraising the available literature and analysing data from Demographic Health Surveys (DHS). The ultimate goal of this research is to support evidence-based policies that prioritise adolescents' health in SSA, helping to create a future free from IPV both during and outside pregnancy. METHODS: This research employed a comprehensive approach, drawing on a systematic literature review and data analysis from DHS conducted in eight SSA countries. This thesis includes three studies: 1) a systematic review of the literature on IPV during pregnancy among adolescents living in SSA; 2) an analysis of the prevalence and severity associated with the experience of physical IPV during pregnancy among adolescents in SSA using data from the DHS; 3) an analysis of health outcomes including exclusive breastfeeding (EBF) and pregnancy termination associated with adolescents who have experienced physical IPV during pregnancy in SSA using data from the DHS. RESULTS: We found evidence of IPV during pregnancy among adolescents in SSA from nine studies selected for the systematic review. Further, analysis of DHS data from eight countries revealed a high prevalence and severity of physical IPV among adolescents. Adolescents who reported physical IPV during pregnancy were more likely to report severe lifetime physical violence and severe injuries. An association was found between physical IPV during pregnancy and pregnancy termination only after controlling for covariates, but no association with EBF even after controlling for variables. CONCLUSION: In conclusion, this study emphasises the urgency for countries in SSA to address IPV during pregnancy among adolescents. The complex combination of social, gender, and cultural norms in SSA contributes to IPV's prevalence and long-lasting effects in vulnerable communities. This study has unravelled the complex nature of physical IPV during pregnancy violence by drawing attention to the interplay between IPV during pregnancy, severity, and adverse health outcomes. Additionally, our research has shed some light on the repercussions of physical IPV during pregnancy on adolescent development, including inadequate breastfeeding behaviours and pregnancy termination. My results highlight the need to implement interventions and evidence-based policies to prevent and address physical IPV during pregnancy in SSA. We can work towards a future where adolescent empowerment and well-being are prioritised by recognising the intersecting variables that form their experiences of IPV and the specific barriers and challenges adolescents face.