Abstract
Background
Despite considerable achievements associated with the MDGs, under-five mortality, particularly in sub-Saharan Africa, remains alarmingly high. Globally, intimate partner violence (IPV) affects one in three women within their lifetime. Little is known about the relationship between IPV and maternal care-seeking in the context of high rates of under-five mortality, particularly among young women and adolescent girls in low- and middle-income countries (LMICs).
Methods
Data from the Kenya Demographic Health Survey (2008–2009) were limited to a sample of women aged 15–24 years (n = 1406) with a child under-five who had experienced IPV in the last 12 months. Using multivariate logistic regression, we constructed three models: (1) base model, (2) controlling for type of residence (urban/rural), and (3) controlling for wealth status and education attainment, to estimate odds ratios (ORs) for the association between IPV and 10 maternal care-seeking behaviors.
Results
Thirty-eight percent of the women had experienced some form of intimate partner violence in the last 12 months. Women who had experience IPV were less likely (1) to complete a minimum of four antenatal visits after single IPV exposure (OR = 0.61, 95% CI = 0.44, 0.86) and after severe IPV (OR = 0.80; 95% CI = 0.44, 0.88) and (2) to deliver in health facility after severe IPV exposure (OR = 0.74; 95% CI = 0.54, 0.89), both adjusted for educational attainment and wealth status. Lower socioeconomic status and living in a rural area were strongly associated with increased likelihood of IPV.
Conclusions
Intersectional approaches that consciously focus on and creatively address IPV may be key to the success of reducing child mortality and improving maternal health outcomes. The implementation of joint programming and development of combination interventions to effectively reduce the risk of exposure to IPV and promote maternal care-seeking behavior are needed to improve child morbidity and mortality in LMICs.
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Abbreviations
- AIDS:
-
Acquired immunodeficiency syndrome
- CI:
-
Confidence interval
- DALYs:
-
Disability-adjusted life years
- DHS:
-
Demographic and Health Surveys
- HIV:
-
Human immunodeficiency virus
- IPV:
-
Intimate partner violence
- ITNs:
-
Insecticide-treated nets
- UNAIDS:
-
Joint United Nations Program on HIV/AIDS
- KDHS:
-
Kenya Demographic and Health Survey
- LMICs:
-
Low- and middle-income countries
- MDGs:
-
Millennium development goals
- MICs:
-
Multi-indicator cluster surveys
- OR:
-
Odds ratio
- ORS:
-
Oral rehydration salts
- SDGs:
-
Sustainable development goals
- U5M:
-
Under-five mortality
- VIF:
-
Variance inflation factor
- WHO:
-
World Health Organization
- YLD:
-
Years lived with disability
- YLL:
-
Years of life lost
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Acknowledgements
We would like to thank Kenya Medical Research Institute (KEMRI) for providing technical and logistical support.
Funding
This project was supported by NIH Research Training Grant #R25 TW009345 awarded to the Northern Pacific Global Health Fellows Program by the Fogarty International Center.
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Contributions
PB contributed to the study conception and design, drafting of manuscript, and acquisition of the data; JZ and MK provided critical revision; BH, BW, and DO contributed to analysis and interpretation of data, and CB contributed to conception and design of the study.
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This study utilized the 2008–2009 KDHS and was approved by the Institutional Review Board of IFC Macro International in compliance with the rules and regulations of US Department of Health and Human Services as it relates to the protection of human subjects and vulnerable populations.
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Not applicable.
Competing Interests
The authors declare that they have no competing interests.
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Burns, P.A., Zunt, J.R., Hernandez, B. et al. Intimate Partner Violence, Poverty, and Maternal Health Care-Seeking Among Young Women in Kenya: a Cross-Sectional Analysis Informing the New Sustainable Development Goals. Glob Soc Welf 7, 1–13 (2020). https://doi.org/10.1007/s40609-017-0106-4
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DOI: https://doi.org/10.1007/s40609-017-0106-4