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Intimate Partner Violence, Poverty, and Maternal Health Care-Seeking Among Young Women in Kenya: a Cross-Sectional Analysis Informing the New Sustainable Development Goals

  • Paul A. BurnsEmail author
  • Joseph R. Zunt
  • Bernardo Hernandez
  • Bradley H. Wagenaar
  • Manasi Kumar
  • Danvers Omolo
  • Cecilia Breinbauer
Article

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.

Keywords

Maternal care-seeking behavior Intimate partner violence Under-five mortality Preventable childhood diseases Antenatal care Gender inequality 

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

Notes

Acknowledgements

We would like to thank Kenya Medical Research Institute (KEMRI) for providing technical and logistical support.

Author Contribution

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.

Funding information

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.

Compliance with Ethical Standards

Ethics Approval and Consent to Participate

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.

Consent for Publication

Not applicable.

Competing Interests

The authors declare that they have no competing interests.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Paul A. Burns
    • 1
    Email author
  • Joseph R. Zunt
    • 1
  • Bernardo Hernandez
    • 2
  • Bradley H. Wagenaar
    • 1
  • Manasi Kumar
    • 3
  • Danvers Omolo
    • 4
  • Cecilia Breinbauer
    • 5
  1. 1.John D. Bower School of Population Health, Department of Population ScienceUniversity of Mississippi Medical CenterJacksonUSA
  2. 2.Institute for Health Metrics and Evaluation, Department of Global HealthUniversity of WashingtonSeattleUSA
  3. 3.University of NairobiNairobiKenya
  4. 4.Food and Agriculture Organization (FAO)United NationsSan FranciscoUSA
  5. 5.Global Mental Health, Departments of Global Health, Psychiatry & Behavioral SciencesUniversity of WashingtonSeattleUSA

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