Abstract
BackgroundGender-based violence is an important risk factor for adverse reproductive health (RH). Community-level violence may inhibit young women's ability to engage in safer sexual behaviors due to a lack of control over sexual encounters. Few studies examine violence as a contextual risk factor.MethodsUsing nationally representative data from five African countries, the association between community-level physical or sexual intimate partner violence (IPV) and the circumstances of first sex (premarital or marital) among young women (ages 20-29) was examined.ResultsIn Mali, and Kenya bivariate analyses showed that young women who had premarital first sex were from communities where a significantly higher percentage of women reported IPV experience compared to young women who had marital first sex. Multivariate analyses confirmed the findings for these two countries; young women from communities with higher IPV were significantly more likely to have had premarital first sex compared to first sex in union. In Liberia, community-level IPV was associated with a lower risk of premarital sex as compared to first sex in union at a marginal significance level. There was no significant relationship between community-level IPV and the circumstances of first sex in the Democratic Republic of Congo or Zimbabwe.ConclusionThese findings indicate that context matters for RH. Individualized efforts to improve RH may be limited in their effectiveness if they do not acknowledge the context of young women's lives. Programs should target prevention of violence to improve RH outcomes of youth.
Highlights
Gender-based violence is an important risk factor for adverse reproductive health (RH) outcomes for women throughout the world
The present study explores the effect of community-level intimate partner violence (IPV) on the circumstances of first sex among sexually experienced women ages 20-29 in five sub-Saharan African countries
In Liberia and Democratic Republic of Congo (DRC), there were no significant differences in the mean level of community IPV by the first sex category; in DRC, community-level IPV was notably higher among young women who had premarital first sex and women who had first sex in union as compared to the other four countries
Summary
Gender-based violence is an important risk factor for adverse reproductive health (RH) outcomes for women throughout the world. IPV is an important public health concern in sub-Saharan Africa, where between 13% and 54% of women report experiencing IPV during their lifetimes [8,14,15]. In sub-Saharan Africa, women ages 1524 are three times more likely to be infected with HIV region, where much attention has been focused on abstinence education to reduce the spread of HIV. The underlying assumption of abstinence education is that youth control the circumstances of first sex, ignoring the possibility that first sex is unwanted or coerced, or that young women may be unable to negotiate condom use due to power imbalances with older partners [25,26]. Gender-based violence is an important risk factor for adverse reproductive health (RH).
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