婦女自主, 對婦女的暴力行為, 及性與生殖健康之間的關係

Violence against women across the world is an extreme manifestation of gender inequality, which
leads to serious health consequences and requires urgent attention (Black et al., 2016). The most
common type of violence is intimate partner violence (IPV) (García-Moreno et al., 2013). A
WHO’s multi-country study on women’s health and domestic violence reported that between 13%
and 61% married women reported physical abuse by an intimate partner in their lifetime, and
between 6% and 59% reported sexual violence (Abramsky et al., 2011). The highest prevalence of
IPV globally was found in low- and middle-income countries. The countries of sub-Saharan Africa,
in particular, stand out as having the highest rates of IPV in the world (Devries et al., 2013).
Regarding health consequences, studies indicate that IPV is an important cause of morbidity and
mortality and is harmful to women’s reproductive health including unwanted pregnancy,
Pregnancy loss, and sexually transmitted infection (STI). Women exposed to intimate partner
violence are also more likely to have poor pregnancy outcomes, experience depression, and are
less likely to use maternal health services (Ononokpono & Azfredrick, 2014). Violence during
pregnancy has been found to be associated with miscarriage, late entry into prenatal care, stillbirth,
premature labor and birth, and low birth weight (Black et al., 2016).
Women’s autonomy can influence their preventive healthcare service utilization including cervical
cancer screening through cultural beliefs and practices. Gender roles contribute to undertaking
cancer screening behaviors among women (A. B. Nguyen, Clark, & Belgrave, 2014) .
The Theory of Maternal Autonomy states that more autonomous women are better equipped to act
upon their preferences related to reproductive health care (Uthman, Lawoko, & Moradi, 2009).
Prior studies have shown that women’s autonomy as well as other individual-level socio-economic
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factors are positively associated with different types of health service utilization such as prenatal
care, antenatal care, and contraceptive use (Ghose et al., 2017; Osamor & Grady, 2016).
Nevertheless, merely individual-level factors do not comprehensively explain the occurrence of
IPV (Fotso, Ezeh, & Essendi, 2009). Studies have shown that causes of any gender-based violence
are deeply rooted in cultural norms and attitudes about acceptability of violence against women
(Fotso et al., 2009). At the community level, the presence of and response to violence against
women is shaped by social norms about gender and power that can either support or discourage
violence (Michau, Horn, Bank, Dutt, & Zimmerman, 2015). Therefore, studies should further
include contextual-level factors (i.e., community norm) in addition to individual-level factors to
examine factors associated with IPV.
Our study contribute to this research area by conducting a detailed and systematic assessment of
the women’s autonomy, intimate partner violence, and other demographic and socioeconomic
factors at both individual and community-level to understand how gendered-based violence
influence women’s reproductive health in three sub-African countries, Ethiopia, Kenya and the
Democratic Republic of Congo. Findings from this study will provide recommendations for policy
makers and program managers to design, implement, and evaluate their programs with regard to
gender equality and reproductive health outcomes.