莊媖智Fentanesh Nibret Tiruneh2026-06-142026-06-142018-01-05https://203.71.86.71/handle/123456789/58061學位別：博士 語文別：英文 指導教授：莊媖智 口試委員：董和銳;黃俊豪;莊坤洋;黃雅莉 中文關鍵字：violence, women, health service utilization 英文關鍵字：violence, women, health service utilizationViolence 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 6 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.系所名稱：公共衛生學系暨研究所thesis