EXPERIENCE OF INTIMATE PARTNER VIOLENCE AS A PREDICTOR OF SEXUALLY TRANSMITTED INFECTIONS AMONG MARRIED WOMEN IN NIGERIA

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O.A. Sigbeku¹ O.I. Fawole² and T.B. Ogunniyan¹

1. Department of Community Medicine, University College Hospital, Ibadan, Nigeria.
2. Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria.

Abstract

Background: Intimate partner violence (IPV) is an important public health issue that is associated with adverse sexual and reproductive health outcomes including sexually transmitted infections (STIs). STIs have recently gained more recognition worldwide because they increase the risk for HIV infection. However, there is dearth of information on the association between IPV and STIs particularly among married women in Nigeria.

Objective: To determine the association between IPV and STIs among married women in Nigeria.

Method: This was a secondary data analysis of the 2008 Nigeria Demographic and Health Survey (NDHS) dataset. A total of 18,402 married women aged between 15 and 49 years were included. Questions about intimate partner violence were adapted from the Conflict Tactic Scale (CTS). Multiple logistic regression models were used to determine relationship between IPV and self-reported STIs.

Results: The prevalence of IPV among married women in Nigeria was 29.3%.
Majority of the women experienced emotional violence (22.1%), 17.3% of the women experienced physical violence while the least experienced form of violence was sexual IPV (4.4%). Majority (60.1%) of the women experienced just one type of IPV, 30.0% two types, 9.9% all three types. The prevalence of selfreported sexually transmitted infections was 7.2%. Logistic regression demonstrated that after controlling for other covariates, women who experienced any form of IPV were found to be more likely to report STI than women who did not [OR 1.357 (95% CI 1.188-1.551)]. In addition, experience of physical and sexual IPV was significantly associated with history of STIs [OR 1.699 (95% CI 1.420-2.034); OR 1.414 (95% CI 1.085-1.843) respectively]. Experiencing two or more types of IPV was significantly associated with history of STIs [OR 1.759 (95% CI 1.446-2.139); OR 2.193 (95% CI 1.636-2.941) respectively].

Conclusion: There is a need to incorporate IPV screening and services in STI clinics. Also, it is important to screen for STIs among women who present with IPV particularly those with multiple types of violence.

Keywords: Intimate Partner Violence (IPV), Sexually Transmitted Infections (STIs), married women, Nigeria

Introduction

Violence Against Women (VAW) is a global phenomenon which has a devastating effect on women’s sexual and reproductive health.¹ The United Nations Declaration on the Elimination of Violence against Women defines violence against women as any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.² Although women suffer violence from many institutions and persons, the World Health Organization’s “Multi-Country study on women’s health and domestic violence against women” confirms that the most common type of violence directed against women is actually carried out by their partners.³ Violence perpetrated against women by an intimate partner is also referred to as Intimate Partner Violence (IPV).

The Multi-country study found that the proportion of ever-partnered women who had ever experienced physical or sexual violence, or both, by an intimate partner in their lifetime, ranged from 15% to 71%. In sub-Saharan Africa the lifetime prevalence of IPV was reported as 20–71% in marriage or current partnerships.^{4, 5} IPV among women in Nigeria is quite prevalent across the different regions in the country. For instance, community surveys conducted in Nigeria reported a prevalence of 45%⁶ among women of reproductive age in six south-western states, 44.6%⁷ and 28%⁸ were found among ante-natal women abused during index pregnancy in south-eastern and northern parts of Nigeria respectively.

There is increasing evidence that IPV is an important correlate of a wide range of adverse reproductive health outcomes for women, including Sexually Transmitted Infections (STIs).⁹ Sexually transmitted infections are a group of contagious diseases in which the main mode of transmission is by sexual intercourse. STIs negatively impact the reproductive health status of women causing lower abdominal pain, dyspareunia, urinary tract abnormalities, recurrent abortions, infertility and even death if not treated.¹⁰ Common STIs include gonorrhoea, trichomoniasis, chlamydial infection, syphilis and Human Immunodeficiency Virus (HIV). Research on the association between IPV and STIs have been widely conducted in developed countries ^11-13 while gaps still remain in developing countries such as Nigeria. To promote the reproductive and sexual health of women, prevention of sexually transmitted infections is crucial. This is because a substantial proportion of female reproductive morbidity is associated with STIs. This study determined the association between experience of intimate partner violence and development of sexually transmitted infections among married women in Nigeria. Hence, it would provide information that will assist interventions to improve the reproductive and sexual health of women.