Reproductive Health Services and Intimate Partner Violence: Shaping a Pragmatic Response In Sub-Saharan Africa

Like it or not, the intersection of violence and reproductive decision-making is showing up in the realities of women's lives. the two movements had better organize to stand over against it.1

More than a decade ago, Lori Heise and other advocates against intimate partner violence highlighted the cogent need for stronger links between their cause and the reproductive health move Since then, the magnitude and implications of violence against women have gained more attention, leading to greater recognition and acknowledgment of the negative results of violence for women's reproductive health.

At the national policy horizontal however, violence and reproductive health frequently remain distinct, despite the framing of the couple issues as essential components of women's human rights and the growing evidence connecting them.2 In particular, linkage is generally inadequately addressed at the service level: Services that explicitly address violence against women are seldom integrated into women's reproductive health services, and there are scarcely any initiatives to integrate reproductive health services into a multisectoral answer to violence against women.3

In this annotate we examine the context of intimate partner violence in Sub-Saharan Africa, outline the intersections between partner violence and reproductive health, and consider the opportunities for linkage at the program and service horizontals In addition, we explore the opportunities and challenges related to developing an active answer to domestic violence within reproductive health services in SubSaharan Africa.

PREVALENCE OF INTIMATE PARTNER VIOLENCE

One of the greatest in quantity common forms of violence against women is that perpetrated by the agency of a husband or other intimate male partner. Intimate partner violence-often called domestic violence-takes a variety of forms, including physical violence (eg slaps, punches, kicks, assaults with a weapon and homicide) and sexual violence (eg unwanted sexual touching, forced or coerc sex or forced participation in degrading sexual acts). Violence is commonly accompanied by dint of emotional abuse, economic restrictions and other controlling behaviors.4

Several population-based reviews from around the world have explored the prevalence of intimate partner violence. In these, women are asked directly about their experiences of specific acts of violence (for example, "Has a generally received or former partner ever hit you with his fist or with something other that could hurt you?").5 Globally, 16-50% of everpartnered women report having been physically assaulted by the agency of an intimate partner.6 In Sub-Saharan Africa, 13-49% of women have at any time been hit or otherwise physically assaulted by means of an intimate male partner, with 5-29% reporting physical violence in the year before the survey7

Research also refer tos that many women are sexually assaulted by means of their partners. Cross-sectional household observes in one province in Zimbabwe and in Ethiopia find that 26% and 59% respectively, of ever-partnered women have at any time been forced to have sex with 20% and 40% reporting unwanted sex in the year before the survey8 The horizontal of overlap between physical and sexual violence differs: a certain number of men are physically violent solitary some are sexually violent sole and some are both physically and sexually violent.9

Research is also illustrating the amplitude to which women are physically assaulted during pregnancy. For a certain quantity of women who experience violence during pregnancy, the abuse is a continuation or intensification of previous abuse, whereas for others, the violence starts after they become pregnant. Ten percent of ever-pregnant women in Zimbabwe and at least 7% in southerly Africa have ever been physically assaulted during pregnancy.10 In Butajira, Ethiopia, 77% of popularly pregnant women report physical abuse during pregnancy; 28% have been punched or kicked in the abdomen.11 In the great majority of cases, the perpetrator is the father of the child.

Although these figures give an indication of the magnitude of partner violence, differences between countries and sites have to be interpreted with caution. of the like kind differences may represent not single actual differences by setting in the prevalence of violence, on the other hand also differences in research methodology, definitions of violence, sampling techniques, interviewer training and skills, and cultural differences that affect a respondent's willingness to reveal intimate experiences.12

EFFECT OF VIOLENCE upon REPRODUCTIVE HEALTH

In many countries, violence against women is still predominantly perceived as a legal or human rights issue. still such violence has wide-ranging health ends Although national data are scarce, a number of small-scale, community-based studies indicate that intimate partner violence is an important cause of morbidity and mortality,13 and an important factor affecting women's reproductive health.14 Forced sex is associated with a range of gynecological and reproductive health question s including HIV and other sexually transmitted infections (STIs), unwanted pregnancy, vaginal bleeding or infection, fibroids, decreased sexual desire, genital irritation, pain during intercourse, chronic pelvic pain and urinary tract infections.15 Studies have linked abuse to unwanted pregnancies, especially among adolescent females,16 and violence greatly limits married women's ability to use contraceptives.17 Furthermore, a history of domestic violence is commonly base to be more prevalent in families with many children.18 Although it has been recommended that elevated violence may be associated with the stresse of large families, data from Nicaragua indicate that the onset of abuse generally be anterior tos having children.19