https://orcid.org/0000-0003-1646-3571
Figures
Abstract
Background
Intimate partner violence (IPV) refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It is the most common form of violence in women’s lives. According to a World Health Organization report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life. In the Gambia, about 62% of pregnant women experience at least one form of violence from an intimate partner. IPV has severe physical and mental health consequences on a woman ranging from minor bodily injury to death. It also increases the risk of low birth weight, premature delivery, and neonatal death.
Methods
A health facility-based cross-sectional study design was carried out to assess the magnitude and factors associated with intimate partner violence among pregnant women seeking antenatal care in the rural Gambia. The study enrolled 373 pregnant women, and a multi-stage sampling technique was used to select the respondents. An interviewer-administered structured questionnaire was used to obtain information from the study participants. The collected data were analyzed using SPSS Ver.22. Bivariate and multivariate logistic regression were used to determine the association between dependent and independent variables. Odds ratio with 95% confidence interval (CI) was computed to determine the presence and strength of associated factors with IPV.
Result
The study reveals that the prevalence of IPV in The Gambia is 67%, with psychological violence (43%) being the most common form of IPV reported by the respondents. The multivariate logistic regression result reveals that being aged 35 years or older [AOR 5.1(95% CI 1.5–17.8)], the experience of parents quarreling during childhood [AOR 1.7(95% CI 1.0–2.75)], and having cigarette smoking partners [AOR 2.3 (95% CI 1.10–4.6)] were significantly associated with IPV during pregnancy.
Conclusion
This study has demonstrated that all forms of IPV in rural Gambia are frequent. Women older than 35 years, had experienced parents quarreling, had a partner who smoked, and a partner who fight with others were more likely report IPV compared to other pregnant women in the study. We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in rural Gambia.
Citation: Jatta JW, Baru A, Fawole OI, Ojengbede OA (2021) Intimate partner violence among pregnant women attending antenatal care services in the rural Gambia. PLoS ONE 16(8): e0255723. https://doi.org/10.1371/journal.pone.0255723
Editor: Yong-hui Dang, Xi’an Jiaotong University School of Medicine, CHINA
Received: September 22, 2020; Accepted: July 22, 2021; Published: August 5, 2021
Copyright: © 2021 Jatta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviation: AB, Ararso Baru; AOR, Adjusted odds ratio; ANC, Antenatal care; COR, Crude odds ratio; CRR, Central River Region; GBV, Gender-based Violence; IPV, Intimate partner violence; JWJ, Joseph W. Jatta; OAO, Oladosu A. Ojengbede; OIF, Olufunmilayo I. Fawole; PAULESI, Pan African University Institute of Life and Earth Science Including Health and agriculture; RePUBLIC, Research and Publication Committee of the University of the Gambia; SSA, Sub-Saharan Africa; SPSS, Statistical Package for Social Sciences; URR, Upper River Region; WHO, World Health Organisation
Background
Intimate partner violence (IPV) is a severe social, medical, and public health issue in all societies [1]. IPV refers to any behavior by either a current or ex-intimate partner or would-be rejected lover that causes physical, sexual, or psychological harm. It includes, but is not limited to, physical aggression, sexual coercion, controlling behavior, psychological, cultural, spiritual, and financial abuse [2].
Evidence suggests that IPV is the most common form of violence in women’s lives [3]. According to a World Health Organization’s (WHO) report, about 1 in 3 women worldwide experience at least one form of IPV from an intimate partner at some point in her life [4]. A review of literature on sub-Saharan Africa (SSA) reveals that the reported IPV among pregnant women by their intimate partners varies from as low as 2% to as high as 66.9% [5–8].
Similarly, IPV is a serious social and health problem in the Gambia [9, 10]. According to a population based study conducted in The Gambia, over 40% of women reported at least one form of IPV [11]. The burden of IPV is even much higher among pregnant women; a previous study conducted in The Gambia indicates that 61.8% of pregnant women experienced at least one form of violence from an intimate partner [9].
IPV has dramatic physical and mental health consequences on the woman, ranging from minor physical injury to death. Stab, gunshot, and head injuries are among the most common physical consequences experienced by pregnant women worldwide [12]. The mental health consequences include depression, suicide ideations, insomnia and low self-esteem [1, 13]. Moreover, IPV has also an adverse effect on fetal health. It increases the risk of low birth weight, premature delivery, and neonatal death [14, 15].
The high prevalence of IPV among pregnant women is worrisome, and some of the factors associated with IPV include, place of residence, educational status, partner’s age, age at sexual debut, dowry payment, substance abuse by husband, and history of violence in the family [16–18].
Addressing the factors associated with IPV among pregnant women in a given society is a crucial step toward preventing IPV and enhancing maternal and child health. As a global partner in gender-based violence (GBV) control, the main goal of The Gambia’s National GBV control program has been the reduction of the burden of GBV by 2020 in line with the Millennium development goals and recently Sustainable Development Goals (SDGs) [19, 20].
Although The Gambia has a high burden of IPV [9, 10], there is a dearth of literature on the factors associated with IPV among pregnant women in the rural Gambia to the best of our knowledge. The available literature on domestic violence in The Gambia focuses mainly on sexual violence among commercial sex workers [10] and physical violence against women [21]. A study focused on intimate partner violence against pregnant women in The Gambia; however, the study was conducted in a single center and particularly restricted to IPV among pregnant women in the urban setting [9]. As a result, available information in the Gambia in general and the rural Gambia, in particular, remained limited. Thus, identifying prevalence and factors associated with intimate partner violence in rural Gambia could be one of the critical steps to minimize the prevalence of IPV and associated adverse maternal and child health outcomes. So, this current study investigates the prevalence and factors associated with IPV among pregnant women in the rural Gambia.
Methods
Study setting and design
This study was conducted at the Upper River Region (URR) of The Gambia. URR is one of the five administrative regions in the country. People in this region, along with the Central River Region (CRR), have the lowest ratings on social indicators than other areas [22]. Each region in the country has a health team that a regional director heads. Under each region, there are hospitals and primary health care facilities, which include major and minor health centers, public and private clinics. The primary health care facilities provide health services to people of the communities in its catchment areas. URR has 12 health centers, and all women seeking antenatal care services at six selected health centers were included in the study. The selected health centres are as follows: Basse Health Centre, Garawol Health Centre, Baja Kunda Health Centre, Demba Kunda Health Centre, Koina Health Centre, and Yorobawol Health Centre.
A health facility-based cross-sectional study design was employed to assess the magnitude and the factors associated with intimate partner violence among pregnant women seeking antenatal care at selected public health facilities in the rural Gambia from February 1 to May 15, 2019.
Eligibility criteria
All pregnant women live within the rural setting for the past six months, and volunteers to participate in the study were included in the study. The respondents who were critically ill or who were in labor were excluded from the study as there were ethical and moral challenges in recruiting such respondents in the study.
Sample size determination
Single population proportion formula was used to estimate sample size:
Where:
n = Minimum sample size for a statistically significant survey
Z = Standard normal deviate at 95% confidence interval two-tailed test is; = 1.96
P = Indicates prevalence of IPV among pregnant women which was 61.8% and taken from the previous study [9].
q = 1-p, d = margin of error taken as 5%= 0.05
After substituting into the formula, the computed sample size was 363. The final sample size with a 10% assumption for non-response rate was 400.
Sampling procedure
A multi-stage sampling technique was used to select respondents.
Stage 1: The health facilities in URR were stratified into two strata based on their functions, namely: major and minor health centers. For the major health centers, they were four, and by simple balloting, 3 out of the four were selected, with each health center attending to an average of 60 antenatal women per antenatal clinic day. The same procedure was followed for the eight remaining minor health centers, and three were eventually selected. The specific sample size was allocated to each stratum using proportion-to-size allocation.
Stage 2: A sampling frame was created from the registry at the antenatal care entry point. The systematic random sampling technique was used to select respondents, which was determined by dividing the estimated average number of women who attended ANC of each facility in a previous similar period for the allocated sample size for each health facility. Lastly, a respondent was selected by every Kth number of pregnant women coming to each health facility for ANC service.
Data collection tool and techniques
An interviewer-administered structured questionnaire was used to collect information from each participant. We adapted a questionnaire that WHO initially developed for a multi-country study on women’s health, which we modified to fit both the objectives of our research and the culture of the respondents [23]. Self-reported experience of IPV during the current pregnancy was the main outcome of this study. The IPV assessed in this study included all physical, sexual, psychological, and economic forms of violence. To identify sexual violence, each woman was asked a series of four questions. To confirm physical violence, six questions were asked; to assess psychological violence, eleven questions were asked; two questions were asked to identify economic violence. The details on these questions are given in Table 1.
Operational definitions
Intimate partner.
A husband, cohabiting partner, boyfriend, or lover, or ex-husband, ex-partner, ex-boyfriend, or ex-lover [24].
Intimate partner violence.
Refers to behavior by an intimate partner that causes physical, sexual or psychological devastation, including actions of physical violence, sexual intimidation, emotional abuse, and controlling behaviors [24].
Data quality assurance
The data quality was assured through careful design, translation, and retranslation of study tool language from the English version to the national languages (Mandinka, Serahuli, and Wolof) and vice versa. The questionnaire was pretested before data collection, and possible corrections were made based on the feedback from the pretest. Participants were approached and interviewed during ANC visits by the language of their preference. In addition, two days of training were given to the data collectors and supervisors. Furthermore, continuous and close supervision of the data collecting procedures, proper categorization, and coding of the data was done. JWJ and AB checked the completeness and consistency of the data daily.
Data entry, processing, and analysis
Data were checked for completeness and inconsistencies, and were cleaned, coded, and entered into the EPI data. Statistical Package for Social Science (SPSS) version 22 was used for the analysis.
Frequency tables, diagrams, and proportions were used to present and summarize the variables of interest. Logistic regression was used to determine the degree of relationship between dependent variables and their associated factors. Evidence has shown that selecting a variable with a p-value cut off 0.05 as a candidate for multivariate analysis can fail in identifying variables known to be important [25]. On the contrary, a purposive selection of a cutoff value of 0.25 has the capability of retaining both significant covariates and important confounding variables in logistic regression [26]. Similarly, a cut-off value of 0.25 has been supported by different studies [25, 27]. Therefore, this study considered all variables with a p-value of < 0.25 on bivariate analysis for multivariate logistic regression analysis, and statistical significance was set at a 5% level.
Ethical approval and consent to participate
Ethical approval was obtained from the Ethical Review Board of the University College of Medicine, the University of Ibadan in Nigeria. Furthermore, ethical clearance was obtained from the Research and Publication Committee of the University of the Gambia (RePUBLIC) and then The Gambia Government/Medical Research Council Joint Ethics Committee (Reference number: R018031V1.1) for permission to conduct this study. The study followed the National Institute of Health guidelines on research involving the use of human subjects.
Permission to conduct the study in the URR Health Region was sought and obtained from the Regional Health Team. Furthermore, the research’s aim, purpose, and importance were clearly and in unambiguous terms explained to each respondent to obtain informed verbal consent. Therefore, each respondent signed a pre-designed consent form in the interviewer’s presence to endorse their participation.
Confidentiality of the information obtained from each participant was maintained. All the data and information collected were coded using numbers, and not at any one point in time was the name of a single participant known. The information on subjects was accessible to only the principal investigator and entered into a password-protected computer.
Results
This study included a total of 373 women in the analysis, making a response rate of 93.3% as twenty-seven women were not included in the analysis because of incomplete data.
Sociodemographic characteristics of respondents
Table 2 shows that most of the respondents are between the age group of 20–24 years, followed by those in the age group of 25–29 years, which accounted for 27% and 26% of the study participants, respectively. About two-thirds of respondents are non-formally educated (66%), and only 2% have attained tertiary education. The vast majority are married (97%), and Islam is practiced by 98% of them. Eighty-seven percent were housewives, of whom about 10% are self-employed, and 3% reported having paid employment. The distribution by tribe shows that 39% (the majority) of the respondents are Serahuli, followed by Mandinka (29%).
Partners sociodemographic status and lifestyle
Table 3 shows that the majority (29%) of the respondents have partners in the age range of 30–39 years. Half of the women’s partners have no formal education (50%), while only 10% reportedly attained tertiary education. Almost all the women (99%) have partners who practice Islam. The majority (81%) of the women’s partners are self-employed, and 16% have paid employment.
About 22% of the women’s partners are habitual cigarette smokers, while 6% are reported to be heavy smokers. Only 2% of the partners are reported to engage in drinking alcohol. Twenty-three percent of the women said their partners had been previously involved in fights with other persons, while 55% claimed their partners have never engaged in fights with others.
Experience of intimate partner violence
The prevalence of intimate partner violence is 67%, as revealed in Table 4; thus, indicating that 67% of the women have experienced at least one form of IPV.
Disaggregation of the prevalence of intimate partner violence
Further disaggregation of the prevalence of intimate partner violence as revealed in Fig 1 exposes the following: while 33% had never experienced any form of violence from their partners, 43% had experienced only the psychological violence, about 9% reported having experienced the combination of psychological and physical violence, nearly 3% reported experiencing a combination of psychological, sexual and economic violence, while almost another 3% had experienced a combination of psychological, physical & economic violence, and about 2% reported experiencing all forms of violence.
Note: N = 373; Psyc = psychological; Phys = physical; Eco = economic; sex = sexual.
Factors associated with intimate partner violence
Factors found to be associated with intimate partner violence are presented in Table 5. It is found that women of ages 35 years and above are about five times more likely to have had an IPV experience than those in the age group 18–24 years. The women’s experience of witnessing a quarrel between their parents is associated with their IPV experience. The odds ratio estimated from the logistic regression shows that women who had seen their parents quarrel are almost twice likely to have experienced IPV. Women with partners who smoke have two and a half more chances of experiencing IPV. Women who reported having witnessed their partners engage in a fight are found to have twice more chances of experiencing any form of IPV than those who have never seen their partners involved in a fight (OR = 2.05, p = 0.010).
Discussion
This study seeks to determine the prevalence and factors associated with IPV among a sample of pregnant women in the rural Gambia. The study findings show that various forms of violence, namely psychological, sexual, physical, and economic violence, were experienced by pregnant women attending ANC services in the rural Gambia.
Our findings reveal that 67% of the pregnant women in this study experienced at least one form of violence from their intimate partner, comparable with similar studies from Ethiopia and Kenya, which reported 68.6% and 66.9% prevalence, respectively [18, 28]. On the other hand, our finding is slightly higher than the report of a similar study in The Gambia, which reports a 61.8% prevalence of IPV [9]. The disparity could be because the previous research from The Gambia only assessed three forms of IPV. In comparison, the present study assessed more than three forms of IPV, including economic violence. In addition, the previous study was conducted in the urban Gambia compared to the present study, which was conducted in the rural Gambia [9]. It has been reported that rural women experience higher IPV rates than urban women [29].
This study also assesses various forms of IPV and their overlapping experienced by pregnant women. The study shows that the most common form of violence experienced by pregnant women was psychological violence alone (43.2%). Even though the reported prevalence from Rwanda was relatively lower than that of the present study (31.7%), psychological violence alone was the most common form of violence in the study [30]. The difference could be attributable to cultural differences between the two countries, wherein in the Gambia, men are considered to be in charge of women; for example, permission must be sought and granted before the woman can go out, or a good woman obeys her husband even if she disagrees with him. These are societal norms in rural Gambia. We have also observed that the most common overlapping IPV among pregnant women is psychological and physical violence. Similar findings were presented from Tanzania and Rwanda [30, 31].
The second most experienced IPV among the respondents is physical violence (15.8%), which is much lower than that of the previous study from The Gambia, which reported a 55% prevalence of physical IPV [9]. A possibility of underreporting among the women in the rural Gambia cannot be ruled out, which may be due to denial, shame, or stigma associated with violence in a marital relationship. Therefore, further studies are needed to justify the reasons for the observed differences. On the other hand, a study from Nigeria reports a 17.3% prevalence of IPV among pregnant women, a figure close to the findings in this study [32]. This could be attributed to similarities in religious and traditional beliefs between the two countries.
The findings of this study indicate that sexual violence is reported by 7.2% of the respondents, which is comparable to the study conducted in Bolivia, which reports 6.9% [33]. However, a cross-sectional study in Ethiopia reports a 36% prevalence of sexual violence among female respondents, which is much higher than the finding of this study [34]. The extreme disparity could be attributed to the fact that talking about the subject matter (sexual experience) is highly sensitive in the Gambia [9]. Therefore, the chances of disclosing if they are experiencing some form of sexual violence from their intimate partners are very slim.
On the other hand, more than 10% of the respondents reported having experienced economic violence from their intimate partners during the current pregnancy. Although the study from Ghana assesses the lifetime prevalence of economic violence, their finding is similar to that of the present study [35]. This similarity can be attributed to the fact that most women in this part of the world depend entirely on their husbands for financial support [36, 37]. This can be seen in the demographic data, which indicates that over 85% of the respondents in this present study are housewives. Moreover, the controlling behavior tendencies by men could ensure that some prevent their wives from engaging in any money-making venture [36].
In this study, a woman’s age is significantly associated with IPV as all the women aged 35 or older are five times likelier to experience IPV from their partners. This can be compared to a study from Sweden, which also finds age as a significantly associated factor to experiencing intimate partner violence [13]. This study also demonstrates an association between a partner who smokes and intimate partner violence among pregnant women in the rural Gambia. A previous study from The Gambia also finds a similar association between having a partner who smokes and IPV experience [9]. The explanation could be that, pregnancy influence the association between IPV and cigarette smoking as there are higher baseline levels of physical and emotional distress that place pregnant women at greater risk of victimization compared to non-pregnant women [38].
The present study finds out that those women who witnessed a quarrel between their parents during childhood were twice likelier to suffer IPV than other women who did not. These findings are consistent with a comparable study from Brazil, which reports that the women who witnessed their mothers quarrelling suffer from IPV than their counterparts who did not witness such [39]. The social learning theory postulates that children learn to exhibit aggressive behaviors because they observe others acting aggressively and can see how these behaviors are reinforced over time [40]. Violence, therefore, tends to have an impact on children who then, in turn, grow to be either perpetrators or victims of IPV. Moreover, the present study finds out that women who witnessed their husbands engage in a fight with other people were twice likelier to experience IPV. This could be explained as the partners being generally aggressive and quarrelsome, they do not spare anyone of their quarrels, including their wives.
Limitations of the study
This study has some limitations. First of all, the data used in this study were collected using self-reported experiences. As a result, due to the sensitive nature of the subject matter in the rural Gambia, social desirability bias may have led to underreporting of IPV in general and sexual IPV. Secondly, the study’s findings could be affected by a recall bias as respondents were required to remember and recount past events. When respondents remember past events, they don’t usually have a complete or accurate picture of what happened. Moreover, a causal relationship would have been challenging to establish due to the study design implemented in the study, which was a cross-sectional study. Therefore, the findings of this study should be considered in light of the limitations above.
Conclusion
This study has demonstrated that all forms of IPV in the rural Gambia are frequent, with psychological violence found to be the most highly prevalent. The study finding illustrates that being older than 35 years, having a cigarette smoking partner, experienced parent quarreling during childhood, and witnessing partners fight with others were the factors that significantly associated with IPV experience during the current pregnancy.
We recommend that IPV screening should be included as an integral part of routine antenatal care services in The Gambia. Community-based interventions that include indigenous leaders, religious leaders, and other key stakeholders are crucial to create awareness on all forms of IPV and address the risk factors found to influence the occurrence of IPV in the rural Gambia. More research is required to provide information from male partners’ side, associated factors of IPV, and effects of IPV on the outcome of pregnancy in The Gambia.
Acknowledgments
Our deepest gratitude goes to PAULESI for facilitating this study. Finally, our particular respect goes to all respondents and data collectors in this study.
References
- 1. Bailey BA. Partner violence during pregnancy: Prevalence, effects, screening, and management. Vol. 2, International Journal of Women’s Health. 2010. p. 183–97. pmid:21072311
- 2.
WHO. Intimate partner and sexual violence (violence against women). World Heal Organ [Internet]. 2017;E.T.: 24.04.2021. Available from: https://www.who.int/violence_injury_prevention/violence/sexual/en/
- 3. Krug EG, Mercy JA, Dahlberg LL ZA. The world report on violence and health. Lancet. 2002;360(9339):1083–8. pmid:12384003
- 4.
WHO. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence [Internet]. 2013. Available from: https://www.who.int/reproductivehealth/publications/violence/9789241564625/en/
- 5. Shamu S, Abrahams N, Temmerman M, Musekiwa A, Zarowsky C. A systematic review of African studies on intimate partner violence against pregnant women: Prevalence and risk factors. PLoS One. 2011;6(3):1–9. pmid:21408120
- 6. Owaka IO, Nyanchoka MK, Atieli HE. Intimate partner violence in pregnancy among antenatal attendees at health facilities in West Pokot county, Kenya. Pan Afr Med J. 2017;28:1–6. pmid:29629015
- 7. Groves AK, Moodley D, McNaughton-Reyes L, Martin SL, Foshee V, Maman S. Prevalence, Rates and Correlates of Intimate Partner Violence Among South African Women During Pregnancy and the Postpartum Period. Matern Child Health J. 2015;19(3):487–95. pmid:24889116
- 8. Alebel A, Kibret GD, Wagnew F, Tesema C, Ferede A, Petrucka P, et al. Intimate partner violence and associated factors among pregnant women in Ethiopia: A systematic review and meta-analysis. Reprod Health. 2018;15(1):1–12. pmid:29304829
- 9. Idoko P, Ogbe E, Jallow O, Ocheke A. Burden of intimate partner violence in the Gambia—A cross sectional study of pregnant women. Reprod Health. 2015;12(1):1–6.
- 10. Sherwood JA, Grosso A, Decker MR, Peitzmeier S, Papworth E, Diouf D, et al. Sexual violence against female sex workers in the Gambia: A cross-sectional examination of the associations between victimization and reproductive, sexual and mental health. BMC Public Health. 2015;15(1):1–10. pmid:25886187
- 11. Jabbi A, Ndow B, Senghore T, Sanyang E, Kargbo JC, Bass P. Prevalence and factors associated with intimate partner violence against women in The Gambia: a population-based analysis. Women Heal. 2020;1–17. pmid:32419660
- 12.
LAC: Gender Rersearch & Advocacy Project. Seeking Safety: Domestic Violence in Namibia and the Combating of Domestic Violence [Internet]. 2012. Available from: http://www.lac.org.na/pub/publications.php%5Cn
- 13. Lövestad S, Löve J, Vaez M, Krantz G. Prevalence of intimate partner violence and its association with symptoms of depression; A cross-sectional study based on a female population sample in Sweden. BMC Public Health. 2017;17(1):1–11. pmid:28049454
- 14. Gurung S, Acharya J. Gender-based Violence Among Pregnant Women of Syangja District, Nepal. Osong Public Heal Res Perspect. 2016;7(2):101–7. pmid:27169008
- 15. Laelago T, Belachew T, Tamrat M. Effect of intimate partner violence on birth outcomes. Afr Health Sci. 2017;17(3):681–9. pmid:29085395
- 16. Owusu Adjah ES, Agbemafle I. Determinants of domestic violence against women in Ghana. BMC Public Health. 2016;16:368. pmid:27139013
- 17. Abate BA, Wossen BA, Degfie TT. Determinants of intimate partner violence during pregnancy among married women in Abay Chomen district, Western Ethiopia: a community based cross sectional study. BMC Womens Health [Internet]. 2016;1–8. Available from: pmid:26729344
- 18. Lencha B, Ameya G, Baresa G, Minda Z, Ganfure G. Intimate partner violence and its associated factors among pregnant women in Bale Zone, Southeast Ethiopia: A cross-sectional study. PLoS One. 2019;14(5):1–14.
- 19.
MOWCSW. National women national review report on implementation of the Beijing (BPFA). The republic of The Gambia.The ministry of women children and social welfare (MOWCSW) women ‘ s bureau [Internet]. Vol. 25. 2019. Available from: https://www.uneca.org/sites/default/files/uploaded-documents/Beijing25/gambia-beijing25_report.pdf
- 20.
Ministry of Women’s Affairs. The Gambia national gender policy 2010–2020. Hum Dev. 2010;
- 21. Yu WY, Bass P, Sanyang E, Lin MR. Risk Factors for Injuries From Physical Violence in African Women in the Gambia. J Emerg Med [Internet]. 2020;58(2):356–64. Available from: pmid:31924468
- 22.
UNICEF. UNICEF Annual Report 2013 –Gambia. 2013;1–29. Available from: https://www.unicef.org/about/annualreport/files/Gambia_COAR_2013.pdf
- 23. Garcia-Moreno C, Jansen HAFM, Ellsberg M, Heise L, Watts C. WHO Multi-Country Study on Women’s Health and Domestic Violence Against Women: Report on the First Results. World Heal Organ [Internet]. 2005;55–89. Available from: https://www.who.int/reproductivehealth/publications/violence/24159358X/en/
- 24. WHO WHO. Responding to intimate partner violence and sexual violence against women. Int J Public Health [Internet]. 2013;68. Available from: www.who.int/reproductivehealth pmid:24354041
- 25. Greenland S, Mickey RM. Re: “The impact of confounder selection criteria on effect estimation.” Am J Epidemiol. 1989;130(5):1066.
- 26. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3:1–8. pmid:18241331
- 27. Bendel RB, Afifi AA. Comparison of Stopping Rules in Forward “Stepwise” Regression. J Am Stat Assoc. 1977;72(357):46.
- 28. Berhanie E, Gebregziabher D, Berihu H, Gerezgiher A, Kidane G. Intimate partner violence during pregnancy and adverse birth outcomes: A case-control study. Reprod Health. 2019;16(1):1–9. pmid:30621726
- 29. Peek-Asa C, Wallis A, Harland K, Beyer K, Dickey P, Saftlas A. Rural disparity in domestic violence prevalence and access to resources. J Women’s Heal. 2011;20(11):1743–9.
- 30. Rurangirwa AA, Mogren I, Ntaganira J, Krantz G. Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: A population-based study. BMJ Open. 2017;7(2). pmid:28399509
- 31. Mulawa M, Kajula LJ, Yamanis TJ, Balvanz P, Kilonzo MN, Maman S. Perpetration and Victimization of Intimate Partner Violence Among Young Men and Women in Dar es Salaam, Tanzania. J Interpers Violence. 2018;33(16):2486–511. pmid:26802044
- 32. Sigbeku OA, Fawole OI, Ogunniyan TB. Experience of intimate partner violence as a predictor of sexually transmitted infections among married women in Nigeria. Ann Ibadan Postgrad Med [Internet]. 2015;13(1):6–16. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26807081%0Ahttp://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=PMC4715374 pmid:26807081
- 33. Meekers D, Pallin SC, Hutchinson P. Intimate partner violence and mental health in Bolivia. BMC Womens Health. 2013;13(1):1.
- 34. Abeya SG, Afework MF, Yalew AW. Intimate partner violence against women in western Ethiopia: prevalence, patterns, and associated factors. BMC Public Health. 2011;11(1):913.
- 35. Alangea DO, Addo-lartey AA, Sikweyiya Y, Chirwa D, Coker-appiah D, Jewkes R, et al. Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial. 2018;1–19.
- 36. Asante F, Fenny A, Dzudzor M, Chadha M, Scriver S, Ballantine C, et al. Economic and social costs of violence against women and girls in Ghana: Country Technical Report. North [Internet]. 2019;22(April):1–77. Available from: https://www.ipsos.com/sites/default/files/ct/publication/documents/2019-07/economic-social-costs-violence-women-girls-ghana-2019.pdf
- 37. Dierickx S, Rahbari L, Longman C, Jaiteh F, Coene G. “I am always crying on the inside”: A qualitative study on the implications of infertility on women’s lives in urban Gambia. Reprod Health. 2018;15(1):1–11. pmid:29304829
- 38. Crane CA, Hawes SW, Weinberger AH. Intimate Partner Violence Victimization and Cigarette Smoking: A Meta-Analytic Review. Trauma, Violence, Abus. 2013;14(4):305–15. pmid:23878146
- 39. Ludermir AB, Araújo TVB de, Valongueiro SA, Muniz MLC, Silva EP. Previous experience of family violence and intimate partner violence in pregnancy. Rev Saude Publica. 2017;51:85. pmid:28954164
- 40. Bandura A. Social Learning Theory of Aggression. J Commun. 1978;28(3):12–29. pmid:690254