Socio-Economic Inequalities and Women's Vulnerability to Severe Intimate Partner Violence in Uganda

Background: Intimate partner violence (IPV) is a serious public health problem in sub-Saharan Africa (SSA) with deleterious effects on the physical, psychological and socio-economic wellbeing of survivors and their families.  In SSA, IPV is linked to mental disorders, high-risk behaviors and HIV vulnerability especially among young women. Evidence from elsewhere suggests that multiple socio-economic inequalities increase women’s vulnerability to IPV. Yet limited evidence exists on the effects of social and structural factors on IPV severity within the context of Uganda. Guided by the theory of gender and power, we use a nationally representative data set to: 1) establish different class profiles describing severity of IPV exposure; and 2) explore the association between socio-economic factors and severity of IPV exposure among ever-married Ugandan women.  

Methods: Data were drawn from 2016 Uganda Demographic Health Survey considering a sample of 7536 ever-married women aged 15–49 years who completed the domestic violence module.  IPV was assessed using the shortened Conflict Tactics Scale. We used latent class analysis (LCA) to examine if distinct patterns of IPV severity existed within ever-married women in Uganda. We then used multinomial logistic regression to determine if social factors of age, decision making, place of residence, religion, alcohol use by husband and economic factors of wealth, education, labor force participation were related to class membership.

Results: Participants’ median age was 26 years, majority resided in rural areas (79.4%; n=5,981), had primary school education (60.9%; n=4,590) and were the poorest on the wealth index (24.1%; n=1,817). LCA resulted in a four-class solution of “severe physical violence, low sexual violence” (n=1501; 19.9%), “severe sexual violence, moderate physical violence” (n=535; 7.1%), “low violence” (n=5,059; 67.1%) and “severe sexual and severe physical violence” (n= 441; 5.9%). Using low violence class as the reference category, multinomial logistic regression results show that women who are younger and have a low education status were more likely to be in the severe sexual and moderate physical violence class compared to their older and more educated counterparts.  Also, women who are younger (compared to older women) and had a low education status (compared to higher education status) were more likely to be in the severe sexual and severe physical violence or severe sexual violence, and moderate physical violence class compared to women in the reference category. Regarding the wealth index, compared to the reference category, poorer women were more likely to belong in the severe sexual and severe physical violence class compared to their richer counterparts. Overall, decision making played a protective role against membership to the severe sexual and severe physical violence class compared to the reference category

Conclusion and Implications: Findings show that ever-married women in Uganda experience severe forms of IPV. There is a need for integrated multi-component interventions that include men and address both sexual and physical violence concurrently. Results also indicated significant associations between low socio-economic status and severe IPV exposure. IPV interventions providing economic empowerment for both women and men are needed urgently.