Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling.

Background: Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia. Methods: A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models. Results: Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78). Conclusion: Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.

Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia.

Violence around pregnancy is critical in nature and major public health problem worldwide. Thus, the present study aims to determine the extent of perinatal partner violence and to identify its individual and community-level factors among postpartum women in Southern Ethiopia. A total of 1342 postpartum women nested in 38 'Kebles' (clusters) were enumerated using multistage-clustered sampling techniques for multilevel analysis. Different parameters were computed for model comparison and model fitness. The overall prevalence of intimate partner violence before, during, and/or after pregnancy was estimated to be 39.9% [95% CI 36.9-44.5]. About 18% of women reported continuous abuse over the perinatal period. Postpartum women who live in rural areas [adjusted odds ratio (AOR) = 2.46; 95% CI 1.21-5.01], or in neighborhoods with high IPV favoring norms [AOR = 1.49; 95%CI 1.01-2.20], high female literacy [AOR = 2.84; 95%CI 1.62-5.01], high female autonomy [AOR = 2.06; 95%CI 1.36-3.12], or in neighborhoods with lower wealth status [AOR = 1.74; 95%CI 1.14-2.66] were more likely to encounter PIPV. The complex patterns of interplaying factors operating at different levels could put pregnant or postpartum women at higher risk of IPV victimization. Therefore, policies that prioritize the improvement of contextual factors, particularly norms toward IPV and women's empowerment are likely to be the most effective interventions.

Postpartum Women's Lived Experiences of Perinatal Intimate Partner Violence in Wolaita Zone, Southern Ethiopia: A Phenomenological Study Approach.

OBJECTIVE: Perinatal intimate partner violence affects the health and safety of postpartum women and their infants. However, it has not been well recognized and addressed in the study setting. Hence, this study aimed to explore postpartum women's lived experiences of perinatal intimate partner violence and its contributing factors in Wolaita Zone, Southern Ethiopia. METHODS: A phenomenological study approach was used to explore postpartum women's lived experiences of perinatal partner violence from January to March 2020. A total of twenty-two postnatal women and five health extension workers (HEWs) were interviewed. Interviews were audio-recorded, transcribed verbatim in local languages, and then translated into English. Data were analyzed thematically, using deductive and inductive coding. The consolidated criteria for reporting qualitative research (CORE-Q) checklist was followed to report the findings. RESULTS: Results indicated that postpartum women had experienced recurrent violence before, during, and after pregnancy from their husbands, with 16 out of 22 women being subjected to perinatal intimate partner violence. A majority of the participants delineated their exposure to perinatal physical violence next to perinatal psychological violence. Many of the interviewed women noted that violence during pregnancy was exacerbated and increased during postpartum. Moreover, the interviewees revealed that some partners were not only a serious threat to their wives, but also their infants during the postpartum period. Four of the participants stated that their newborns were hit and thrown by their father and became unconscious. Participants linked husbands' perinatal violence with suspicion about the newborn, male-child preference, partner infidelity and jealousy, contraceptives usage, alcohol consumptions, indifference to shortages on household necessities, improper parenting, and financial problems. CONCLUSION: This study highlights that postpartum women are experiencing continuous and severe forms of perinatal IPV in the study setting. Thus, community-level interventions that minimize perinatal partner violence against postnatal women and their infants are needed.