This study examined the prevalence and factors associated with sexual violence among Ugandan rural women of reproductive age. The prevalence of sexual violence among our participants was 24.3%. This prevalence is slightly higher than the national prevalence of 22% . Rural settings have been linked with higher rates of physical and sexual violence than urban areas, which can be attributed to the difference in the social-dynamics that increase chances of domestic violence in rural areas [10,24,25]. Compared to urban settings, the strong cultural believes, ties and norms, as well as higher poverty levels in rural areas, could explain the higher prevalence of sexual violence [6,10,25].
The study identified several factors that were significantly associated with sexual violence, including women's educational level, region, wealth index, justified beating, healthcare decision-making, and husband drinking frequency.
Women with a tertiary educational level and richest wealth quintile were less likely to experience sexual violence than the less educated and poor ones. Higher (post-secondary) level of education implies more awareness about individual rights, and educated women are more financially stable and more empowered compared to the poor less educated . The results agree with previous studies that also reported higher educational level and richest wealth quintile as protective factors against not only sexual violence but also gender inequality [6,15,26]. This implies that more efforts and targeted interventions are needed to improve the livelihoods of rural women to reduce financial dependence on their husbands. In addition, promotion of girl-child education is a vital tool for women empowerment, improving the social status and reducing gender-based violence.
Women from Western and Eastern Uganda had the highest chances of having experienced sexual violence, compared to those in the Northern region. The findings are in line with Wandera et al., who reported the highest rate of sexual violence in the Eastern region, followed by Western, Central, and Northern regions . However, the results deviate from a recent meta-analysis that reported Northern Uganda having the highest rate of sexual violence (50%) within Sub-Saharan Africa . Although the Northern region has a record of past civil wars that were characterised by the violation of human rights, including sexual abuse , our study found no significant chances of sexual violence among women in this region. The reasons underlying the higher risks of sexual violence in the Western and Eastern regions of the country are not clear, calling for further investigation. However, the higher sexual violence risks in these regions may be linked to social-cultural norms such as women subordinate, justified violence, among others [28,29].
In addition, women who justified beating showed higher odds of sexual violence, unlike their counterparts. The results agree with previous studies that highlight justified violence as a risk factor for sexual violence [28,29]. Strict adherence to cultural norms that emphasise women's inferiority to men or those which objectify women affects the mindset and awareness of women about their rights . Justified violence against women is deeply rooted in cultural norms and practices like payment of bride price, grooming women to be submissive and subservient, among others. All these disempower women from taking part in sexual decision-making while mounting men with infinite sexual contact with their wives . Therefore, there is a need for culture-oriented sensitisation programs to condemn negative cultural norms and practices that violet women's rights.
The study also noted that women who were involved in healthcare decision-making had lower chances of experiencing sexual violence compared to those who did not. The ability to make independent healthcare decisions imply knowledge of one's rights, as well as empowerment. Women who do not take part, at all, in their healthcare decision making are more likely to be less empowered and so are prone to not only sexual violence but also physical violence . In addition, joint decision making (wife and husband) could imply better communication and fewer incidences of misunderstandings, thus less chances of sexual violence in a home. The results agree with Semahegn's study , which also indicated joint decision-making as a protective factor against not only sexual violence but also other forms of domestic violence.
The study revealed that women with husbands who often get drunk were more likely to be sexually abused compared to those whose husbands don't get drunk. The results agree with previous studies that also highlighted the husband's behaviour like alcohol consumption as a risk factor for not only sexual violence but also physical violence [6,28]. Excessive alcohol consumption has been linked with aggressive behaviour and increases the chances of misunderstandings and conflict among partners leading to sexual violence, especially when the woman does not drink .
Notably, although it became non-significant on controlling for missing data, working status also had some association with sexual violence. Employed women showed higher odds of sexual violence compared to the unemployed ones. This finding is similar to other studies that have also reported working women having more chances of being sexually abused [25,31,32]. Although employment directly translates to women empowerment , it has been shown, in several studies, not to be a protective factor against sexual violence among women [25,32,33]. This could be due to the work-related sexual abuse faced by women, depending on the type of employment, especially in the informal sector. For example, some studies have also reported higher rates of sexual violence among female sex workers as well as casual labourers [34,35,36]. This implies a need to strengthen the country's available protective policies to ensure the safety of working women.
Strengths and Limitations of the study
Standardised procedures are a requirement of DHS surveys in data collection, and validated questionnaires are used, which ensures the internal and external validity of the results. Secondly, we used the most recent nationally representative sample and weighed the data for analysis, and therefore, our results are generalised to all Ugandan women aged 15 to 49 years.
However, the study had some limitations, such as the possibility of information bias, as well as recall, and interviewer biases since most data on the predictors were based on self-reporting, which could not be verified through records, and respondents gave answers about events that occurred in the past. In addition, data on explanatory variables such as wealth and working status reflected the women's conditions at the time of the survey and not at the time experiencing sexual violence. Hence, women may have moved from one category of classification into another. Such non-differential misclassification may have reduced the strengths of observed associations.