Intimate partner violence against women is a human rights violation as well as a global public health issue (1). Particularly, sexual violence perpetuated by intimate partners continues to occur throughout the world especially among women. Sexual violence is defined as “any sexual act, attempt to obtain a sexual act, or other acts directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting” (2). It includes rape, attempted rape, unwanted sexual touching and other non-contact forms” (3).
Globally, 1 in 3 women have experienced physical and/or sexual violence by an intimate partner or sexual violence by any perpetrator in their lifetime (2). Lifetime Intimate Partner Violence (IPV) prevalence range from 20% in the Western Pacific, 22% in high-income countries and Europe, and 25% in the WHO Regions of the Americas to 33% in the WHO African Region, 31% in the WHO East Mediterranean Region, and 33% in the WHO South-East Asia Region (3).
Sexual violence has many consequences of which unintended pregnancy is one such. Unintended pregnancy is defined as “a pregnancy that is either unwanted, where a pregnancy occurred when no children or no more children were desired, or the pregnancy is mistimed, where the pregnancy occurred earlier than desired” (4). According to (5), there were 121 million unintended pregnancies worldwide annually, between 2015–2019 (uncertainty intervals (UIs) 1128–1315), corresponding to a global rate of 64 unintended pregnancies (UI 60–70) per 1,000 women in the age group 15–49. Unintended pregnancy rates among women ages 15–49 vary by area, ranging from 35 pregnancies (UI 33–39) in Europe and Northern America to 91 pregnancies (UI 86–96) in Sub-Saharan Africa (5). Unwanted pregnancies and mistimed or unwanted births affect women’s health negatively; this negative effect extends to both the well-being of children and family alike.
Mistimed or unplanned pregnancies and births have a variety of implications, ranging from socioeconomic to physiological. Expectant mothers may undertake risky health behaviour such as unsafe abortion or delayed initiation of antenatal care (6). Maternal depression is not uncommon too (7); in some situations, young mothers drop out of school thereby increasing the burden of care on families. Women who are unable to plan their pregnancies are more likely to have unsafe or repeat abortions, while those who are unable to time or space their pregnancies are more likely to have maternal problems such as obstetric fistula, uterine rupture, and pregnancy-related death (8). Preterm birth, low birth weight, and small for gestational age are all linked to pregnancies spaced less than 18 months apart. Children, especially in resource-limited contexts, may experience more rivalry with their siblings for parental attention, food, education, and medical care if space between births is reduced (8).
Sexual violence against women and girls not only violates their rights, but limits their ability to participate in society as well and essentially reduces their health and well-being (9). In addition, sexual spousal violence affects a woman's physical, mental, sexual, and reproductive health, as well as her ability to make decisions (10). IPV fosters an environment that impacts a woman's autonomy, participation in decision-making related to her own health care, availability and use of contraceptives, and bargaining for safe sex, leading to unprotected sex and unexpected pregnancy (11–13).
Intimate Partner Violence (IPV) in pregnancy increases the likelihood of miscarriages, stillbirths, pre-term deliveries and low birth weight babies. A WHO study (14) found that women who have experienced IPV are 16% more likely to miscarry and 41% of them are more likely to give birth prematurely. Depression, post-traumatic stress and anxiety disorders, sleep problems, eating disorders, and suicide attempts are all possible outcomes of this type of violence (14). Women and girls as a result may also suffer isolation, inability to work, loss of wages, lack of participation in regular activities and limited ability to care for themselves and their children. The 2013 WHO study further shows that women who had been exposed to IPV were nearly twice as likely to suffer from depression and drinking problems compared with those who have not (14).
Unintended pregnancies have also been linked to sexual violence (15,16). IPV history (9,17)) and experience of spousal violence (physical or sexual violence) have both been found to be associated with unwanted pregnancies (11,18). A study by (11) in Moldova, Azerbaijan and Ukraine, found that women who had ever experienced physical or sexual violence had a higher risk of unintended pregnancies. Similarly, (18) found that women in Bangladeshi who had ever experienced domestic violence from their husbands/partners were more likely to report unwanted pregnancies (AOR: 1.46–1.54) than women who did not.
In similar setting, (19) found that women aged 15–49 in Damot Gale Woreda district of Southern Ethiopia who married later in life, had fewer children, were exposed to radio, discussed family planning with their husbands, had control over their health care, and were visited by a family planning worker, were less likely to have an unintended pregnancy. Women's inability to prevent unwanted pregnancy, on the other hand, was primarily attributable to a desire to have more children, a lack of contraceptive knowledge, spouse disapproval, difficulties in obtaining contraceptives, and contraceptive technique failure (19).
(20) used data from Ethiopia's 2011 DHS to investigate socioeconomic and demographic factors of unwanted childbearing among women age group 15–49. Women who were young, unmarried, of rich wealth status, high parity, ethnic majority, had less than a secondary education, and had a large household size were more likely to report unwanted births comparatively (Ibid).
A further analysis of the 2010 Malawi DHS, (21) found that a woman’s age, fertility preference and the number of children ever born influenced mistimed pregnancies. On the other hand, a woman's age, wealth status, fertility preference, and residence all increased the likelihood of an unwanted pregnancy.
Spousal sexual violence and unintended pregnancies are also prevalent in the country of this study, Zambia. In 2018, 15% of currently married women age 15–49 reported ever-experiencing sexual violence by husbands or partners (22). The 2018 Zambia Demographic and Health Survey (ZDHS) also shows an increase in unplanned pregnancies from 33% in 1992 to 38% in 2018. This scenario supports already provided evidence where there exists (9,11,13,18,23) linkages between sexual violence and unintended pregnancies.
The literature reviewed hereby shows that there is a paltry of evidence on studies focusing on understanding the association between spousal sexual violence and unintended pregnancies in Zambia. Some studies that may have been conducted on this subject were based on teenage and adolescent fertility, contraceptive use, HIV and unintended pregnancies (24–26). However, there is a dearth of evidence that IPV affects women’s fertility and evidence further shows that very few studies have explored the relationship between IPV and women’s ability to control their fertility especially in developing countries like Zambia (17). Thus, this study was designed to explore the association between sexual violence and unintended pregnancies in Zambia using data from a nationally representative sample based on the 2018 DHS.
The developed conceptual framework in Fig. 1 attempts to demonstrate the association between sexual violence and unintended pregnancy in Zambia. The main predictor variable in this study was sexual violence, influenced as well by socio-economic and demographic factors such age, education level, wealth status among many others. Women who have ever experienced sexual violence are more likely to report unintended pregnancies. Furthermore, demographic and socio-economic characteristics influence women’s likelihood of experiencing sexual violence, ever use of contraception and reproductive health decision-making capacity and these may also contribute directly or indirectly to unintended pregnancies.