IPV was a prevalent issue amongst female undergraduates in this study. The prevalence of IPV (51.2%) reported in this study is higher than that reported in a similar study conducted in Ibadan Nigeria amongst female students . This suggests that more than half of Female Undergraduates in Abia State have been abused by their partners with its attendant consequences on their emotional, physical and sexual health. Furthermore, if screenings are not carried out abused students during their clinic/hospital visits for somewhat innocuous or unexplainable injuries or conditions, IPV diagnosis will be missed and there may be recurrence with worsening consequences which may greatly interfere with the student’s health, academic performance and may at the extreme lead to homicides or suicide. This rate was also higher than the IPV prevalence rate of 42.0% reported amongst HIV negative women in a cross-sectional study done in Aminu Kano Teaching Hospital . The Composite Abuse Scale (CAS) tool was used to assess IPV in this study which is different from the tool used in this study. Furthermore, this study was restricted to reproductive age women (15–49 years of age). These all may have accounted for the lower prevalence reported. A much lower prevalence rate of 28% was also reported in a study done in Ahmadu Bello Teaching Hospital . However, this study was done amongst pregnant women attending ANC clinic and wanting to keep any act of domestic violence against them a secret may have led to underreporting. In the African continent, a study from Rwanda amongst pregnant women reported an IPV prevalence of 35.3% in the last 12 months . This is also much lower than was reported in this study though both studies used the Conflicts Tactics Scale tool for ascertaining IPV. However, another study from Africa, Zambia to be precise, reported a prevalence of 48.4% which is very close to the prevalence reported in this study . Moving to the European continent, the prevalence reported in this study is higher than what was reported in Spain . This study reported a lower prevalence of 19.2% amongst women. However, there may have been gross underreporting of IPV as these women were studied in the immediate postpartum period and the fear of losing custody of their children if they report physical abuse may have led to a lot of them keeping mum on the issue. In addition, the lower prevalence rates of IPV in Europe compared to this study and the above reviewed studies in Africa may also be due to better law enforcement against IPV perpetrators serving as a deterrent to others.
Moving on to the forms of IPV, this study revealed prevalences of 78.9%, 42.0% and 30.8% for emotional, physical and sexual violence respectively amongst Female Undergraduates in Abia State. This is slightly similar in pattern to what was reported in the NDHS 2013 study for Abia State differing only in which form was the commonest . From the 2013 NDHS, a prevalence of 12.9%, 21.2% and 5.5% for emotional, physical and sexual abuse respectively were reported in Abia State . Both studies agreed that the least common form of abuse amongst women in Abia State is sexual abuse but differed in findings for the commonest form, with the NDHS reporting that the commonest was physical abuse with a prevalence of 21.2% while the commonest from this study was emotional abuse with a prevalence of 78.9%. This study was restricted to female undergraduates in Abia State while the NDHS surveyed all women in Abia state and this may account for the disparity in prevalence and commonest patterns reported. The pattern of IPV reported in this study is also very similar to the patterns reported in other studies from other parts of Nigeria [7, 12, 13, 18, 19]. One thing common to the pattern of IPV in all the studies reviewed above (despite the varying prevalence rates) is that Emotional/psychological violence was the most commonly reported form of abuse against women followed by physical violence and sexual violence being the least commonly reported. In addition, the reported pattern in this study is similar to what was reported in studies from West Africa. A study from Togo reported that the rates of physical abuse amongst both Women Living with HIV/AIDs (WLWHA) and HIV negative women (63.1% as against 69.7% respectively) was significantly higher than the rate of sexual abuse amongst both WLWHA and HIV negative women (39.3% compared to 35.3%) . This corresponds with the pattern of abuse reported in this study. It is important to note at this juncture that the study from Togo failed to study psychological violence and concentrated on physical and sexual violence. Nonetheless, the similarity in forms can be due to the similarities in culture amongst the West African countries with trans-border business and marriages propagating a mixture in cultures and norms. Away from West Africa, it is seen that studies from other parts of Africa showed a different pattern of IPV occurrence amongst women [6, 21]. To expatiate on this, it is seen that studies from Ethiopia, Namibia and Tanzania all reported the prevalence of physical, sexual and emotional violence as 48.7%, 58.6% and 9.2% respectively, 30.6%, 16.5% and 8.4% respectively and 46.7%, 30.7% and 15.3% respectively . This pattern reported in these countries suggest that emotional violence is the least common form of IPV amongst the three studied forms of IPV which is different from what was reported in this study. Cultural differences, different levels of patriarchy and legalization of male roles across the different countries and regions in Africa may be responsible for this deviation in pattern. Also, most of the studies outlined above did not study psychological/emotional abuse as an entity of its own. This may also account for the difference in pattern of IPV observed. In Europe, studies from Spain showed a similar pattern of IPV to that reported in this study . Amongst pregnant women in Spain, 15.5% experienced emotional abuse, 7.1% experienced physical abuse and 1.3% reported sexual abuse . The Public health significance of increased forms of IPV amongst female undergraduates are vast and range from non-adherence to medications, poor academic performance, reduced health seeking actions, increased associated morbidities and so on and all these may increase mortality and reduce productivity in the society.
Individual factors are factors peculiar to the individual and they have been found to be risk factors for IPV [2, 22]. This study reported that females who witnessed domestic violence as a child were over 3 times more likely to experience IPV later in life. This is congruent with the finding from Ibadan Nigeria where it was reported that students who had exposure of inter-parental violence were significantly associated with experiencing IPV later in life . A study from the United States also reported that the most auspicious finding they made in WLWHA and HIV negative women was the strong association of childhood abuse and risk for later abuse in both groups . Though the study done in the United States was a Prospective cohort study which is different from this which was a cross sectional study, both report this same finding as one of the predictors of IPV in women. Witnessing abuse as children especially amongst parents may have a profound normalization effect on the child. Future abuse may not be seen for what it is due to the numbing effect her childhood experience has had on her psyche thus making her more vulnerable to abuse. This mindset may also be transferred down to their children thereby resulting in inter-generational normalization of abuse and various forms of violence. Partner frequent use of alcohol is another individual factor associated with IPV amongst female undergraduates in this study where it was reported that females whose partners use alcohol frequently were at least five times at risk of experiencing IPV. The disinhibition associated with alcohol use may result in heightened response from the victim’s partner to minimal provocation from the victim. Disinhibition from alcohol use may also result in the partner having multiple sexual partners – an issue that usually fuels discord amongst couples. Frequent alcohol use may also lead to partner neglect and also constitute a drain on couple finances. This may fuel tension amongst couples which may eventually lead to violence. Frequent alcohol use by partner may be his adaptation mechanism to the numerous societal and/or economic challenges facing the nation, for example owed salaries, downturn in business fortunes, academic problems and so on. The 2013 NDHS corroborated this finding as it reported that women whose husbands or partners get drunk often were more likely to report IPV than women whose husbands drink but do not get drunk and women whose husbands do not drink . This is also congruent with findings in studies from Enugu, Ebonyi, Kano, and Ibadan [7, 13, 24]. In all these studies, partner alcohol use was a predictor for IPV amongst women – similar to what was reported in this study. In the World report on violence and health, heavy drinking was reported as one of the factors that may influence occurrence of IPV . Husband drunkenness was also one of the factors associated with occurrence of IPV in a multi-country study done in nine different countries . Similarly, a report stated that the harmful use of alcohol influences both perpetration and experience of IPV. This they reported can occur in isolation or synergistically with other factors . In the study from Osogbo, partner alcohol use was reported as one of the predictors of IPV in WLWHA . This finding was also reported amongst WLWHA from studies conducted South Africa . Female smokers of cigarette or marijuana were also reported in this study to be eleven times at risk of experiencing IPV. This is very similar to what was reported in a study done in Ibadan Nigeria amongst female students where it was reported that there was a higher rate of IPV amongst students who were smokers than amongst those who were not smokers . This finding of an association between smoking and IPV was similar to what was reported in the study from South Africa amongst HIV positive pregnant women even though the South African study did not state the type of substance which was being abused by the partner which resulted in IPV amongst the women . Cigarette and marijuana use can influence the occurrence of IPV the same way alcohol does. Both agents lead to dependence and disinhibition which may alter the partners sensorium and lead to violent responses to provocation, responses which may not have occurred had the substances not been used. They can also affect the couple’s finances as people who abuse these may also have other substances they abuse for a prolonged high, substances which most times do not come cheap. Irritation from low finances or the partner requesting for money may lead to tension amongst them, tension that may degenerate to violence. Disinhibition from cigarette and marijuana smoking may also lead to having multiple sexual partners, a situation which may heighten tension amongst couples and may lead to violence. Relationship factors are factors peculiar to the relationship that influence occurrence of IPV [2, 22]. Earning/receiving more than one’s partner in a month was reported in this study to be one of the risk factors associated with IPV in female undergraduates. It was reported that female undergraduates who received/earned more than their partners monthly were at least twice at risk of experiencing IPV. Earning more than one’s partner in a patriarchal/male dominated society may lead to IPV as the men may not be comfortable with knowing their partners earn more than they do and are financially superior. This may lead to inferiority complex problems on the man’s part and tension build-up, tension which may eventually lead to violence. Also, if the man asks the woman for money or financial assistance and the woman refuses either because she genuinely does not have or she has but does not want to give, the man may feel insulted and may resort to violence to assert his masculinity over the woman. The urge to always be the alpha male/dominant partner in the relationship despite the earning disparity may lead to tension amongst the couples which may also be responsible for the violence that occurs in the relationship. This finding of an association between earning more than partner and IPV was congruent with findings from both Enugu and Ebonyi States . The study from Enugu reported that spouse unemployment was a factor associated with occurrence of IPV amongst pregnant women . This was also reported in the study from Abakaliki and Osogbo amongst pregnant women and WLWHA respectively [24, 25].
The major strength of this study is that the study is among the first studies in South Eastern region of Nigeria to explore IPV holistically amongst female undergraduates to the best of our search. Secondly, female undergraduates (fulltime, part-time and sandwich programs) from the 2 biggest universities (MOUAU and ABSU) with 4 different campuses located in different parts of Abia state were used for this study. This gives a very good representative spread of undergraduate respondents from different locations of Abia State improving the generalizability of this study. Finally, both online and physical questionnaires were used to reduce the possibility of selection bias and restricting respondents to only those with access to smart devices (phones and tablets) connected to the internet. A few limitations were observed in this study. IPV is a very sensitive issue and some people may be guarded about providing information on abuse and some may have recall bias of some events or not want to talk about it at all. Also, due to the cross-sectional design of this study, only associations of IPV could be tested for and this study was unable to determine causal relationships or describe temporal associations between some of the factors associated with experience of violence. Some of the above limitations were mitigated by assuring respondents of full confidentiality of their responses, advising them to fill the questionnaire (either online or physical) in a private space with little distractions, advising them in the introductory section of the questionnaire not to proceed if some of the questions may cause them any form of distress and providing the researchers contact for easy accessibility incase the respondent needed any form of psychosocial support or help with reporting recent or ongoing abuse.