Socio-cultural factors influencing intimate partner violence among school-going young women (15−24 years old) in Maputo-City (Mozambique)

Abstract

Although there is increased awareness about intimate partner violence (IPV) since the 2013 WHO report, providing solutions to address the problem remains a concern. According to the WHO (2020), research investigating factors underpinning IPV among young women remains of particular importance since the prevalence around the world is still escalating. Sub-Saharan Africa (SSA) carries the heaviest burden of intimate partner violence (36.6% of the global estimates). The burden is skewed toward young women aged 15−24 (19% to 66%) and is a public health concern (2, 5). Cultural and contextual geographical overlap of risk factors elevates the chances of early occurrence of IPV. Thus, the World Health Organization encourages integrated and contextual prevention programs to promote awareness and gender equality, targeting adolescents and young girls for effective interventions. However, the harmful social norms and the acceptance of the males’ dominant role in society perpetuates gender inequality to the detriment of females. Although the Mozambican constitution entrenches gender equality, these negative, harmful norms and the community acceptance of violence and male-dominant norms are upheld by society and place younger women in a subservient role and at increased risk of IPV (6-8). Cultural practices such as lobola, where the brides' families receive gifts and money, and in exchange, their daughter joins the husband’s family, were reported as promoting violence. The rationale for this is that some families do not allow their daughters to divorce when their partners abuse them because of the stigma and the fact that they would need to return the acquired lobola (8, 9). Although it is acceptable and normal for men to have more than one partner in some societies, this is likely to promote disharmony and lead to violence (6-8, 10-12). Further, with the current prevalence of epidemics such as HIV and other sexually transmitted infections, the risk of multiple sexual partners can affect the health outcomes of all women (13-15). IPV is deeply entrenched in cultural practices and decision-making processes. Men make all the decisions concerning their relationship and women’s sexual and reproductive health. Prevention programs have been mainly addressed towards adult and ever married or cohabiting women. There is no available data quantifying the burden of IPV and the prevalence and contextual factors influencing intimate partner violence among younger women in Mozambique. Thus, the prevention of IPV among this group is one of the main challenges regarding reducing the prevalence of IPV.

Purpose The study aimed to determine the prevalence and investigate the socio-cultural factors influencing IPV among younger school-going women in the KaMpfumu district, Maputo city.

Objectives • To conduct a scoping review of the evidence of socio-cultural factors influencing IPV among young women in SSA • To explore individual and socio-community factors influencing IPV among school-going young women in KaMfhumu district, Maputo city • To estimate the prevalence of physical, sexual and psychological violence among school-going young women in KaMfhumu district, Maputo city • To identify contextual risk factors associated with IPV among young women in KaMphumu district, Maputo city • To inform a model of a preventive intervention to target school-going young women in Maputo city

Methods The study, which used mixed methods, employed an exploratory sequential design using both qualitative and quantitative methods. It was underpinned by the Social-Ecological Theory (1), based on the evidence that a range of interactive factors at the individual, relationship, community, and societal levels explain the risk of IPV. Phase 1 was a scoping review study carried out to determine the extent to which studies on socio-cultural factors influencing IPV among young women (15−24 years) have been conducted. Further, it determined how well different geographic areas are represented and whether the methodologies used are sufficient to describe the prevalence and risk factors associated with IPV among young women in Sub-Saharan Africa. We used online databases to identify published studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines by Arksey and O’Malley were used to select studies, and primary studies were assessed using the Mixed Method Appraisal Tool, version 2011. Thematic content analysis was used to summarize the findings of the scoping review. Phase 2 of the study used an exploratory, descriptive qualitative study design. We used purposive sampling to enrol 66 participants. We held six focus group discussions, each comprising 10−12 female students in schools in the KaMpfumu district, to explore the study objectives. The data were analyzed using a thematic content analysis approach. Phase 3 was a cross-sectional study conducted among younger women aged 15−24 years attending schools in the KaMpfumu district, which used a questionnaire to investigate the study objectives. We used a probability proportional random sampling strategy to recruit participants. The data were collected using a self-administered questionnaire, informed by the exploratory study results and the combined questionnaire from the WHO Multi-country surveys of violence against women. Binary and multivariate logistic regression analyses were performed, investigating the association between IPV and the predictors. Odds ratio (OR) and 95% confidence interval (CI) were reported, and for statistically significant associations, p<0.05.

Results The scoping review results revealed that the majority of publications, 8 (61.5%), reported cross-sectional studies, while 4 (31.5%) were qualitative studies. Using a customized quality assessment instrument, 12 (92.3%) studies achieved a “high” quality ranking with a score of 100%, and 7.7% of the studies achieved an “average” quality ranking with a score of 75%. The scoping review results show that while the quality of the studies is generally high, research on socio-cultural factors influencing IPV among young women would benefit from a careful selection of methods and reference standards, including direct measures of the violence affecting young women. Prospective cohort studies are required linking early exposure with individual, community and societal factors and detailing the abuse experienced from childhood, adolescence and youth. The qualitative study results revealed four main themes that emerged from the data and included: 1) (Individual level), related to knowledge of young women about IPV through witnessing friends being physically abused by their partners, from friends sharing personal experiences of IPV and experiencing the accepting attitudes of their mothers toward IPV; The meanings that young women give to the occurrence of IPV viewed as a violation of the human rights of women; The alcohol use a contributing factor for IPV and the economic status of women leading to acceptance of IPV. 2) (Relationship level) related to the Influence of friends. 3) (Community level) related to religious beliefs that placed men at the head of the social order above women and 3) (societal level) related to factors promoting acceptance of IPV, and these included social acceptance of violence and the male chauvinism; The recommendations advocated by the young women to prevent IPV, and these included the promotion of awareness about IPV and the use of support services for the victims and the need to create specific IPV counselling centres for young women to meet their needs and to allow the counsellors to screen for other potential sexual and reproductive problems which affect young women. The quantitative results revealed that of the 413 participants, 248 (60%) (95% CI: 55.15-64.61) had experienced at least one form of IPV in their lifetime. This includes one act of psychological or sexual, or physical violence. Of the 293 participants who had had a partner in the previous 12 months, 186 (63.4%) (95% CI: 57.68-69.00) reported IPV in the 12 months before the data collection. Psychological violence was the predominant type of violence, with lifetime prevalence reported by 270 230 (55.7%) and over the previous 12 months, by 164 (55.9%) young women. The risk of IPV was associated with young women lacking religious commitment (AOR, 1.596, 95% 272 CI: 1.009–2.525, p=0.046) and if the head of the young women’s household was unemployed (AOR, 1.642 95% CI: 1.044–2.584, p=0.032).

Conclusion The prevalence of IPV in young women attending schools in Maputo is high. Those young women not committed to religion, young women whose head of the household was unemployed, young women with a much older and employed partner and young women’s beliefs about male superiority emerged as important socio-cultural factors influencing IPV in the study setting. The findings thus confirmed the contextual gaps that may hinder programs aimed at preventing IPV among younger women. The results highlighted socio-ecological factors that interact at the individual, community and societal levels in fostering IPV risk.

Recommendations This study highlights that the government’s policies to reduce IPV should incorporate the contextual socio-cultural factors that emerged, and interventions need to consider a multilevel approach. The educational sector should also develop comprehensive programs that integrate socio-economic empowerment strategies to increase young women’s autonomy to decide about their lives. There is also a need to address religious beliefs from their cultural perspectives in such programs and improve social interactions that promote violence-free relationships. Community development interventions to reduce IPV are required to ensure effective and supportive programs tackling gender-egalitarian norms, to safeguard the physical, sexual and emotional wellbeing of young women in Maputo city.