Semahegn et al. Reproductive Health           (2019) 16:93 
https://doi.org/10.1186/s12978-019-0726-5
REVIEW Open Access
Are interventions focused on gender-norms
effective in preventing domestic violence
against women in low and lower-middle
income countries? A systematic review and
meta-analysis
Agumasie Semahegn1,2* , Kwasi Torpey1, Abubakar Manu1, Nega Assefa2, Gezahegn Tesfaye2 and
Augustine Ankomah1,3
Abstract
Background: One in three women experience intimate partner violence worldwide, according to many primary
studies. However, systematic review and meta-analysis of intimate partner violence is very limited. Therefore, we set
to summarize the findings of existing primary studies to generate evidence for informed decisions to tackle domestic
violence against women in low and lower-middle income countries.
Methods: Studies were searched from main databases (Medline via PubMed, EMBASE, CINAHL, PopLine and Web of
Science), Google scholar and other relevant sources using electronic and manual techniques. Published and
unpublished studies written in English and conducted among women aged (15–49 years) from 1994 to 2017 were
eligible. Data were extracted independently by two authors, and recorded in Microsoft Excel sheet. Heterogeneity
between included studies was assessed using I2, and publication bias was explored using visual inspection of funnel
plot. Statistical analysis was carried out to determine the pooled prevalence using Comprehensive Meta-Analysis
software. In addition, sub-group analysis was carried out by study-setting and types of intimate partner violence.
Results: Fifty two studies were included in the systematic review. Of these, 33 studies were included in the meta-analysis.
The pooled prevalence of lifetime intimate partner violence was 55% (95% CI: 52, 59%). Of these, main categories were
lifetime physical violence [39% (95% CI: 33, 45%); psychological violence [45% (95% CI: 40, 52%)] and sexual violence [20%
(95% CI: 17, 23%)]. Furthermore, the pooled prevalence of current intimate partner violence was 38% (95% CI: 34, 43%). Of
these, physical violence [25% (95% CI: 21, 28%)]; psychological violence [30% (95% CI: 24, 36%)] and sexual violence [7.0%
(95% CI: 6.6, 7.5%)] were the pooled prevalence for the major types of intimate partner violence. In addition, concurrent
intimate partner violence was 13% (95% CI: 12, 15%). Individual, relationship, community and societal level factors were
associated with intimate partner violence. Traditional community gender-norm transformation, stakeholders’ engagement,
women’s empowerment, intervention integration and policy/legal framework were highly recommended interventions to
prevent intimate partner violence.
(Continued on next page)
* Correspondence: agucell@yahoo.com
1Department of Population, Family and Reproductive Health, School of
Public Health, College of Health Science, University of Ghana, Legon, Accra,
Ghana
2College of Health and Medical Sciences, Haramaya University, Po. Box 235,
Harar, Ethiopia
Full list of author information is available at the end of the article
© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 2 of 31
(Continued from previous page)
Conclusion: Lifetime and current intimate partner violence is common and unacceptably high. Therefore, concerned
bodies will need to design and implement strategies to transform traditional gender norms, engage stakeholders,
empower women and integrate service to prevent violence against women.
Protocol registration: PROSPERO: 2017: CRD42017079977.
Keywords: Domestic violence against women, Systematic review, Meta-analysis
Plain English summary than the cumulative problem of cancer, road traffic acci-
Domestic violence against women (VAW) is a well-re- dents and malaria which are massive threat and an uncon-
cognized public health concern and systematic human trollable public health challenge for the upcoming
rights violation. It has a serious negative impact on generation [4]. VAW is sturdily interconnected with gen-
women’s lives. Domestic VAW is common and still un- der inequality that affects women’s negotiation ability
acceptably high in different parts of the world as ob- about reproductive health and related issues [5–7]. The
served from several primary studies which have been expenses associated with VAW has been estimated to be
conducted on the frequency and its associated factors. 3.7% of the countries’ gross domestic product, which is al-
Additionally, some interventional studies have been con- most comparable with what several countries devote on
ducted in some parts of the world revealed that gender- primary education [8]. Yet, it has been considered exclu-
norms transformation through behavioral change and sively as private matter and negligible issue by the govern-
communication focused program can promote gender- ments’ of various countries, hence not perceived as a
equality norm and avert domestic VAW. Summarized or crime [4, 5, 9].
synthesized evidence is still needed to inform and per- Global and regional commitment to fighting domestic
suade policy makers and stakeholders, so they can take VAW is reflected in various international statues. For ex-
an evidence based decision making approach. One of the ample, the United Nations aims to build an enabling
most challenging issue is that most countries’ govern- household situation in improving women’s right, their
ments have considered VAW as a minor and socially political participation, economic empowerment and
tricky issue. There is some ambiguity as to whether safety [10]. In addition, provision of comprehensive and
VAW is a private or public matter. This systematic re- universal access to sexual and reproductive health care
view and meta-analysis aimed at summarizing existing has been a strategy to avert domestic VAW in the
primary study findings to determine its level and associ- Maputo Plan of Action (2016-2030) [11]. Further, re-
ated factors, identify effective interventions to prevent search evidence has revealed that women empowerment
domestic VAW and make key recommendations. The and community mobilization are the most recom-
purpose is to contribute evidence to be used by program mended interventions to minimize the expenses associ-
planners, policy makers, clinicians and other stake- ated with VAW and its consequences [12]. The problem
holders to make an informed decision on the issue of of domestic VAW is caused and exacerbated by poverty,
domestic VAW. The study showed that more than half alcohol consumption and societal receptive attitude to-
of the women experienced VAW, and almost one-third wards inequitable gender-norms, which has been exhib-
of the women have experienced current VAW. Interven- ited through denying access to education; lack of
tion strategies should focus on traditional gender role autonomy and justifying wife-beating by fellow women
transformation to minimize the relationship power-gap [9, 13–20].
and prevent VAW. Furthermore, women’s experience of domestic violence
is significantly associated with several and multiple poor
Background physical and mental health outcomes [1, 9, 14, 17, 21–
Globally, VAW is a well-recognized public health problem 27]. Likewise, VAW has been associated with various
and a gross pervasive violation of human rights. About poor reproductive health conditions such as HIV, unin-
35% of women experience VAW [1, 2], and almost tended pregnancy and unsafe abortion [1, 4, 7, 9, 15–18,
two-third of women murders are committed by their in- 20, 25, 28–41]. Therefore, VAW needs a comprehensive
timate partners every year. About five percent of the approaches to empower women economically, trans-
women’s total health years loss has been attributed by do- form traditional gender-norms in improving their com-
mestic VAW which is also exacerbated by authority in- munication and negotiation skills [9, 17, 42]. There is a
equity in relationship [3, 4]. Additionally, VAW causes ill paucity of summarized evidence on; the level of domes-
health and its associated devastating outcome are more tic VAW, its associated factors, proven evidence on the
Semahegn et al. Reproductive Health           (2019) 16:93 Page 3 of 31
technical approach and key research recommendations domestic VAW as well as effective interventions and key
in low and lower-middle income countries (LLMICs). recommendations to prevent VAW. In addition, published
However, many primary studies have been conducted in and unpublished studies that have been conducted on
LLMICs. The main purpose of this systematic review women (15–49 years) in LLMICs to assess VAW and were
and meta-analysis was to summarize existing primary written in English (1994–2017) were eligible for the sys-
studies in LLMICs to determine the prevalence of do- tematic review. The LLMICs were selected based on the
mestic VAW and its associated factors; to identify effect- World Bank’s country classification [45]. Case series, edi-
ive and proven interventions and make key torials, commentaries, life stories and fact sheet reports on
recommendations. It will provide an insight to policy VAW were excluded.
makers, program planners, clinicians, researchers and
other stakeholders to make an informed decisions on is- Selection of studies
sues related to VAW. Studies were selected using eligibility criteria and screened
through four steps for the systematic review and meta-
Review question(s) analysis. Initially, studies were screened and selected for
subsequent evaluation based on their titles and abstracts,

 What was the level of domestic VAW in LLMICs? that is, if studies clearly reported on domestic VAW and

 What were the factors associated with domestic its associated factors. Secondly, the two authors (AS and
VAW in LLMICs? GT) independently screened the studies’ abstract section

 What were the research evidence that should (aims, methods, results and conclusion) to proceed to the
translate into routine action in LLMICs? next step. Studies whose abstract section briefly reported

 What were the studies’ key recommendations on the the prevalence of domestic VAW and its associated factors
prevention of domestic VAW in LLMICs? were included in the next evaluation process. Thirdly,
studies selected by abstract screening were re-assessed
Method development and protocol registration independently by authors (AS and GT) with focus on the
The protocol for the systematic review and meta-analysis has full-text. Eventually, selected studies were appraised for
been registered in the International Prospective Register of final inclusion in the systematic review and meta-analysis.
Systematic Reviews (PROSPERO) (ID: CRD42017079977). In cases where the authors could not reach a consensus
This systematic review and meta-analysis methods was on studies, a third person was involved to appraise using
written according to the preferred reporting items for same checklist, in the hope of helping to make a final
systematic review and meta-analysis (PRISMA) guide- decision. The studies selection process adhered to the
line [43]. The filled PRISMA checklist is attached as PRISMA flow diagram [43] (Fig. 1).
Additional file 1.
Measurement of outcomes and exposures
Searching methods and identifications of studies The two phrases [domestic violence and intimate part-
Studies were searched using medical subject headings ner violence (IPV)] were interchangeably used as an out-
(MeSHs), manual and email methods. Main electronic come variable in this systematic review process. The
databases [Medline via PubMed, EMBASE, CINAHL, outcome was assessed based on the prevalence of
PopLine and Web of Science], direct Google search and domestic/intimate partner VAW (psychological, physical,
other relevant sources were used to access studies before sexual and concurrent). IPV was presented in two forms
December 31st, 2017. In addition, emails were sent to (lifetime versus current). The lifetime IPV was assessed
authors whose studies were included to request studies. using the studies’ report of women’s experience of IPV
In addition, relevant citations from retrieved studies during their lifetime. Furthermore, women’s experience
were searched. Search strings were constructed using of IPV over the last 12 months preceding the survey was
keywords and their combinations based on the review labeled as current IPV. Exposure variables were clas-
questions. However, search strings were modified to suit sified according to the ecological model (individual,
to the databases interface accordingly. The overall detail relationship, community and societal level factors).
of the search strategies are presented as Additional file
2: 2-1 to 2-4. The overall search results were exported to Quality assurance of the systematic review
the Endnote citation manager software [44], and dupli- Published and unpublished studies were searched for
cate studies were removed. and considered for this systematic review to minimize
publication bias. The electronic, manual and email
Eligibility criteria and type of studies included search strategies were carried out to ensure comprehen-
Observational and interventional studies were eligible to sive retrieval of studies from main databases and other
determine the level of, and factors associated with relevant sources. Eligibility, quality assessment criteria,
Semahegn et al. Reproductive Health           (2019) 16:93 Page 4 of 31
Fig. 1 Diagramatic presentation of the selection process of studies for systeamtic review
selection process and data extraction templates were studies characteristics description are presented on
properly designed by the authors to assure quality. tables [see Tables 1 and 2]. Two authors (AS and GT)
Methodological quality assessment of the studies was abstracted the data from selected studies and labeled the
carried out using the Joanna Briggs Institute (JBI) critical data extraction template using Microsoft Excel sheet.
appraisal checklist for observational studies [46], for Quantitative data, number of women who had expe-
more detail of the critical appraisal is presented as rienced VAW (labeled = Yes), who had not experienced
Additional file 3. The authors (AS and GT) per- VAW (labeled = No) and total participants (n) were
formed the selection of studies and data abstractions. separately recorded in a Microsoft Excel sheet. The more
Any disagreements were resolved through consensus, detail of abstracted data is stored in Excel Sheet (see
and sometimes, other authors who were not involved Additional file 5).
in data extraction adjudicated to make final decision.
Potential publication biases were explored using the
funnel plot. Detail of funnel plots for each outcome Data synthesis
variables is included as Additional file 4: 4-1. Hetero- The pooled estimate of domestic VAW was computed
geneity between included studies was assessed using I2. using the Comprehensive Meta-Analysis (CMA) soft-
Sub-group analysis, random effects model and qualitative ware [91]. Substantial heterogeneity was assumed to
narration were carried out to minimize the risk of bias. In be I2 (> 75%) [92, 93]. Potential publication bias was
addition, the risk of bias (ROB) for interventional studies checked through visual assessment of the funnel plot
was assessed. The detail of the risk of bias assessment is [94, 95]. The random effects model [96] was used to
attached as Additional file 4: 4-2. moderate the sample size variation which might have
had an influence on the pooled estimate. In addition,
Study description and data extraction sub-group meta-analysis was performed by study set-
The studies’ characteristics (authors-date, study area/ tings and types of domestic VAW (lifetime, current,
country), its aims, designs, sample size, sampling pro- psychological, physical and sexual violence). Further-
cedure, response rate, key findings and recommen- more, the associated factors with VAW were qualita-
dations are described on a template. More details of the tively synthesized according to the ecological framework
Semahegn et al. Reproductive Health           (2019) 16:93 Page 5 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Sapkota et al. 2016, To estimate the magnitude Cross-sectional Married women Systematic 355 NR The prevalence of lifetime Domestic/ IPV is still rampant
Nepal [47] of different forms of domestic (15–49 years) random and current physical IPV in the society with several
violence and identify its sampling were 29.6 and 15.2%, forms. Differentials power in
associated factors respectively. While sexual relationship and poor mental
IPV was 6.8 and 2.3%, and health was found to be
psychological IPV was 31.0 positively associated with
and 18.3%. The overall violent episodes.
lifetime and current IPV
were 38.6 and 23.1%.,
respectively. Furthermore,
concurrent IPV was12.4%.
Husband’s controlling
behavior and having poor
mental health were found
to be at higher risk of IPV.
Fikree F. et al., 2006, To assess the magnitude and Cross-sectional Pregnant Systematic 300 NR Women’s lifetime physical Almost one million Pakistani
Pakistan [48] determinants of IPV before women sampling and sexual IPV were 44 and women are physically abused
and during pregnancy (15–49 years) 36%, respectively. Women at least once in lifetime. RH
who were ever physically stakeholders should be
abused and all reported encouraged to advocate for
verbal abuse. Wife’s education domestic violence screening
and duration of marriage
were significantly associated
to violence. 55% of the
women believed that
antenatal care clinics were
a good time to enquire
about IPV.
Semahegn et al., 2013. To determine magnitude of Cross-sectional married women Systematic 682 100% The prevalence of DVAW Awareness creation to avoid
Ethiopia [49] domestic violence and identify (15–49 years) sampling was 78.0%. Psychological, traditional gender norm, and
its predictors physical and sexual violence support wife via integrating
were 73.3, 58.4 and 49.1%, with community health
respectively. Husband program.
alcohol consumption,
being pregnant, low decision
making power and annual
income were predictors of
domestic violence
Ali et al., 2014. To investigate level and Cross-sectional Women Multistage 1009 The prevalence of physical, The prevalence of domestic
Sudan [50] factors associated with VAW (15–49 years) sampling psychological and sexual VAW is high in eastern Sudan.
violence was 33.5, 30.1 and
47.6%. Husband education,
polygamous marriage, and
alcohol consumption were
significantly associate factors.
Hayati et al. 2011, To examine associations Longitudinal Women Random 765 NR Lifetime exposure to sexual Women who did not support
Indonesia [51] between IPV and husbands, (15–49 years) sampling and physical IPV were 22 the right of women to refuse
psychosocial, behavior, and 11%. Sexual IPV was sex were more likely to
Semahegn et al. Reproductive Health           (2019) 16:93 Page 6 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
attitudes and gender roles associated with husbands’ experience physical IPV.
age (less than 35 years and Those who justified wife-
educated less than 9 years). beating were more likely to
Exposure to physical violence experience sexual IPV.
was strongly associated with Women’s risk of IPV is due to
husbands’ being unfaithful, traditional gender-norms.
using alcohol, fighting, having
childhood witnessed and the
attitudes and norms
expressed by the women
confirm that unequal gender
relationships.
Doku and Asante, investigates factors that Longitudinal Women Two stage 10,607 NR IPV was 39%. Women aged Interventions and policies
2015. Ghana [52] influence women approval survey (15–49 years) sampling (< 34 years) were more likely should be geared at
of domestic physical violence to approve physical IPV than contextualizing intimate
aged 35 years and above. partner violence in terms of
Women with no education the justification of this
(OR = 3.1, CI:2.4–3.9), primary behavior, as this can play
education (OR = 2.6, CI:2.1–3.3) an important role in
and secondary education perpetration and
(OR = 1.8, CI:1.4–2.2) had victimization.
higher risk to physical IPV
than women who had secondary
education or higher. Women
belonging Muslims (OR = 1.5,
CI:1.3–1.8) and traditional
believer (OR = 1.7, CI:1.2–2.4)
were more likely to physical
VAW. Women in the richest,
rich and middle wealth index
were less likely to physical
VAW of wives compared to
the poorest.
Dalal K et al., 2014, To examines the associated Cross-sectional Women Multistage 4210 NR IPV was 32.4%. Emotional, The findings have immense
Nepal [53] factors at various level of the (15–49 years) sampling physical and sexual IPV were policy importance as a
victims of IPVAW 17.5, 23.4 and 14.7%, respectively. nationally representative
Joint decision making for study and indicating
contraception, husband’s necessity of more gender
non-controlling behavior and equality.
friendly feelings were
emerged as less likely to
be IPV.
Sambisa W. et al., 2011 explored the prevalence and a population- Women multi-stage 9122 The current physical IPV was Physical IPV in urban
Bangladesh [54] correlates of past-year based survey (15–49 years) cluster sampling 31%. The risk of physical IPV Bangladesh demonstrating
physical VAW was lower among older the seriousness of
women, women with post- multifaceted phenomenon
primary education and as a social and public health
belonging to rich households issue that needs a
Semahegn et al. Reproductive Health           (2019) 16:93 Page 7 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
and women whose husband comprehensive intervention
considered their opinion in strategies.
decision-making. Women
were at higher risk of abuse
if they lived in slums, had
many children and approved
wife beating norms.
Abate et al. 2016. To assess the prevalence and Cross-sectional women Simple 282 94.3 The prevalence of IPV was Increasing community
Ethiopia [27] associated factors of IPV (15–49 years) random 44.5%. More than half (55.5%) awareness about the
during recent pregnancy sampling experienced all three forms consequences of the practice
of IPV. The joint occurrence could be important through
of IPV was 56.5%. Dowry community health workers.
payment decreases IPV
(AOR 0.09, 95% CI 0.04, 0.2)
and pregnant women whose
marriage didn’t undergo
marriage ceremony were 79%
were less likely to experience
IPV (AOR 0.21, 95% CI: 0.1, 0.44).
Rapp et al., 2012, To investigate the association Population based Married women Multi stage 69,805 NR IPV was 52.1% in Bangladesh Further research should be
Bangladesh & India between spousal education surveys (DHS) (15–49 years) random and 69.7% in India. Wives done to reveal unknown
DHS [55] gap and domestic violence sampling with higher education than determinants so that suitable
their husband were less likely interventions to reduce DV
experience violence as can be developed
compared with equal or less
education. Equally high
educated couples raveled the
lowest likelihood of
experiencing domestic violence.
Dhakal L et al., 2014. To examine the relationships Cross-sectional Women Two stage 3114 NR Approximately 15% of married IPV was common issue.
Nepal [14] between IPV and STIs DHS survey (15–49 years) stratified cluster women experienced some Integration of IPV prevention
sampling form of IPV. The odds of and RH programs is needed
getting STI were 1.88 [95% to reduce the burden of STIs.
CI:1.29, 2.73] times higher
among women exposed to
any form of IPV in compared
to women not exposed to
any form of IPV
Rahman M, 2015. To assess the association Population based Married A stratified, 1875 NR The experience of IPV was Prevention of IPV which was
Bangladeshi [38] between IPV and TOP among survey (DHS) pregnant multistage 31.4%. The experience of associated with pregnancy
married women women cluster sample sexual and physical IPV termination may reduce the
(15–49 years) were 13.4 and 25.8%, respectively. high incidence of termination
Physical IPV was significantly of pregnancies in Bangladesh.
associated with both TOP
ever (OR = 1.36; 95%
CI: 1.05–1.77) and TOP in last
5 years (OR = 1.72; 95%
CI: 1.11–2.06).
Semahegn et al. Reproductive Health           (2019) 16:93 Page 8 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Tumwesigye et al. To assess the pattern and (UDHS 2006) Women Two stage 1743 99.7% Physical IPV was 48%. Women IPV preventive measure
2012 Uganda [56] levels of PIPVAW and its (15–49 years) cluster whose partner got drunk should address reduction of
associated factors systematic often were 6 times more drinking among men,
sampling likely report PIPV (95% CI: 4.6, empowerment of women
8.3) as compared with never via education, employment
drunk. The higher the education and increased income.
level of women the less
likelihood of experience of IPV.
Yigzaw T et al., 2004. To assess the prevalence Cross-sectional Women Systematic 1104 NR IPV was 50.8%. Physical IPV is highly prevalent. Its
Ethiopia [25] of domestic violence and (15–49 years) sampling violence was found to be prevention should be
associated factors 32.2%, while that of forced comprehensive and multi-
sex and physical intimidation faceted. Women prefer
amounted to 19.2 and 35.7%, educational approach to
respectively. Exposure to minimize IPV through IEC,
parental violence as a girl was empowerment and legal
the strongest risk factor for reform.
being victim of violence later
in life while alcohol
consumption was the major
attribute of IPV.
Delamou et al., 2015, To describe the prevalence cross-sectional Women All women who 232 NR Lifetime, IPV was 92%. Where, A holistic approach that
Guinea [57] and correlates of IPV Family study (15–49 years) attend the clinic psychological, sexual and includes promotion of
Planning users physical IPV were 79.3, 68.1 women’s rights and gender
and 48.4%, respectively. Joint equality, existence of laws
occurrence IPV was 24%. IPV and policies is needed to
was higher in women with prevent and respond to IPV.
secondary level of education
than higher level of education
(AOR: 8.4; 95% CI 1.2–58.5).
Kabir Z et al., 2014 To investigate the association Longitudinal Women Convenient 660 NR Prevalence of physical, sexual It is important to screen for
Bangladeshi [58] between IPV and maternal study (15–49 years) and emotional IPV were both IPV and depressive
depression 52, 65 and 84%, respectively. symptoms during pregnancy
The husband’s education and postpartum.
(OR: 0.41, CI: 0.230.73) and a
poor relationship with the
husband (OR: 2.64, CI: 1.076.54)
were significantly associated
with IPVAW.
Kazaura et al., 2016. To determine the magnitude Cross section Women Systematic 471 NR The lifetime IPV was 65% with IPV towards women was
Tanzania [59] of IPV and associated factors (15–49 years) sampling 34, 18 and 21% reporting high. Based on hypothesis
current emotional, physical of IPV and HIV co-existence,
and sexual violence, respectively. there should be strategies
The prevalence of women to address the problem of
perpetration to physical IPV IPV especially among women
was above 10% regardless to
their exposure to emotional,
physical or sexual IPV.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 9 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Kouyoumdjian To identify risk factors for IPV Rakai community Women Cluster 15,081 NR Lifetime and current IPV were These findings are useful for
et al.2013, in women of the reproductive Cohort (2000–2009) (15–49 years) sampling 49.8 and 29.0%, respectively. the development of
Uganda [60] age in Rakai district of Uganda The risk of IPV associated with prevention strategies to
sexual abuse during young prevent and mitigate IPV
age, early age of first sex, in women.
lower level of education,
forced first sex, relationship
of short duration, having
partner of same age or
younger, alcohol use and
thinking that violence is
acceptable.
Rahman et al. 2012, To explore the association DHS, 2007 Married women multi-stage 2001 NR Physical IPV was 48%. Sexual There is an association
Bangladeshi [41] between IPV and use of (15–49 years) cluster IPV violence was 18.7, and between exposure to IPV
RH care sampling 14.1% was experienced both and lower use of
physical and sexual IPV. reproductive health care
Maternal experience of IPV services
was associated with low use
of receiving sufficient ANC.
Deyessa N. et al., To explore VAW in a Cross-sectional Women simple 1994 NR Women had beliefs and norms Semi-urban lifestyle and
2010 Ethiopia [61] low-income setting (15–49 years) random favoring VAW, living in rural literacy promote changes
sampling and illiterate women were in attitudes and norms
more likely to experience against IPV.
VAW. Literate rural women
who were married to an
illiterate spouse had the
highest odds of IPV
(AOR, 3.4; 95% CI: 1.76.9).
Karamagi et al., 2006. To determine prevalence Cross-sectional Women Cluster 457 NR The life time and current IPV IPV is linked with gender
Uganda [62] of IPV and identify risk factors (15–49 years) survey were 54 and 14%, respectively. inequality, alcohol, poverty
method Women having higher and multiple sexual partner.
education and satisfied Programs for the prevention
marriage were associated of IPV need to target these
with low risk of IPV, while underlying factors.
alcohol consumption, rural
residence and husband
having multiple sexual partner
were associated with high
risk of IP.
Das et al.2013 To describe the level of IPV Cross sectional Women 2139 NR The prevalence of IPV was The element of violence are
India [63] and its social determinants (15–49 years 15% in which physical, sexual mutually reinforcing and
and psychological IPV were need to be taken into
12, 2 and 8%, respectively. account collectively and
Almost one- third (35%) of framing public health
IPV was justifiable. The initiatives.
experience of IPV was associated
with poorer families and
husband alcohol use.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 10 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Burgos-Soto J. et al., To describe the effect of IPV Cross-sectional Women Systematic 454 NR Lifetime physical and sexual IPV screening should be
2014. Togo [35] on care-seeking behaviors (15–49 years) sampling IPV among HIV-infected carried out at health-care
of women women were significantly settings. Couple-oriented HIV
higher than among uninfected prevention interventions and
women (63.1 vs. 39.3% and couple dynamics in terms
69.7 vs. 35.3%). IPV was strongly of IPV is needed.
associated with male partner
multi-partnership, early start
of sexual life and gender
submissive attitudes.
Yimer T. et al., 2014. To assess the magnitude of Cross-sectional Women multistage 425 97.9% IPV was 32.2%. Psychological, Domestic violence during
Ethiopia [64] domestic violence and its (15–49 years) sampling sexual, and physical IPV were current pregnancy is high
associated factors among 24.9, 14.8, and 11.3%, which may lead to a serious
pregnant women respectively. Married women health consequence both
(≤15 years) (AOR, 4.2,95% on the mothers and on their
CI;1.9–9.0); childhood witness fetus.
(AOR = 2.3,95%CI;1.1–4.8),
having drinker partner
(AOR = 3.4, 95% CI 1.6–7.4),
and undesired pregnancy by
partner (AOR = 6.2, 95%
CI 3.2–12.1) were the main
significant factors.
Dalal K et al., 2013. to examine the associations Cross-sectional Married women 4465 NR Physical IPV was 48%. For Microfinance plans are
Bangladeshi [65] between microfinance (15–49 years). women with secondary or associated with an increased
programme membership higher education, and women exposure to IPV among
and IPV at the two wealthiest levels educated and empowered
of the wealth index, microfinance women.
programmes membership
increased the exposure to IPV.
Educated women who were
more equal with their spouses
in their family relationships in
decision-making increased
their exposure to IPV.
Eme T Owoaj et al., To determine the prevalence Cross-sectional Women cluster 924 98.6% The prevalence of lifetime Community based IPV
2012, Nigeria [66] of physical violence and the (15–49 years) sampling experience of physical IPV prevention programmes
factors predisposing women was 28.2%. The significant targeted at breaking the
in a low-income community predictors for physical IPV cycle of abuse, transforming
were previous experience of gender norms which
psychological abuse support IPV and reducing
(aOR: 4.71; 95% CI: 3.23–6.85); alcohol consumption
sexual abuse (aOR: 5.18; should be developed
3.21–8.36); having attitudes
supportive of IPV (aOR: 1.75;
1.2–2.4); partner’s daily alcohol
consumption (aOR: 2.85;
1.50–5.41); and previous
Semahegn et al. Reproductive Health           (2019) 16:93 Page 11 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
engagement in a physical
fight (aOR: 3.49; 1.87–6.50).
Laisser et al. 2011. To explore community Ground theory/ Community Purposive 75 NR Moving from frustration to Raising of the human rights
Tanzania [67] members’ understanding and qualitative study members sampling inquiring traditional gender perspective, as well as
their responses to IPV. norms that denoted a actively engaging men,
community in transition re-enforcement of legal
where the effects of IPV had rights, and provision of
started to fuel a wish for adequate medical and
change. Justified as part of social welfare services.
male prestige illustrates how
masculinity prevails to justify
violence. Results in “emotional
entrapment” shows the
shame and self-blame that is
often the result of a violent
relationship.
Deribe K et al., 2012 to assess the magnitude of Cross-sectional Women Systematic 845 100% The lifetime prevalence of Physical and sexual VAW is
(Ethiopia) [68] IPV in Southwest Ethiopia in (15–49 years) sampling sexual or physical IPV, or both common. Interventions
predominantly rural community was 64.7%. The lifetime sexual targeting controlling men
and physical violence were might help in reducing IPV.
50.1 and 41.1%, respectively.
41.5% of women experienced
physical and sexual IPV
concurrently, in the past year.
Men who were controlling
were more likely to be violent
against their partner.
Antai and Adaji, To examine the role of cross-sectional Women Multistage 19,226 IPV was 22% (physical, sexual Further research
2012. Nigeria [40] community-level norms and study (15-49 years) cluster and emotional IPV were 15, 3 recommended on IPV
association between IPV sampling and 14%, respectively). IPV screening on pregnancy
and TOP types were significantly terminated site.
associated with factors
reflecting relationship
control, relationship inequalities,
and educational level, justified
wife beating, age of first
marriage, and contraceptive use.
Kapiga et al.2017 known about the prevalence Cross sectional Women Random 1021 97.3% Lifetime and current IPV were The high prevalence of IPV
Tanzania [69] of this type of behavior and (baseline for (15–49 years sampling 61 and 27%, respectively. and its strong links with
other related abuses in Tanzania RESPECT RCT study) Lifetime economic abuse and symptoms of poor mental
current emotional abuse were health underline the urgent
34 and 39%, respectively. Age need for developing and
and socio-economic status, testing appropriate
physical violence (OR = 1.8; interventions to tackle both
95% CI: 1.3–2.7) and sexual IPV and abusive behaviors.
violence (OR = 2.8; 95% CI:
1.9–4.1) were associated with
increased poor mental health.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 12 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Feseha et al.2012. to assess the magnitude of Cross-sectional Women Simple 422 100% The current physical IPV and Physical IPV is serious
Ethiopia [70] intimate partner physical (15–49 years) random lifetime were 25.5 and 31.0%, problem among women.
violence and associated factors. sampling respectively. Significant risk Multifaceted interventions
factors associated with such as male counseling,
experiencing physical IPV increasing awareness on
were being a farmer (AOR, the consequences of IPV
3.0, 95%CI: 1.7, 5.5), knowing and the effect of substance
women in neighborhood use like alcohol will help
whose husband to beat them to reduce IPV.
(AOR, 1.87, 95%CI: 1.0, 3.5),
Muslim (AOR, 2.4, 95%C.I:
1.107, 5.5), and having a
drunkard partner (AOR = 2.1,
95%C.I:1.0, 4.5).
Osinde et al., 2011. To assess the prevalence and Cross-sectional Women Simple SRS 317 NR The prevalence of lifetime Most of HIV positive
Uganda [71] factors associated with IPV (15–49 years) and current IPV were 36.6 women experienced IPV.
among HIV infected women and 29.3%, respectively. The Likewise, women who were
attending HIV care in Kabale prevalence physical and sexual taking antiretroviral drugs
Hospital, Uganda. were 17.6 and 12.1%, for HIV treatment were
respectively. There was a more likely to report any
significant but inverse type of IPV. The implication
association between education of these findings is that
level and physical IPV (ARR, women living with HIV
0.50, 95% CI: 0.31–0.82), and especially those on
sexual/psychological IPV antiretroviral drugs should
(ARR, 0.47; 95%CI: 0.25–0.87). be routinely screened for IPV.
Likewise, there was a significant
inverse association between
education level of the spouse
and IPV (ARR, 0.57, 95%
CI 0.25–0.90). Use of ART was
associated with any type of
IPV (ARR 3.0. 95%CI 1.2–8.5).
Yigzaw T et al. 2010. To assess community Qualitative Key informant Purposive 46 NR The normative expectation There is insufficient
Ethiopia [72] perceptions and attitude that conflicts are inevitable in understanding of VAW and
towards violence against marriage makes it difficult for many people hold a
women by their spouses society to reject violence. non-disapproving stance
Methods Acts of VAW represent regarding violence against
unacceptable behavior women by their spouses
according to existing social calling for a culturally
and gender norms when sensitive information,
there is no justification for the education and
act and the act causes severe communication intervention.
harm. There is considerable
permissiveness of violent acts.
Marital rape is not understood
well and there is less
willingness to condemn it.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 13 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Uthman OA, et al., To develop and test a model Cross-sectional Women Stratified 8731 NR Physical, sexual and emotional Public health interventions
2011. Nigeria [73] of individual- and community- study (NDHS 2008) (15–49 years) multistage IPV were 10.4, 2.3 and 14.3%, designed to reduce IPVAW
level factors of IPV cluster respectively. Childhood must address people and
sampling witnessed, tolerant attitudes the communities’ tolerant
towards IPV and women with attitude in which they live
tolerant attitudes and in order to be successful.
community with tolerant
attitudes were more likely
to have reported IPV.
Bamiwuye and To examine whether women Cross-sectional Women Multistage 38,426 NR The six SSA countries IPV was Experience of violence cuts
Odimegwu, 2014, 6 from poor households are studies (DHSs) (15–49 years) cluster 40.5%. Physical, sexual or across all household
SSA countries [74] more likely to experience samplings emotional) ranges from 30.5% poverty-wealth statuses
violence from husband than in Nigeria, 43.4% in Zimbabwe, and therefore may not
other women who are from 45.3% in Kenya, 45.5% in provide enough explanation
middle or rich households. Mozambique, 53.9% in Zambia on whether household
and 57.6 in Cameron. The two poverty necessarily serve
countries (Zambia and to facilitate the ending of
Mozambique); the experience violence. These results
of violence is significantly suggest that eliminating
higher among women from VAW in SSA requires a
non-poor (rich) than comprehensive approach
(poor and middle). Other two rather than addressing
countries (Zimbabwe and household poverty-wealth
Kenya); women from poor alone.
households are more likely to
have ever experienced IPV
than those from non-poor
households.
Abeya et al., 2012. To explore the community Cross-sectional Women and Purposefully 115 NR Most discussants perceived, More efforts are needed
Ethiopia [75] attitude, strategies women’s men (FGDs) IPV is accepted in the to dispel myths,
suggested measures to community in circumstance misconceptions, traditional
stop VAW of practicing extra marital sex norms and beliefs of the
and suspected infidelity. The community. There is a
suggested measures for need of amending and
stopping or reducing women’s enforcing the existing laws
violence focused on provision and formulating the news
of education for raising policy.
awareness at all level using a
variety of approaches
targeting different stakeholders.
Bazargan-Hejazia et al., To examine the lifetime Cross-sectional Women two-stage 8291 NR The prevalence of emotional, The prevalence of different
2013. Malawi [76] prevalence of different types (15–49 years) systematic physical and sexual IPV were types of IPV in Malawi
of IPV and its association with sampling 13, 20 and 13%, respectively. appears slightly lower than
age, education, and residence Women (15–19 years) were that reported for other
significantly less likely countries in SSA. Further
emotional IPV, women (25–29) studies are needed to
were significantly more likely assess the attitudes and
to report being physically behaviors of Malawi women
Semahegn et al. Reproductive Health           (2019) 16:93 Page 14 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
abused (OR 1.35; CI: 1.05–1.73), towards acceptability and
and women (30–34) were justification of IPV as well
significantly more likely sexual as their willingness to
IPV, compared to women disclose it.
(45–49) (OR 1.40; CI: 1.03–1.90).
Women who had no ability
to read were less likely to
report sexual IPV than their
counterparts who could read
a full sentence (OR 0.76;
CI: 0.66–0.87).
Zacarias et al.2012 To examine the occurrence, Cross-sectional Women Consecutive 1442 96.1% The overall IPV during the Controlling behaviors over
Mozambique [77] severity, chronicity and (15–49 years) case past 12 months was 70.2%. partner, co-occurring
predictors of IPV Physical, psychological and victimization and childhood
sexual violence were the abuse were more
common IPV in Mozambique. important factors.
Almost one fourth of women
experienced combination of
the three type of IPV.
Meekers et al., 2013, To examine the relationship Cross-sectional Women Multistage 10,119 NR Life time physical and It showed that mental
Bolvia [78] between IPV and mental health survey (15–49 years) sampling psychological IPV were 71.7 health service is need for
and 42.4%, respectively. victims of IPV.
Current IPV was 47%. Of these,
physical, psychological and
sexual IPV were 19.2, 21.1 and
6.9%, respectively.
Abeya et al., 2011. To investigate the prevalence, Cross-sectional Women Multistage 1540 96.3 Lifetime, current and concurrent Three out of four women
Ethiopia [79] patterns and associated (15–49 years) systematic IPV were 76.5, 72.5 and 56.9%, experienced at least one
factors of intimate partner sampling respectively. Rural residents incident of IPV in their
violence against women in (AOR 0.58, 95% CI 0.34–0.98), lifetime. This needs an
Western Ethiopia literates (AOR 0.65, 95% urgent attention at all
CI 0.48–0.88), female headed levels of societal hierarchy
households (AOR 0.46, 95% including policymakers,
CI 0.27–0.76); older women stakeholders and
(AOR 3.36, 95% CI 1.27–8.89); professionals to alleviate
abduction (AOR 3.71, 95% the situation.
CI 1.01–13.63), polygamy
(AOR 3.79, 95% CI 1.64–0.73),
spousal alcoholic consumption
(AOR 1.98, 95% CI 1.213.22),
spousal hostility (AOR 3.96,
95% CI 2.52–6.20), and
previous witnesses of parental
violence (AOR 2.00, 95%
CI 1.54–2.56) were factors
associated with an increased
likelihood of lifetime IPV.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 15 of 31
Table 1 description of observational studies included in the systematic review and meta-analysis (Continued)
Author, country Study aim Design Population Sampling sample RR Main findings Authors key conclusion
procedure and recommendation
Koenig M. et al. To examine individual risk Cross-sectional Women Cluster 5109 NR Overall, 40.1% of women had Little progress in reducing
2003. Ugnada [6] factors associated with recent survey (15–49 years) sampling ever experienced levels of IPV is likely to be
IPV and community attitudes psychological IPV and 30.4% achieved without
of women had ever significant changes in
experienced physical threats prevailing individual and
or violence. The male partner’s community attitudes
alcohol consumption and his toward IPV.
perceived human
immunodeficiency virus (HIV)
risk in increasing the risk of IPV.
Wandera et al. To investigate the association Cross-sectional women Multistage 1307 NR IPV was 27%. Women’s IPV Interventions addressing
2015 Uganda [80] between IPSV and partner survey (DHS 2011) (15–49 years) cluster experience was higher whose IPSV should be place more
controlling behaviors sampling partner were jealous if they emphasis on reducing
talked with other men, if partners controlling
accused them of unfaithfulness, behaviors and the
if their partner did not permit prevention of problem
them to meet with people, if drinking.
their partner tried to limit
contacts, got drunk, and women
afraid of their partner.
Deyessa N et al., Cross-sectional Women SRS 1994 94.3% The lifetime prevalence of any Recommend public health
2009, Ethiopia [81] (15–49 years) form of IPV was 72.0%. strategies, interventions
Physical violence was 49.5%. and service provision
Valladares E et al., To estimate the prevalence Cross-sectional Women Cluster 478 99.8% The prevalence of emotional, Although these women
2005. Nicaragua [82] and characteristics of partner (15–49 years) sampling physical, sexual and concurrent have poor access to social
abuse during pregnancy IPV were 32.4, 13.4, 6.7 and resources and high levels
17%, respectively. Factors of emotional distress, they
such as women’s age below are rarely assisted by the
20 years, poor access to social health services.
resources and high levels of
emotional distress were
independently associated with
violence during pregnancy.
RR Response Rate, NR Not Reported
Semahegn et al. Reproductive Health           (2019) 16:93 Page 16 of 31
Table 2 description of the interventional studies
Author, Study aim Design Population Sampling sample Intervention Main findings Key conclusion and recommendation
country procedure
Abramsky To assess the community- Cluster RCT Women SRS Baseline = Control: existing The intervention was associated Community mobilization program on
et al.2014. level impacts of SASA! a (15–49 1583 service with significant lower social a the social acceptability of IPV, past
Uganda [83] community mobilization years) Post-line = Intervention: cceptance of IPV among women year prevalence of IPV and level of
intervention to prevent 2532 SASA: Community (ARR, 0.54, 95% CI: 0.38–0.79) and sexual concurrency archived
violence and reduce mobilization(start, lower acceptance among men important community impact and
HIV-risk behaviors awareness, support (0.13, 95% CI: 0.01, 1.15); significantly now delivered n control
and action) greater acceptance that a women communities and replicate in
can refuse sex among women other countries.
(1.28, 95% CI:1.07, 1.52) and men
(1.31,95% CI:1.00 to 1.7); 52% lower
physical IPV (0.48, 95% CI:0.16,1.39);
and lower levels of sexual IPV
(0.76,95% CI: 0.33 to 1.72). IPV was
more likely to receive supportive
community responses. Sexual
concurrency was significantly lower
(0.57, 95% CI: 0.36, 0.91).
Gupta To evaluate the incremental RCT Women Simple 934 Control: VSIA Slightly lower odds of reporting Combined intervention significantly
et al.2013. impact of adding gender (15–49 random Intervention: past year physical and or sexual reduce economic abuse and justified
Cote d’IVoire dialogue groups to an years) and sampling combined IPV in the combined group than wife beating. But, no significant
[84] economic empowerment men (VSLA+GDG) VSAL alone (OR, 0.92, 95% CI: reductions on physical and or sexual
group savings program on 0.58, 1.47). Women in the combined IPV or sexual IPV alone.
level of IPV group were significantly less likely to
report economic abuse than control
(OR, 0.39, 95% CI: 0.25, 0.60).
Acceptance of wife-beating was
significantly reduced on intervention
group (OR: −0.97, 95%
CI: −1.67, − 0.28).
Pulerwitz J assessed the effects of a Quasi- young Randomly 809 Control: existing Participants in the GE + CE Promoting gender equity is an
et al., 2015. community-based project in experimental people assigned service intervention were twice as likely important strategy to reduce IPV
Ethiopia [85] Ethiopia that worked with (15–24 Active comparator: (P < .01) as those in the comparison
young men to promote years) community education group to show increased support for
gender-equitable norms Intervention: combined gender-equitable norms. Also, the
and reductions in IPV (group education and percentage of GE+ CE participants
community education) who reported IPV toward their
partner decreased from 53 to
38% between baseline and end
line, and the percentage in the
CE-only group decreased from
60 to 37%; changes were negligible
in the control group.
Falb LK, To assess treatment RCT Women Random 682 Control: VSIA For child brides; there were no Intervention participants with a
et al., 2015. heterogeneity based on (15–49 sampling Intervention: statistically or marginally significant history of child marriage may have
Cote d’IVoire child marriage status for an years) combined decreases in physical and or sexual greater difficulty benefiting from
[86] intervention seeking to (VSLA+GDG) IPV. The odds of reporting economic interventions that seek to reduce IPV.
reduce IPV abuse in the past year were lower in
the intervention arm for child brides
Semahegn et al. Reproductive Health           (2019) 16:93 Page 17 of 31
Table 2 description of the interventional studies (Continued)
Author, Study aim Design Population Sampling sample Intervention Main findings Key conclusion and recommendation
country procedure
relative to control group child brides
(OR, 0.33, 95% CI: 0.13, 0.85). For
non-child brides; women were less
likely to report physical and or sexual
IPV (OR, 0.54, 95% CI: 0.28, 1.04),
emotional violence (OR, 0.44; 95%
CI: 0.25, 0.77), and economic abuse
(OR, 0.36, 95% CI: 0.20, 0.66) in the
combined intervention arm than
savings only groups.
Krishnan S. Examined men’s and RCT Couples Random 567 Intervention: Women who reported that violence RESPECT study indicate that
et al., 2012. women’s attitudes about sampling Conditional cash was ever justified if a woman refuses concerted efforts to reduce IPV and
Tanzania IPV, relationship power, and transfers (CCT) sex were more than twice as likely promote gender equity have the
[87] sexual decision making promoted safe to report IPV (aOR = 2.29,95% potential to make a positive
and couples’ sex CI:1.65–3.17). Furthermore, women difference in the relatively short
were less likely to report IPV when term.
both partners shared sexual decision
making (aOR = 0.70, 95% CI: 0.5–0.98),
as compared to women’s partner
controlled sexual decision making.
Notably, women were less likely to
report IPV when both partners had
equal power (aOR = 0.43, 95%
CI: 0.21–0.89) or they controlled more
power (aOR = 0.91, 95% CI: 0.28–2.94).
Wagman AJ. assess whether provision Cluster RCT Women Random 11,448 standard of care Compared with control groups, the SHARE could reduce some forms of
et al.,2015. of a combination of IPV (15–49 sampling individuals HIV services plus a SHARE intervention groups had fewer IPV towards women and overall HIV
Uganda [88] prevention and HIV services years) community- self-reports of past-year physical IPV incidence, possibly via reduction in
would reduce IPV and HIV mobilization (16%) in control groups vs. (12%) in forced sex and increased disclosure
incidence intervention the intervention groups; aPRR 0·79, 95% of HIV results.
Safe Homes and CI 0·67–0·92) and sexual IPV (13%) to
Respect for (10%); 0·80, 0·67–0·97). Incidence of
Everyone (SHARE) emotional IPV did not differ
Pro (20% vs 18%); 0·91, 0·79–1·04). SHARE
had no effect on male-reported IPV
perpetration.
Green PE, To assess the effect Cluster RCT Women Random 1800 5 days business The program doubled the business Increasing women’s earnings has
et al., 2015. of successful poverty (15–49 sampling advice, 150USD ownership and incomes. It showed no effect on IPV.
Uganda [89] alleviation on women years) and supervision small increases in marital control,
empowerment and intimate self-reported autonomy and quality
partner relationship of intimate partner relationship), but
essentially no change in IPV and no
effects on women’s attitude towards
gender-norms and a non-significant
reduction in autonomy.
Abramsky To explore the community Cluster RCT Women Cluster baseline = Control: existing SASA was associated with reductions It highlights the important role of
et al., 2016 mobilization intervention aged sampling 1583 service in women’s current physical IPV community-level norm-change in
Semahegn et al. Reproductive Health           (2019) 16:93 Page 18 of 31
Table 2 description of the interventional studies (Continued)
Author, Study aim Design Population Sampling sample Intervention Main findings Key conclusion and recommendation
country procedure
Uganda [90] to prevent VAW achieved 18–49 Endline = Intervention: (0.48, 95% CI 0.16–1.39), as well as achieving community-wide
community-wide reductions years 2532 SASA: Community men’s perpetration of IPV (0.39, 95% reductions in IPV risk.
in physical IPV mobilization(start, CI 0.20–0.73). Community-level
awareness, support normative attitudes were the most
and action) important mediators of intervention
impact on physical IPV risk, with
norms around the acceptability of
IPV explaining 70% of the intervention
effect on women’s experience of IPV
and 95% of the effect on men’s
perpetration.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 19 of 31
Fig. 2 Forest plot of the lifetime intimate partner violence in LLMICs (n = 19)
model (individual, relationship, community and societal Sexual intimate partner violence
factors) [97]. From 15 studies with a sample of 29,127 women
(15–49 years), the pooled prevalence of sexual IPV
Results was 20% (95% CI: 17, 23%). The lifetime sexual IPV
Intimate partner violence in LLMICs was the highest in SSA [42% (95% CI: 32, 54%)]
Lifetime intimate partner violence (Fig. 5).
Nineteen studies with a sample of 35,974 women
(15–49 years), the pooled estimate of lifetime IPV was Current intimate partner violence
55% (95% CI: 52, 59%). IPV in sub-Saharan Africa Thirty three studies with a sample of 216,043 women
(SSA) (14 studies) and Asian countries (4 studies) (15–49 years), the pooled prevalence of IPV was 38%
were 59% (95% CI: 52, 65%) and 46% (95% CI: 28, 65%), (95% CI: 34, 43%). The prevalence in SSA is almost simi-
respectively (Fig. 2). lar with the pooled prevalence (Fig. 6).
Physical intimate partner violence
From 18 studies with a sample of 44,664 women Types of current intimate partner violence
(15–49 years, the pooled prevalence of lifetime phy- Physical intimate partner violence
sical IPV was 39% (95% CI: 33, 45%). Furthermore, From thirty one studies with a sample of 141,820 women
lifetime IPV in SSA was 43% (95% CI: 35, 50%) (15–49 years), the pooled prevalence of physical IPV
(Fig. 3). during the past 12 months was 25% (95% CI: 21, 28%).
The subgroup analysis of seven studies in Asian coun-
tries was 31% (95% CI: 22, 41%) (Fig. 7).
Psychological intimate partner violence
From 15 studies with a sample of 42,600 women (15–49
years), the pooled prevalence of lifetime psychological Psychological intimate partner violence
IPV was 46% (95% CI: 40, 52%). The sub-group analysis From 20 studies with a sample of 115,798 women (15–49
shows consistent findings with the overall pool preva- years), the pooled prevalence of psychological IPV was
lence across the regions (Fig. 4). 30% (95% CI: 24.0, 36%) (Fig. 8).
Semahegn et al. Reproductive Health           (2019) 16:93 Page 20 of 31
Fig. 3 Forest plot of the Lifetime physical intimate partner violence against women (n = 18)
Fig. 4 Forest plot of the lifetime psychological intimate partner violence against women (n = 15)
Semahegn et al. Reproductive Health           (2019) 16:93 Page 21 of 31
Fig. 5 Forest plot of the lifetime sexual intimate partner violence against women (n = 15)
Sexual intimate partner violence Muslim [65, 70]. In addition to Muslim women, women
From 27 studies with a sample of 124,739 women (15–49 belonging to the traditional religion (worshipers) and
years), the pooled prevalence of current sexual IPV was being in other faith(s) were more likely to accept physical
7% (95% CI: 7, 8%). However, the subgroup pooled preva- IPV than women belonging to Christianity [52].
lence was a bit higher than the overall pooled prevalence.
It was 19% (95% CI: 13, 27%) in SSA countries (Fig. 9). Age Differences between women’s and their husbands’
age had an inconsistent relationship with the experience
Concurrent intimate partner violence of IPV. In three studies, physical IPV was significantly
From eleven studies with a sample of 8315 women (15–49 associated with women’s age and age at first marriage
years), the pooled prevalence of women’s experience of [40, 48, 56]. Women’s age 20 years and younger was a
IPV concurrently was 13% (95% CI: 12, 15%). In the mean- risk factor associated with IPV [82]. In one study,
time, the prevalence of concurrent IPV in SSA was 27% women who married at age 15 or young were four times
(95% CI: 16, 42%) which is two times higher than the more likely to experience IPV than women got married
overall pooled IPV prevalence in LLMICs (Fig. 10). older than 15 years [64]. While women (15–19 years)
were less likely to report emotional IPV, women (25–29
Contributing factors of domestic violence against women years) and women (30–34 years) were more likely to re-
Individual level factors port being physical and sexual IPV, respectively than
women (45–49 years) [76]. Nevertheless, in two studies,
Socio-demographic factors The socio-demographic older age women (35–49 years) were three times more
characteristics of the couples were identified as factors likely to report lifetime and current IPV than women
associated with IPV. In six studies, place of residence (15-19 years) [53, 79]. In addition, the age of husbands
was one of the factor associated with IPV whereby was a positive predictor of IPV [40, 49], but sexual IPV
women living in rural area were more likely to experi- was associated with husbands younger than 35 years [51].
ence IPV than urban dwellers [25, 52, 61, 62, 65, 79].
Similarly, in two studies, women’s religion was a factor Education Women’s lifetime IPV remained significantly
associated with IPV, such that women belonging to associated with women’s level of education. In six stud-
Islam were more likely to experience IPV than non- ies, uneducated or primary educated women had almost
Semahegn et al. Reproductive Health           (2019) 16:93 Page 22 of 31
Fig. 6 Forest plot of the current intimate partner violence against women (n = 33)
double the prevalence rate of any form of IPV who occupations [66, 70]. In one study, women who has been
attended secondary or higher education [6, 48, 52, 53, in the poorest microfinance group under supported by
60, 65]. In five studies, the higher the women’s educa- the microfinance programmes in Bangladesh have no
tional level, the lesser the likelihood of experiencing significant change on IPV exposure, except some im-
physical IPV. Women with higher education than their provement on economic empowerment [65]. Likewise, the
husbands were less likely to experience IPV than women women whose partners are employed (earned in cash)
with equal or less education than their husbands [40, 55, were 93% less likely to experience physical IPV than those
56, 62, 71]. In two studies, women in equally high educated women whose partners were farmers (earned in kind)
marriages revealed the lowest likelihood of experiencing [70]. Likewise, in three studies, women were economically
IPV. Education was found to be significantly protective dependent, and or did not have their own means of
from IPV, for both women as victim and men as perpe- earnings and controlling their earnings were more likely
trator [55, 79]. Furthermore, the educational status of to report sexual IPV than their counterparts [49, 51, 72].
husbands was associated with women’s experience of less Similarly, women heading business or engaged in different
IPV and less violent behavior to their wives [27, 50, 53, 54, types of jobs were 50% less likely to report lifetime IPV
58]. On the other hand, women with no education were than women have not heading business (almost jobless
about three times more likely to approve (accept) IPV than women) [79]. On the contrary, housewives were less likely
women with secondary or higher education [52]. IPV to be experienced sexual IPV than women who have a job
remained higher and even increased in the case of women different from housewives [68].
with secondary to vocational levels of education as com-
pared to those with a higher level of education [57, 66]. Childhood witness Domestic IPV was significantly as-
sociated with women and their husband childhood witti-
Occupation In two studies, women who were engaged ness of parental violence. Although the strength of
in manual labor (farming) were three times more likely association varies (ranged from four to thirteen times),
to be exposed to IPV than women with non-farming those women whose mothers were hit by their fathers
Semahegn et al. Reproductive Health           (2019) 16:93 Page 23 of 31
Fig. 7 Forest plot of the current physical intimate partner violence against women (n = 31)
Fig. 8 Forest plot of the current psychological intimate partner violence against women (n = 20)
Semahegn et al. Reproductive Health           (2019) 16:93 Page 24 of 31
Fig. 9 Forest plot of the current sexual intimate partner violence against women (n = 27)
Fig. 10 Forest plot of the pooled prevalence of concurrent intimate partner violence against women (n = 11)
Semahegn et al. Reproductive Health           (2019) 16:93 Page 25 of 31
during their childhood were more likely to report life- Relationship factors
time and current IPV than their counterparts [25, 53,
61, 72, 79]. Likewise, in some studies, women whose Women’s decision making status Decision making
husbands were beaten by someone in their family power was a predictor of IPV [49]. Generally, the odds
during their childhood were two times more likely to of IPV was less by 50% for women who had an equal
report experiences of IPV than those who were not say in household decision-making. Sexual violence was
beaten during childhood [53, 72, 79]. In addition, 35% less likely to occur among women who had a share
women’s exposure to physical IPV was 5 to 6 times in household decision-making [25]. Interestingly, the
more likely to be higher on women whose husband probability of women being physically abused de-
having witnessed that their mothers being beaten by creased by 8.2% for those women whose husbands
their fathers than women whose husband had no history dominated household decision-making, whereas wife-
(witness) of maternal IPV [51, 66, 70]. Furthermore, in dominance in household decision-making had a mar-
one study, IPV was associated with women who had a ginal effect on physical violence [54]. However, women
history of sexual abuse during childhood, adolescence or who decided on spending their own or husband’s
even an early age of first sex [60]. earning with a joint decision-making approach in view
of their own healthcare utilization, large household
purchase, or contraceptive use were less likely to be
Husbands’ controlling behaviors and mental health victims of IPV than women who made decisions by
condition IPV was higher among women who were themselves [53].
afraid of their husbands [53, 80]. Women whose hus-
bands had controlling, hostile and or rude behaviors Infidelity and lack of satisfaction in marriage In four
were almost three to four times more likely exposed studies, women whose husbands had engaged in extramarital
to any type of IPV than their counterparts [47, 53, sex or had multiple sexual partners (unfaithful) were two
68, 77, 79]. Women who had high levels of emotional times more likely to be at risk of IPV than their counterparts
distress were associated with IPV [82]. Furthermore, [51, 62, 72, 80]. Yet, exposure to physical IPV was associated
women whose husbands previously engaged in phys- with being unfaithful. Women who agreed that a
ical fight were 3.5 times more likely to experience woman was obliged to have sex with her husband had
IPV than others. In a similar way, women with an a lower risk of exposure to physical IPV than those
unhealthy mental status were two times more likely who disagreed [51]. Women who had poor relation-
to experience IPV than women with a healthy mental ships with their husbands were 2.6 times more likely
status [47]. to experience physical IPV [58]. Furthermore, women
who had a satisfaction in their marriage were noted to
face a low risk of IPV [62]. Sexual IPV was higher
Husband alcohol consumption Women whose hus- among women whose partner were jealous if they
bands’ drank alcohol were more likely to experience IPV talked with other men, suspected them of unfaithful-
than women whose husbands did not drink alcohol. As ness, did not permit them to meet even female friends,
we found from several studies, husbands’ alcohol con- limit their contact with family [80]. Those women who
sumption is the most commonly reported factor asso- did not believe a wife could do anything if a husband
ciated with IPV [6, 25, 49–51, 56, 60, 62–64, 66, 70, wanted a girlfriend were three times more likely to be
79, 80]. Furthermore, in one study, IPV was signifi- exposed to physical IPV [68]. In the same view,
cantly associated with husband’s use of psychoactive women who could refuse sex with their partners or
substances [66]. ask their husbands to use condoms were two times
more likely to be victims of IPV than their peers who
could not [53]. Women who had worries on issues
Pregnancy status In three studies, pregnant women about their daily activities and did not discuss them
with high parities had a higher probability of expe- with their partners were more likely to experience IPV
riencing lifetime IPV than non-pregnant women [48, than women who did discuss their issues [66].
49, 66]. Furthermore, in one study, women whose
pregnancies were undesired by their partners was six Type of marriage In five studies, the type of marriage
times more likely to have risk of current IPV than was significantly associated with IPV. Women who
pregnancy desired by partner [64]. Likewise, in two were married or cohabitated by abduction; women
studies, the likelihood of women’s experience of life- married to distant relatives; women with a polyga-
time IPV was consistently higher as the number of mous partner or in a polygamous marriage; payment
children increased [48, 54]. of dowry and marriage undergone without ceremony
Semahegn et al. Reproductive Health           (2019) 16:93 Page 26 of 31
were more likely to experience IPV than their coun- Similarly, in eight studies, there is a need to employs com-
terparts [27, 48, 50, 61, 79]. prehensive and culturally acceptable approaches including
medical (psychiatric) counseling, community mobilization,
Duration of marriage In two studies, this factor was gender advocacy and effective development of IEC to
significantly associated with higher experience of phy- dispel myths, misconceptions, negative traditional
sical abuse. Women who were married for 5–9 years norms and beliefs, gender inequality and to reduce the
(OR, 3.8) or ten or more years (OR, 3.7) were at higher costs of IPV [6, 40, 54, 68, 70, 72, 75, 79].
risk of being abused than women who were married for
less than 5 years [48, 60]. Human right based approach
In one study, community level awareness of human
Wealth index and economic status IPV and wealth rights as well as advocacy for women’s rights is crucial
index had an association but an inconsistent relationship [67]. In four studies, more investments in IPV preven-
across the wealth quintiles. In six studies, women tion strategies are needed to address the intergenera-
belonging to the poorest wealth index categories tional transfer of deeply entrenched cultural-norms
were most likely to be exposed to IPV than women which support male dominance and gender inequality
in the rich wealth index [51, 52, 54, 63, 65, 74]. [57, 66, 73, 90].
Other studies, microfinance program membership was
associated with a two-three-fold increase in exposure to Stakeholder engagement
IPV [65], as were family and financial problems associated The urgent attention of policymakers, stakeholders, pro-
with IPV [66, 79]. fessionals and other concerned bodies is needed at all
levels of society. Stakeholders should design interventions
Community level factors targeting behavioral and social factors which can help to
prevent IPV [79]. Likewise, resources should be mobilized
Presence of the traditional gender norms In two by policy-makers, public health experts, researchers
studies, women’s exposure to IPV were more likely to and other stakeholders to prevent IPV [48, 59, 63, 72].
be high in communities who adhered to traditional Advocacy is very important and can be done as religious
patriarchal gender norms or beliefs and supported institutions, media, government and non-governmental
(accepted) attitudes towards wife beating [51, 54]. Mean- associations encourage gender equality by [66, 67, 70, 73].
while, women who agreed that “a good wife obeys her
husband” and/ or “a man should show who the boss is” Policy formulation and legal framework
were more likely to experience sexual IPV than women The issue of gender equality, women’s rights and legal
who disagreed. In addition, women who agreed that a sanctions need due attention during policy formulation
woman had no reason to refuse sex with her husband and endorsement of laws to prevent VAW are crucial. In
were three times more likely to be exposed to IPV as many instance of VAW, the punishment to perpetrators
compared to who agreed for some reasons [51]. In were light and not commensurate with the offence
addition, women who worked outside the home but victims filed. The law should be more responsive to
whose husbands did not make enough money had an VAW to help address this challenge [25, 68]. Perhaps,
increased risk of IPV by 5.2% than women whose survivors are encouraged to disclose their experience of
husbands made enough money [54]. IPV to people who are in position or have an autonomy,
and implementing the existing law for punishment [70].
Community attitude towards wife-beating Communi- Policymakers should take immediate action to break
ties whose attitudes supported IPV [66] by thinking that hierarchical barriers between spouses, and promote
justified wife-beating is acceptable [60], or encouraged gender equality while amending the existing laws or
societal gender beliefs or norms [54], reflected relation- formulating new policies [52, 53, 75]. However, evi-
ship control, and relationship inequalities [40, 51] were dence based efforts are needed to re-enforce legal
significantly associated with women’s experience of IPV. rights or existing laws and policies and ensure their
effective implementation to prevent and respond to
What were the key recommendations from the studies? VAW [54, 57, 67].
Transformation of community’s traditional gender norms
In seven studies, undertaking a massive and intensive in- Women empowerment
formation, education and communication (IEC) approach Six studies have recommended that building women’s
is a recommended strategy on transforming a com- capacity through education, employment, income and
munity’s culture and traditional gender norms in order to other economic opportunities, and addressing imbalance
enhance gender equality [25, 27, 38, 47, 49, 51, 61]. of power between men and women are crucial to
Semahegn et al. Reproductive Health           (2019) 16:93 Page 27 of 31
prevent IPV [25, 47, 52, 53, 56, 79]. Likewise, promising more likely higher in the community mobilization inter-
public health strategies (increasing awareness of the con- vention than control group. Likewise, current physical,
sequences of IPV, strengthening the self-esteem of sexual and concurrent IPV were lowered in the inter-
women and girls and promoting equity in marital rela- vention group by 52, 24%, and 435 respectively than the
tionships) are needed to change attitudes towards gender control group. In addition, women experiencing IPV in
inequality, and are essential to avert IPV [47, 70, 79]. intervention communities were more likely to receive
Furthermore, addressing household poverty-wealth com- supportive community responses. [83, 90]. In one study,
prehensively [74], enhancing the safety of women, promot- the community-level normative attitude towards physical
ing fertility control methods and women’s reproductive IPV and IPV acceptability norms were improved in the
health service [40] are some other recommended interven- intervention group than the control. In addition, men’s
tions to prevent and control IPV. suspicion of their partner for infidelity and communi-
cation about sex were improved [90]. Similarly, in one
Intervention integration study, community engagement and group education
Innovative strategies are needed to provide support and combined interventions reduced IPV almost by 20% while
counselling to IPV survivors, who are rarely assisted by the CE-only group reduced it by 23%, and enhanced
health care professionals [82]. Research findings have gender equitable norms [85].
strongly recommended that IPV prevention inter- In the two interventional studies which is mainly
ventions be integrated with community health programs; focused on women’s economic empowerment through a
reproductive health and other health services to be more village loan and saving association approach, women in
comprehensive, close to household level and accessible the combined groups were significantly less likely to
to IPV survivors [27, 49, 53, 67, 70]. Integration may report economic abuse than control group (OR, 0.39,
help to enhance medical screening of survivors for STI 95% CI: 0.25, 0.60) [84, 86]. In one study, while attitude
including HIV, provide male partner counseling and towards refusal of sex did not significantly change,
other health care support. Furthermore, the authors [38, women in the combined (VLSA and GDG) intervention
48, 67, 78] recommended that reproductive health group reported a lower experience of current IPV and
service providers should be encouraged to advocate for also acceptance of justified wife-beating than VLSA
IPV and mental health screening during antenatal care. alone, but it was not statistically significant [84]. In one
study, women who got married when they were children
Engaging men and other influential persons on IPV were 46% less likely to report physical and or sexual
prevention violence in the combined intervention group than the
Research findings have proposed that community pro- control. The reduction was however, not statistically
grams that have a couple-centered approach are needed significant in the overall IPV [86].
to promote non-violent masculinity values and norms Women’s attitudes about IPV and power relationships
[47, 51, 58]. Moreover, working with men is a win- were associated with their IPV experience. In one study,
win-approach to prevent IPV. Efforts are needed to women who report violence was ever justified if a
focus societal, community, relationship and individual woman refuses sex were two times more likely to expe-
level approaches which engage men to promote men’s rience IPV than control group. Furthermore, women in
non-violent behavior and gender equality and to minimize joint (both partners) sexual decision making relation-
infidelity [51, 62, 67]. In addition, interventions addressing ships were 30% less likely to report IPV as compared to
IPV should place more emphasis on reducing partners’ women whose partners controlled sexual decision-mak-
controlling behaviors and to prevent men’s alcohol drink- ing. Notably, women were 57% less likely to report IPV
ing habits [56, 62, 66, 80]. Furthermore, involving when both partners had equal power [87]. However,
mother-in laws would be a significant move [47]. Also, women’s economic empowerment was doubled for those
community health workers could be active players in women in the safe home and respect for everyone
raising community awareness about IPV [27, 49]. (SHARE) intervention group. Likewise, women in the
intervention group were 20% less likely to experience
What are the proven evidence? IPV than those in the control group. Nevertheless,
We systematically selected eight interventional studies SHARE had no significant effect on emotional IPV, men’s
that had been conducted in LLMICs [83–90]. The detail behavior (perpetration) [88], overall IPV, women’s auto-
of GRADE for the summary of evidence for different nomy and women’s attitude towards gender norms [89].
outcomes is attached as an Additional file 6. In two
studies, the social accepting attitude of IPV was lowered Discussion
by community mobilization intervention. Women’s atti- This systematic review and meta-analysis determined
tude towards sex refusal when necessary was 1.3 times the prevalence of domestic IPV and its types, associated
Semahegn et al. Reproductive Health           (2019) 16:93 Page 28 of 31
factors, effective interventions and key recommendations unpublished studies and sub-group analysis by setting
to prevent domestic VAW. We found out that the and violence types, it had some limitations. One of the
pooled prevalence of lifetime IPV was 55% (95% CI: 52, main limitations was the inconsistent definition of IPV
59%). Of these, lifetime physical, psychological and across some studies. Hence, we used both IPV and do-
sexual violence were 39, 45 and 20%, respectively. Further- mestic VAW synonymously. The second limitation of
more, the pooled prevalence of current IPV was 38% (95% this systematic review and meta-analysis is that it did
CI: 33.0, 43%). Of these, prevalence of current physical, not carry out quantitative synthesis on the factors asso-
psychological and sexual violence were 25, 30 and 7%, ciated with domestic VAW due to the high heterogeneity
respectively. In addition, the pooled prevalence of women’s between included studies. However, it is difficult to find
experience of concurrent IPV was 13% (95% CI: 12, 15%). absolutely homogeneous studies in terms of setting,
This finding is consistent with the WHO’s global estimates method, analysis and interpretation.
and multicounty study whose findings indicated that
one-in- three women experienced domestic VAW in their
Implication of the review
lifetime [1, 98, 99].
Domestic violence against women is a common women’s
As evidence shows that IPV was significantly associ-
life experience and mostly perceived as minor and so-
ated with educational level, place of residence, eco-
cially tricky by many governments. However, its conse-
nomic status, having witnessed abuse during
quences have a devastating impact on national gross
childhood, husbands’ having controlling behavior, hus-
domestic product and costs much higher than the
bands’ alcohol consumption, pregnancy status and
budget allotted for primary education. Hence, generating
parity. Notwithstanding, sexual violence was common
evidence on the prevalence, associated factors and
among women who had husbands younger than 35
identifying effective interventions applicable in poorly
years. Furthermore, women in unfaithful relationships
resourced settings is very crucial. This systematic review
and unsatisfied marriages as well as women who mar-
and meta-analysis can give critical insight about VAW,
ried early and have experienced forced first sex, short
associated factors, and effective interventions. Therefore,
duration of marital life, and poor mental health had a
concerned stakeholders can use the findings of this study
higher risk of experiencing IPV. In addition, the
as main evidence to inform policymakers, program
presence of traditional gender-norms and wife-beating
designers and local planners construct and for imple-
accepting attitudes were linked with a high risk of do-
ment policies to prevent IPV in LLMICs.
mestic violence. This finding is also consistent with
the ecological model formulated in 1998 [97, 100]
which is very applicable in low and lower-middle in- Conclusion
come settings and is targeted at the deep rooted Both lifetime and current domestic IPV are still high in
causes. LLMICs. More than half of the women in the studies
This systematic review found out that IPV prevention had experienced lifetime domestic IPV, and almost
should focus on community culture or traditional one-third of the women had experienced current IPV.
gender-norm transformation; stakeholders’ engagement; In addition, almost one-in-ten women experienced
women empowerment (capacity building); engaging men more than one type of IPV concurrently. Domestic
and other influential people (mother and/ or father IPV is a complex public health and human rights vio-
in-laws, sister-in-law, neighbors); intervention should lation which is associated with factors at the individ-
focus on service integration with other relevant sectors ual, relationship, community and entire system level.
(mainly health sector for screening and other care However, most of the associated factors are prevent-
and support); policy formulation and provision of able. Interventions integrating legal framework and
legal framework and implementation of human right programs that focus on transformation of traditional
based approaches. This finding is consistent with gender-norms are most important to prevent IPV. Com-
other reviews that recommended focus on the struc- munity mobilization and awareness creation to transform
tural drivers of unequal power in relationships to gender-norm reduced IPV by half. However, the economic
prevent VAW [98, 100–102]. empowerment intervention had reduced some influ-
We included observational and interventional studies. ences on women (reduced economic abuse), but it was
However, we interpreted the findings to meet our review not statistically significant in the prevention of IPV.
objectives. Nevertheless, we did not mix-up the findings Therefore, we suggest that researchers, program plan-
of the observational and interventional studies. Though, ners, policy makers, clinicians and other concerned
this systematic review and meta-analysis used relatively stakeholders should invest in the implementation of
comprehensive search of the major databases; included gender-norms focused on community based interven-
both quantitative and qualitative studies; published and tions to prevent IPV.
Semahegn et al. Reproductive Health           (2019) 16:93 Page 29 of 31
Additional files Box 235, Harar, Ethiopia. 3Population Council/Ghana, Yiyiwa Drive, Accra,
Ghana.
Additional file 1: PRISMA checklist. (DOC 85 kb)
Received: 7 June 2018 Accepted: 24 April 2019
Additional file 2: 2-1 & 2-1-1: Searching strategy on PubMed database.
2-2 Searching strategy on Medline database. 2-3 Searching strategy on
EMBASE database. 2-4 Searching strategy on CNHAL database. (ZIP 2206 kb)
Additional file 3: ReferencesStudies quality assessment using JBI critical appraisal
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