Gender‐Based Violence and Associated Factors Among Women of Reproductive Age in Awi Zone, Northwest Ethiopia: A Mixed Study

ABSTRACT

Background and Aims

Gender‐based violence (GBV) remains a critical global health and human rights issue, with one in three women affected worldwide. Local evidence on its prevalence and determinants is limited in the study area. This study aims to determine the magnitude of GBV, identify and explore associated and aggravating factors among reproductive‐age women in the Awi Zone Administration, Amhara Region.

Methods

A community‐based mixed‐method study, combining a cross‐sectional survey and an exploratory qualitative design, was conducted in February 2025. Quantitative data were collected using a semi‐structured questionnaire, while qualitative data were gathered through key informant interviews. Data was entered into EpiData 4.6 and analyzed in SPSS version 26. Bivariable and multivariable binary logistic regressions were employed to identify factors associated with the outcome variables. Qualitative data were analyzed thematically, and findings from both approaches were triangulated.

Results

A total of 735 women participated in the study (95.4% response rate). Overall, 57.0% (95% CI: 53%–61%) reported experiencing at least one form of GBV in the past 12 months. Multivariate analysis showed that lack of education [AOR = 1.52; 95% CI: 1.02–2.28], alcohol use [AOR = 1.66; 95% CI: 1.19–2.32], low wealth index [AOR = 1.76; 95% CI: 1.22–2.52] and being employed [AOR = 0.40; 95% CI: 0.22–0.74] were associated with GBV. Qualitative findings revealed GBV was widely reported and normalized, manifesting as physical, sexual, and emotional abuse. Poverty, low education, substance use, and weak legal systems fueled its occurrence.

Conclusion

GBV is widespread and culturally normalized, fueled by low education, poverty, alcohol use, and weak legal enforcement, whereas employment offers some protection. Therefore, women's education and economic empowerment should be strengthened, legal protections enforced, and community‐based interventions implemented to shift cultural norms and reduce GBV.

1. Introduction

Gender‐based violence (GBV) is “any act of gender‐based violence that causes, or is likely to cause, physical, sexual, or psychological harm or suffering to women, including threats of such acts, coercion, or arbitrary deprivation of liberty, whether in public or private life [1]. GBV is a critical violation of human rights and a global public health problem [2, 3]. GBV involves various acts of physical, sexual, emotional, verbal, economic, and psychological violence committed by intimate partners, family members, or others [4, 5]. Globally, roughly 30% of women have experienced at least one form of GBV in their lifetime, and an intimate partner commits 38% of female homicides [6]. GBV was found to be a leading cause of morbidity and mortality among women aged 15–44 years, with over 1.3 million deaths annually being attributed to such violence [7]. The health consequences of GBV are unintended pregnancy, unsafe abortion, sexually transmitted infections like HIV/AIDS, traumatic fistula, mental illness, and social consequences such as stigma, rejection, and loss of economic resources [8, 9, 10, 11].

In Africa, ever‐partnered women have experienced lifetime intimate and/or sexual physical partner violence (IPV) at about 40% [12], and in SSA, IPV and non‐IPV forms were estimated at 44% and 14%, respectively [13]. In Ethiopia, prevalence ranged between 10.8% and 68.2%, as per regional and methodological differences [8, 14, 15]. The 2016 Ethiopian Demographic and Health Survey noted that 33% of women aged 15–49 had been subjected to physical or sexual violence, 47% had been subjected to physical violence, and 10% had been subjected to rape [16]. Conflict settings perpetuate GBV, such as in Northern Ethiopia, where sexual violence has been used as a strategy of terror, humiliation, and ethnic violence, with survivors having higher levels of stigma and severe reproductive health outcomes [16, 17, 18].

GBV is driven by a complex interplay of individual, relational, community, and societal determinants. At the personal level, factors such as educational attainment, age, marital status, substance use, adherence to rigid gender ideologies, and childhood exposure to violence [1, 2]. Relational determinants include partner controlling behaviors, marital conflict, polygamy, and women's economic dependence on male partners [3, 4]. At the community level, poverty, tolerance of violence, and weak law enforcement mechanisms further exacerbate vulnerability [5]. Societal‐level drivers include structural gender inequalities, patriarchal norms, armed conflict, displacement, and limited policy or legal protections for women [19, 20]. In Ethiopia and across sub‐Saharan Africa, quantitative studies have largely focused on intimate partner violence [21, 22, 23]. Qualitative evidence, however, underscores how stigma, harmful norms, and underreporting mask the true burden of GBV [24, 25]. Still, important gaps remain, particularly regarding non‐partner sexual violence, community power relations, conflict exposure, and intersectional risks such as ethnicity, age, and disability [26, 27].

Global and national responses have emphasized strengthening health system responses, gender‐transformative policy application, and investment in sustainable prevention [19]. Sustainable Development Goal 5 (SDG 5) addresses ensuring there is gender equality and empowering women and girls, target 5.2, ending all forms of violence against women and girls in public and private spaces [28]. However, GBV is underreported, particularly where there is conflict and scarcity of resources [12, 25]. In conflict‐affected settings, such as the Awi Zone, the dynamics of GBV are intensified by disruptions to social, economic, and institutional structures. Prolonged civil conflict in the region has resulted in displacement, economic instability, and weakened law enforcement and protection systems. Very few community‐based studies have systematically assessed GBV among Ethiopian reproductive‐age women, especially in conflict‐affected or displaced areas, such as Awi Zone, Amhara regional state, Northwest Ethiopia. Guided by a socio‐ecological perspective, this study conceptualizes GBV as the result of interacting with individual, relational, community, and societal factors, all of which may be exacerbated in fragile settings.

In view of the huge gaps in both the prevalence and determinants of GBV—most importantly, non‐IPV ones, context‐specific risk factors, and the synthesis of qualitative and quantitative results—this study will set the prevalence of GBV and examine related factors among reproductive‐age women in Awi Zone. By providing locally relevant data on trends, determinants, and contextual drivers of GBV, the research seeks to shape interventions, improve policy, and contribute to global efforts to stem GBV and its adverse consequences.

2. Methods

2.1. Study Design, Setting, and Period

A mixed‐method study, combining a community‐based cross‐sectional survey and exploratory and phenomenological qualitative design, was conducted in February 2025 in the Awi Zone, Amhara Region, Northwest Ethiopia, an area affected by civil conflict for over 2 years. The Zone has 12 Woredas, three city administrations, and a population of 1.38 million (677,239 men and 704,882 women), including 276,424 women of reproductive age. Health infrastructure includes one general and four primary hospitals, 49 health centers, and 206 health posts, supported by 1828 health workers and 726 administrative staff. The zonal hospital and health centers have GBV wards staffed with specially trained doctors and nurses.

2.2. Population

The source population comprised all women of reproductive age residing in Awi Zone. For the quantitative study, participants were women of reproductive age selected randomly from districts in the Zone. For the qualitative study, participants included reproductive‐age women who had experienced GBV for in‐depth interviews (IDIs), and key informants such as MCH and GBV focal persons, as well as health service providers involved in GBV care in the Zone.

Inclusion criteria: Women of reproductive age who had lived in Awi Zone for at least 6 months.

Exclusion criteria: Women who were critically ill and unable to provide information at the time of data collection.

2.3. Sample Size Determination

For the quantitative component, the sample size was determined using a single population proportion formula with the following assumptions: 25.1% prevalence of violence against women from a prior study in Seqota Town [29], 95% confidence level, 5% margin of error, 10% non‐response rate, and a design effect of 2. This resulted in a final sample size of 770 participants.

For the qualitative component, IDIs and key informant interviews (KIIs) were conducted with women who had experienced GBV, as well as MCH and GBV officers, health care providers, and GBV focal persons. The number of interviews was guided by data saturation, continuing until no new themes or information emerged. Participants were purposively selected to ensure diversity in experiences and perspectives. Data saturation was assessed based on the recurrence of themes across interviews, and no substantially new themes emerged during the final interviews.

2.4. Sampling Procedure

For the quantitative component, a multistage sampling approach was used. Of the 12 administrative districts in Awi Zone, four were selected by simple random sampling (lottery method). Within these, 11 kebeles were randomly chosen from 43. With support from health extension workers and kebele administrations, households with eligible participants were identified, and the required sample was proportionally allocated to each kebele. Systematic random sampling was then applied, using a sampling interval (Kth = N/n), where N is the total number of households in the kebele and n is the allocated sample size. For example, in Ambiki kebele, 1315 households contained eligible participants, and 40 were required; thus, Kth = 1315/40 ≈ 33. The first household was selected by lottery, and subsequent households at fixed Kth intervals. If multiple eligible women lived in one household, one was randomly chosen by lottery.

For the qualitative component, purposive sampling was applied, considering residence (urban/rural) and educational status to ensure maximum variation and capture diverse perspectives on GBV.

2.5. Measurements and Variables

The dependent variable: GBV (Yes or No)

The independent variables: in this study were grouped into four major categories. Individual sociodemographic characteristics included age, religion, marital status, ethnicity, educational status, occupation, source of information, gravidity, and parity. Family‐related characteristics comprise the head of household, living conditions, family size, and wealth index. Lifestyle characteristics of the partner were assessed in terms of substance use, such as alcohol consumption, khat chewing, and cigarette smoking. Finally, conflict‐related characteristics focused on displacement from home and loss of resources due to theft.

Reproductive‐age women: Women aged between 15 and 49 years [30].

GBV: A woman who experienced at least one of the three forms of violence (physical, sexual, or emotional) in the last 12 months was considered to have experienced GBV (YES); otherwise, she was not considered a GBV victim (NO) [31].

Physical violence: Saying “yes” to at least one of six items: being pushed, slapped, punched with a fist or object, kicked, choked, intentionally burned, or threatened/attacked with a weapon [31].

Sexual violence: Saying “yes” to at least one of three items: being physically forced into sexual intercourse, forced into other unwanted sexual acts, or coerced through threats into sexual activity [31].

Emotional violence: Saying “yes” to at least one of three items: being humiliated in front of others, threatened with harm to oneself or loved ones, insulted, or made to feel bad about oneself [31].

Mass media exposure: Listening to the radio or watching television at least once a week is considered regular exposure [32].

2.6. Data Collection Tool and Procedure

Quantitative data collection: A semi‐structured questionnaire, adapted from the 2016 EDHS and other literature [33], was used to collect data on sociodemographic, family, lifestyle, conflict‐related factors, and experiences of GBV, categorized into physical, sexual, and emotional forms. The tool was developed in English, translated into the local language, and then back‐translated to English for semantic consistency. Four female diploma nurses, familiar with the community and its culture, collected the data to encourage openness on sensitive issues under the supervision of a public health professional. Data were gathered through face‐to‐face interviews in private settings. Sensitive GBV questions were placed later in the questionnaire to minimize distress and non‐response. Informed consent was obtained, including parental/caregiver consent for participants under 18.

Qualitative data collection: The principal investigators conducted IDIs and KIIs, supported by a moderator and note‐taker. Interviews took place at convenient times and locations, allowing participants, especially GBV survivors, to express their experiences freely and reflect on their own interpretations. Sessions were audio‐recorded unless declined, in which case detailed handwritten notes were taken. At the end, participants were encouraged to share additional thoughts or comments.

2.7. Data Quality Assurance

For the quantitative component, data collectors received training on participant approach and data collection procedures. The questionnaire was pretested on 5% of the sample in Zegem district to check clarity, wording, sequence, and skip patterns, with modifications made accordingly. It was administered in the local language, then back‐translated into English to ensure consistency. During data collection, close supervision was provided by the investigators and supervisor, with regular reviews to address challenges. Completed questionnaires were checked for completeness before entry.

For the qualitative data, trustworthiness was ensured through peer debriefing and triangulation of data sources. All interviews were tape‐recorded (with simultaneous note‐taking), transcribed verbatim, and repeatedly reviewed for accuracy.

2.8. Data Processing and Analysis

Quantitative analysis: Data were cleaned, coded, and entered EpiData 4.6, then exported to SPSS version 26 for analysis. Descriptive statistics summarized participants’ characteristics and GBV prevalence. Cross‐tabulations and Chi‐square tests assessed associations between variables. Binary logistic regression was used to examine crude associations, with variables at p ≤ 0.25 in the bivariable analysis entered the multivariable regression. Adjusted odds ratios (AOR) with 95% CI were reported, and associations were considered significant at p < 0.05. Results were presented in texts, tables, and graphs. This study employed a multi‐stage sampling design, which may introduce clustering at the kebele level. However, given the relatively large number of clusters and the use of systematic sampling within kebeles, the intra‐cluster correlation is assumed to be minimal. Therefore, a standard logistic regression was applied.

Qualitative analysis: Audio‐recorded interviews were transcribed in Amharic, cross‐checked with field notes, and translated into English. Transcripts were manually coded and analyzed to identify themes, with quotations used to illustrate key points. Emerging themes were integrated with quantitative findings for a comprehensive understanding of GBV perceptions.

2.9. Ethical Approval and Consent to Participate

Ethical clearance was obtained from the Injibara University College of Medicine and Health Sciences Research Review Committee. Permission letters were secured from Awi Zone, district health offices, and health centers. Written informed consent was obtained from all participants, with the right to decline or withdraw at any time clearly explained. For participants under 18, consent was obtained from a parent or caregiver. Interviews were conducted privately, and data were used solely for research purposes. To ensure confidentiality, no names were recorded; instead, unique codes were assigned to questionnaires, and all personal identifiers were removed.

3. Results

3.1. Sociodemographic Characteristics

A total of 735 women participated in the study, yielding a 95.4% response rate. Among them, 310 (42.2%) were aged 25–34 years, with a mean age of 26 years (SD ± 7.28), with a normal distribution. Nearly two‐thirds, 453 (61.6%), identified as Orthodox Christians, while more than half, 388 (52.8%), were married. In terms of education, 140 (34.7%) had no formal schooling, and 277 (37.7%) were unemployed or housewives (Table 1).

Table 1.

Sociodemographic characteristics of the study participants in Awi Zone, Northwest Ethiopia, 2025 (N = 735).

Variable	Category	Frequency (n = 735)	Percent (%)
Age	15–24	295	40.1
	25–34	310	42.2
	35–49	130	17.7
Religion	Orthodox	453	61.6
	Protestant	59	8.0
	Muslim	223	30.3
Ethnicity	Agew	415	56.5
	Amhara	279	30.0
	Tigray	4	0.5
	Oromo	34	4.6
Marital status	Unmarried	203	27.6
	Married	388	52.8
	Divorced & Widowed	144	19.5
Educational level	No education	246	33.5
	Primary	145	19.7
	Secondary	176	23.9
	Above secondary	168	22.8
Occupation	Unemployed/housewife	277	37.7
	Employed	181	24.6
	Merchant	113	15.4
	Student	101	13.6
	Others	63	8.6
Gravida	0	141	19.2
	1–2	297	40.4
	3–4	159	21.6
	5+	138	18.8
Parity	0	211	28.7
	1–2	280	38.1
	3–4	146	19.9
	5+	98	13.3
Access to media (TV)	Yes	278	37.8
	No	457	62.2
Husband age (n = 388)	20–29	76	19.6
	30–39	182	46.9
	40–62	119	30.7
Husband's educational level (n = 388)	No education	92	23.7
	Primary	118	30.4
	Secondary	61	15.7
	More than secondary	117	30.2
Husband occupation (n = 388)	Unemployed/Farmer	101	26.0
	Gov't/NGO employed	107	27.6
	Merchant	91	23.5
	labor/driver/others	89	22.9
Husband has another wife (n = 388)	Yes	104	26.8
	No	284	73.2

3.2. Family, Lifestyle, and Conflict‐Related Information

More than half of the participants, 388 (52.8%), were living with their husbands. In most households, 519 (70.6%) were male‐headed. Based on the wealth index, 439 (59.6%) of the participants were categorized as poor. Among the study participants, 370 (50.3%) reported drinking alcohol, while 312 (80.4%) of their male partners also consumed alcohol. Conflict had a significant impact, with 128 (17.4%) participants displaced from their homes, primarily due to war, which accounted for 92 (71.9%) of the reported causes. Among those displaced, 42 (32.8%) reported that their resources had been looted (Table 2).

Table 2.

Family, lifestyle, and conflict‐related information of the study participants in Awi Zone, Northwest Ethiopia, 2025 (N = 735).

Variables	Response category	Frequency	Percentage
Currently live condition	With my husband	388	52.8
	With family & relatives	271	36.8
	Alone	76	10.3
Head of household	Male	519	70.6
	Female	216	29.4
Family size	≤ 3	294	40.0
	4–5	293	39.9
	≥ 6	148	20.1
Wealth index	Poor	439	59.6
	Middle	114	15.4
	Rich	182	24.8
Cigarette smoke	No	727	98.9
	Yes	8	1.1
Drink alcohol	Yes	370	50.3
	No	365	49.7
Type of alcohol	Tellaa	225	60.6
	Arakib	95	25.6
	Beer	50	13.6
Chat chewing	Yes	28	3.8
	No	707	96.2
Husband drinks alcohol (n = 388)	Yes	312	80.4
	No	76	19.6
Husband‐cigarette smoke (n = 388)	Yes	54	13.9
	No	334	86.1
Husband‐chat chewing (n = 388)	Yes	74	19.1
	No	314	80.9
Displacement	Yes	128	17.5
	No	607	82.5
Cause of displacement (n = 128)	War	92	71.9
	Shortage of food	29	22.7
	Lack of health services	7	5.4
Resource stolon (n = 128)	Yes	42	32.8
	No	86	67.2

^a Local beer.

^b Local whisky.

3.3. Prevalence and Perpetrators of GBV

Of the 735 reproductive‐age women who participated in the study in Awi Zone, 419 (57.0%; 95% CI: 53%–61%) reported experiencing at least one form of GBV in the past 12 months. Emotional violence was the most common type, affecting 335 women (45.6%; 95% CI: 41.6%–49.6%), followed by physical violence in 279 women (38.0%; 95% CI: 34.0%–42.0%) and sexual violence in 243 women (33.1%; 95% CI: 29.1%–37.1%). Sexual violence was most frequently perpetrated by husbands, reported by 133 women (18.1%), followed by soldiers, reported by 84 women (11.4%). Emotional violence was mainly inflicted by soldiers (127 women, 17.3%) and community members (59 women, 8.0%). Physical violence was most committed by husbands (85 women, 11.6%) and community members (45 women, 11.2%).

3.4. Factors Associated With GBV

In the bivariable analysis, five variables—marital status, educational level, occupation, alcohol consumption, and wealth index—were identified as candidates for multivariable logistic regression at a p‐value of < 0.25. In the multivariable model, four factors remained significantly associated with GBV at the 5% level of significance. The model showed good fit (Hosmer–Lemeshow test = 0.98), no evidence of multicollinearity (VIF < 5, tolerance > 0.1), and explained 18.7% of the variance in GBV experience (Nagelkerke R ² = 18.7%).

Women with no formal education were 1.52 times more likely to experience GBV compared to those with secondary education or above [AOR = 1.52; 95% CI: 1.02–2.28]. Alcohol consumers were at higher risk, being 1.66 times more likely to experience GBV than non‐drinkers [AOR = 1.66; 95% CI: 1.19–2.32]. Employment was protective, as women in paid jobs were 60% less likely to experience GBV compared to unemployed women or those in other occupations [AOR = 0.40; 95% CI: 0.22–0.74]. Finally, participants in the poorest wealth category were nearly twice as likely to experience GBV compared to those in the richest group [AOR = 1.76; 95% CI: 1.22–2.52] (Table 3).

Table 3.

Bivariate and multi‐variable logistic regression analysis of factors associated with GBV among women in Awi Zone, Northwest Ethiopia, 2025 (N = 735).

Variable	Category	GBV		COR (95% CI)	AOR (95% CI)	p value
		No	Yes
Drinking alcohol	No	200	165	1	1
	Yes	116	254	2.65 (1.970, 3.85)	1.66 (1.19, 2.32)*	0.02
Educational status	No education	134	112	1.62 (1.08, 2.40)	1.52 (1.02, 2.28)*	0.03
	Primary	75	70	1.81 (0.78, 1.75)	0.85 (0.57, 1.27)	0.43
	Secondary	99	77	1.51 (0.98, 2.09)	0.69 (0.47, 1.01)	0.057
	Above secondary	111	57	1	1
Occupation	Unemployed and a housewife	107	170	1	1
	Employed	71	110	0.97 (0.14, 0.50)	0.40 (0.22, 0.74)*	0.003
	Merchant	57	56	0.61 (0.56, 1.81)	0.99 (0.55, 1.78)	0.97
	Student	51	50	0.61 (0.94, 2.77)	0.61 (0.36, 1.05)	0.07
	Other	30	33	0.69 (0.39, 1.19)	0.99 (0.54, 1.83)	0.99
Marital status	Un married	83	120	1	1
	Married	187	201	0.63 (0.4, 1.00)	0.66 (0.32, 1.23)	0.25
	Widowed and divorced	46	98	0.42 (0.22, 0.82)	1.33 (0.20, 1.55)	0.72
Wealth index	Poor	260	178	1.78 (1.15, 2.31)	1.76 (1.22, 2.52)*	0.002
	Middle	92	54	2.44 (1.34, 3.40)	1.87 (1.14, 3.05)*	0.012
	Rich	67	84	1	1

Note: *Bold values with * sign indicates: statistical significant variables with a p‐value below 0.05.

3.5. Qualitative Study Results

The interview guide covered key domains, including experience of GBV, types and forms of violence, perceived causes and contributing factors, consequences of GBV, and coping mechanisms and support systems.

Sociodemographic Characteristics of the Participants in the Qualitative Study: Three KIIs and five in‐depth interviews (IDIs) were conducted under the qualitative component with participants from diverse backgrounds. Although the number of interviews was relatively small, participants were purposively selected to ensure diversity in experiences and perspectives. Data saturation was assessed based on the recurrence of themes across interviews, and no substantially new themes emerged during the final interviews.

The KIIs involved two male health professionals (one medical doctor and one MCH & GBV focal person) and one female police officer, all of whom had education levels above secondary school. The IDIs involved five female participants aged 16–34 years, most of whom had primary‐level education. They were of various occupations, including housewives, students, the unemployed, and commercial sex workers. Most of the participants were Orthodox Christians, with a single Muslim participant, and their marital status ranged from unmarried to married. This diversity ensured the collection of a range of opinions regarding GBV in the Awi Zone, Amhara Region. For the qualitative study, thematic analysis was conducted using data from KIIs and IDIs. The findings were classified under four overarching themes [1]: experiences of GBV [2], types and forms of GBV [3], causes of GBV, and [4] consequences of GBV. The findings are presented below with supporting narratives from participants.

4. Theme 1: Experiences of GBV

GBV was found to be prevalent and occurs at home, school, workplace, streets, public vehicles, and even in worship centers. Women were reported to be subjected to different forms of violence in both rural and urban settings.

A 34‐year‐old male MCH and GBV focal person expounded: “GBV is gender‐based violence due to an imbalance of power, which includes physical, sexual, and psychological violence. The effects are unwanted pregnancy, STIs, HIV, sleeplessness, depression, and social withdrawal. It is common in Chagni town and includes rape, biting, threatening, and restricting the economic activities of women.” (KII1).

A 31‐year‐old female police officer also said: “Fights are always expected between women and men who are in unions, and even family mediators cannot stop it because it is culturally acceptable.” (KII2).

Survivors also shared lived experiences. One woman said: “Gender‐based violence among married women is normal. For example, a man near our home always forces his wife to do things against her will and threatens her family if she does not agree.” (IDI4). Others reported daily restrictions: “He doesn't let me visit my family. I must do the household chores, cook, and look after livestock on my own.” (IDI3).

5. Theme 2: Types and Forms of GBV

The most frequently reported forms were physical violence, ranging from punching and slapping to intense beatings with objects.

A survivor recalled: “My husband once broke my teeth with a stone.” (IDI3). Another stated: “He beats me immediately if I question him.” I sometimes sleep without food. When I report to my family, the beating is doubled.“ (IDI5). Culturally, this violence was naturalized. As one woman explained: “A husband is like a corrector. He is supposed to be punished and put his wife on the right path. If he doesn't beat her, he is not a husband.” (IDI3). Sexual violence was also common, and it was frequently framed as a husband's right.

A 34‐year‐old woman explained: “Even if you don't feel like it, you are compelled to have sex. You must follow his orders.” (IDI1). A participant said: “Most people are unaware of the difference between rape and normal sex. Any husband can't rape his wife; it's his right. Even the Qur'an is cited to support it.” (IDI4). Forced sex outside marriage was also described, with women being coerced into transactional sex to pay school fees or rent (IDI5). Emotional abuse occurred in the form of insults, neglect, and extramarital affairs. Survivors described humiliation when told to tolerate adultery and fear of divorce due to stigma, financial dependency, or love for children. One woman explained: “When I think about all these challenges, I think of suicide, especially when my children ask for food I don't have.” (IDI1).

6. Theme 3: Factors Facilitating GBV

Poverty was consistently mentioned as one of the drivers of GBV, leading to property violations, neglect, and economic coercion.

As explained by one woman: “He asked me to bring 10,000 Ethiopian birrs from my family. When I refused, he beat me.“ (IDI2). Low education and poor decision‐making power also reinforced women's vulnerability. As one participant explained: “If women are not educated, they are bound to be dependent and in the hands of men.” (IDI4). Alcohol and drug abuse, and cultural beliefs normalizing violence as a marker of love, also propagated abuse. For instance, one woman stated: “God does not allow me to decide in my own home. My husband can even beat me, and it is a sign of how much he loves me.” (IDI5). Institutional weaknesses were also reported. The legal system was said to be corrupt and unsupportive: “Even if you have evidence, you will not get justice. Cases are covered up, and no one gives attention to them.” (IDI3). Armed conflict was also given as an underlying cause of violence. A police officer explained: “During the conflict, men could run away, but women were at home and faced emotional abuse, sexual assault, and physical injury.” (KII3).

7. Theme 4: Consequences of GBV

The consequences of GBV were described as severe and long‐lasting. Unwanted pregnancy, repeated abortions, infertility, HIV, fistula, and physical trauma were cited by women. A survivor clarified: “I had an abortion in my first pregnancy when my husband beat me. Twice as much the same thing happened. Then I developed secondary infertility.” (IDI5). Another clarified: “Most of the women who come for abortion services are sexual violence survivors from employers or partners, but they are afraid to report.” (IDI1). Emotional consequences included depression, stigma, and suicidal ideation. “Victims are ashamed and depressed; some even move to other places to avoid stigma.” (IDI3). Physical injury was also reported: “My sister's husband broke her arm when he beat her. She says she will never love him again.” (IDI4). Divorce was also a common outcome: “I left my husband because he constantly insulted and beat me, especially when he was drunk. I realized I would always have problems with him, so I left.” (IDI3).

8. Discussion

This study has found that 57% (95% CI: 53%–61%) of women of reproductive age in Awi Zone had ever experienced at least one form of GBV in the past 12 months. This finding is comparable to findings from Dessie town (56.5%) [34], Bahir Dar town (60.5%) [35], and Northern Shewa zone (58%) [36], but greater than those documented from Northwest Ethiopia (37.9%) [37], Tigray (21%) [38], and an estimated 37% national prevalence in a meta‐analysis [39]. On the contrary, it is lower than that reported in Sekota town (64.8%) [29] and Manicaland, Zimbabwe (78.3%) [40]. Similarly high rates of prevalence have also been reported in Northern Iraq, where 66% of women experienced one or more of IPV in the last year [41]. The WHO global estimate of one in three women having experienced physical or sexual IPV or non‐partner sexual violence [42] positions the current finding at the higher end of national and global prevalence. While conflict‐related factors such as displacement were not statistically significant in the multivariable model, the overall context of prolonged civil instability may still contribute indirectly to the high burden of GBV through disruption of social structures, economic hardship, and weakened institutional protection mechanisms. High prevalence may also reflect the patriarchal norms that normalize male authority, as reflected in the qualitative findings [43]. The other reasons may be due to the deeply entrenched gender norms that embrace violence, limited accessibility to protective interventions, weak legal enforcement, and low community surveillance during insecurity. Conflict‐related stressors, including male unemployment, drug use, and militarization, are also associated with higher IPV risk, as shown in other conflict‐affected settings in Sub‐Saharan Africa [44, 45]. These likely also overlap to enhance the observed prevalence over national and global estimates. Women's educational level was found to be the predictor of GBV. Women with no formal education were twice as likely to be victimized compared to those with primary or higher education. This is supported by showing other studies that education empowers women with rights consciousness, negotiation skills, and economic independence, and reduces the acceptability of abuse [46, 47]. Qualitative descriptions augmented this, in that less‐educated women conceptualized violence as unavoidable or warranted, but educated women described self‐respect and countered patriarchal rule. This identifies education as a buffering agent and as a change mechanism for altering community gender role norms. In addition, education is also a mechanism for disrupting intergenerational transmission of gender‐inequitable norms.

Alcohol use emerged as another strong GBV predictor. Quantitatively, women whose partners consumed alcohol were found to be at higher risk of experiencing violence, and qualitatively, survivors indicated beating, insults, or being forced into sex when husbands returned home drunk. For example, a case of her husband's coercive sex and kicking after alcohol consumption was reported by one of the participants. These findings confirm previous Ethiopian research [48] and global reviews linking alcohol misuse with IPV perpetration [49]. Alcohol consumption drastically impairs judgment, incites violence, and justifies violent masculinity, creating an environment where women are most at risk of abuse [50]. Alcohol consumption in this setting may also reflect socially constructed expressions of masculinity, where intoxication is culturally tolerated and may legitimize aggressive control over partners. Harm associated with alcohol is therefore a prime place of intervention to help avert GBV.

Socioeconomic status is also a key factor for GBV. Those with the poorest wealth index were 1.7 times more likely to have been victims of GBV compared to those in the wealthiest. This finding is consistent with recent evidence highlighting how socioeconomic vulnerability and structural instability interact to increase women's risk of GBV in fragile settings [51, 52]. Unemployed women were also at greater risk, consistent with findings in Amhara [34] and Uganda [1]. Semi‐structured interviews provided a picture of how economic dependence forced women to remain in abusive marriages for fear of divorce and poverty. One participant informed me that without the earnings of her husband, her children, and herself, she would have no home or food. Such accounts demonstrate how gender inequality and poverty intersect to curtail the freedom of women and expose them to exploitation and violence, including sexual coercion and human trafficking. This concurs with evidence that economic empowerment interventions could reduce IPV by improving women's bargaining power [53].

GBV outcomes reported here were wide‐ranging. Women reported repeated forced pregnancy, miscarriage, unsafe abortion, infertility, HIV/AIDS, and obstetric fistula. Mental health outcomes included depression, insomnia, suicidal thoughts, and isolation, consistent with international literature implicating IPV with adverse reproductive and mental health outcomes [44, 54]. Women's narratives of miscarriage after attacks or considering suicide due to impoverishment caused by violence highlight the intense burden on their health of GBV. Socially, survivors experienced stigma, divorce, and family breakdown, in line with previous Ethiopian research done in Seqota Town [29]. Such additive effects further contribute to the evidence for GBV as both a personal trauma and as a structural driver of poor maternal health, family pathology, and intergenerational disadvantage.

Generally, this study shows that GBV in the Awi Zone is widespread and structurally ingrained in social, cultural, and economic systems. Quantitative data present determinants and prevalence, while qualitative narratives richly describe the normalization, justification, and perpetration of violence. The intervention points are seen to be education, economic empowerment, alcohol control, and legal accountability. Increasing educational and work opportunities for women, with community mobilization to alter gender norms that are injurious, has reduced violence elsewhere in the African continent [42, 53]. Programs on GBV in Awi Zone thus need a multisectoral strategy bringing together health, justice, education, and community leadership to establish a society where women's rights, dignity, and safety are upheld.

9. Strengths and Limitations of the Study

One of the strengths of this study is the use of primary data collected with a mixed‐method design, combining quantitative and qualitative approaches. Triangulation added richness of understanding, validity, and robustness of findings. The study also covered a wide geographical area, thereby improving the generalizability of findings.

Despite this strength, several limitations should be acknowledged. The cross‐sectional nature of the study limits the ability to establish a causal relationship. The prevalence of gender violence would have been underreported as the topic is sensitive and prone to cause fear, guilt, or stigma that may deter reporting. This was countered with the use of female data collectors and interviewing in secluded locations to minimize social desirability bias and ensure confidentiality. Underreporting cannot, however, be entirely avoided.

The recall bias may have affected participants’ ability to report experiences of violence over the past 12 months accurately. To minimize reporting bias, female data collectors conducted interviews in private settings to ensure confidentiality and reduce discomfort. The qualitative part has a small number of IDIs, which may limit the breadth of perspectives. However, efforts were made to ensure diversity of the participants, and findings were interpreted as exploratory. Finally, the analysis did not explicitly adjust for the clustering inherent in the multistage sampling design. This may have led to underestimation of standard errors and narrower confidence intervals; therefore, findings should be interpreted with caution.

10. Conclusions and Recommendations

This study found that more than half of the Awi Zone reproductive‐aged women had experienced GBV during the previous year, rates above national and international estimates, which were findings influenced by the effects of conflict, poverty, long‐standing gender norms, alcohol intake, and weak enforcement of laws. While work and education were identified as being protective, qualitative studies established that cultural acceptance of wife‐beating, economic dependence, and limited decision‐making ability continue to normalize abuse and silence its victims. Although the identified determinants are consistent with broader sub‐Saharan African evidence, this study provides important context‐specific insights from a conflict‐affected setting, which are critical for localized intervention planning.

Hence, this study recommends that women's empowerment and education, legal enforcement of protection, and community programs to counteract negative norms are most crucial. Multi‐sectoral collaboration among health, education, and legal departments and male engagement in prevention can bring long‐term reform. Future research should investigate the reproductive and mental health consequences of GBV and examine community‐level interventions during conflict to guide practice and policy.

Author Contributions

S.B. contributed to conceiving, designing, and executing the study, including developing the questionnaire, overseeing data collection, conducting statistical analysis, and writing the report. A.G.E., T.E.D., G.A., and Z.S.Y. played key roles in supervision, statistical analysis, and modeling, executing the study, report writing, and manuscript preparation. All authors have read and approved the final version of the manuscript.

Funding

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Transparency Statement

The lead author, Zemenu Shiferaw Yadita, affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request. The corresponding author had full access to all of the data in this study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.