Abstract
Background
In Nigeria, the relationship between spousal violence and pregnancy termination had not been adequately explored.
Objectives
To assess the prevalence of spousal violence, and examine the relationship between spousal violence and pregnancy termination.
Methods
Data on spousal violence among ever married women was extracted from the 2013 Nigeria Demographic and Health Survey. The outcome variable is pregnancy termination. The explanatory variables were the type of spousal violence experienced by the women in the last 12 months preceding the survey. Descriptive statistical analysis and binary logistic regression were applied using stata version 12.
Results
Results show that 13.8% of women had ever terminated pregnancy; 19.9% had ever experienced at least one type of spousal violence; and women who had ever terminated pregnancy had higher prevalence of all types of spousal violence. Women who had ever experienced spousal physical violence were 9% more likely to experience pregnancy termination (OR=1.09; CI: 1.03–2.86); and women who had ever experienced spousal emotional violence were 33% more likely to experience pregnancy termination (OR=1.33; CI: 0.97–1.95).
Conclusions
Spousal violence is significantly related to pregnancy termination. Improving women's sexual and reproductive health in the country requires fresh initiatives that address spousal violence to further reduce women's exposure to pregnancy termination.
Keywords: Spousal violence, pregnancy termination, married women, Nigeria
Introduction
One hundred years of Nigerian nationhood (1914–2014) have accomplished little in terms of improving the health and well-being of women. Women's health particularly sexual and reproductive health remain greatly undermined by widespread socio-cultural practices that continue to treat Nigerian women mostly as inferior to men. One of these culturally sanctioned practices is wife battery which is now globally noted and discussed in the context of spousal violence. Spousal violence is a type of gender-based violence that can occur among both heterosexual and same-sex partners. It refers to physical, sexual or psychological harm perpetrated by a current or former partner or spouse1. However, evidence abounds that physical violence is not only the dominant form of spousal violence, but is also the precursor of other forms of violence in intimate relationships2–3.
Studies have shown that women living with female partners experience less spousal violence compared with women living with male partners4 indicating that men are the key perpetrators of spousal violence. Recent evidence from a Demographic and Health Survey (DHS) 2000–2012 assessment of violence against women aged 15–49 years in 34 countries show that not less than 10% of ever married women surveyed experienced physical and/or sexual violence. The survey further reveals that in 6 countries, more than 10% of the women experienced violence during their most recent pregnancy5.
In Nigeria, the 2008 Nigeria Demographic and Health Survey (NDHS) found that 22.4% of the surveyed women had experienced physical violence; 5.3% had experienced physical and sexual violence; and 29.3% had experienced physical or sexual violence. It further found that 5.1% of women experienced violence during pregnancy; and current husband/partners were the dominant perpetrators of physical and sexual violence against every married woman6. The most recent DHS in the country also found that among ever-married women, 14% had experienced spousal physical violence, 5% had experienced spousal sexual violence, and 19% had experienced spousal emotional violence7. Prevalence of spousal violence thus continued unabated in the country in spite of nearly a decade of the design and implementation of National Gender Policy that mainly seeks to promote the enjoyment of women's fundamental human rights and sexual and reproductive health8.
Research over the decade has provided ample evidence of the negative effects of spousal violence on women's reproductive health. These include homicide, suicide, physical injuries, unwanted pregnancies, increased vulnerability to sexually transmitted infections (STIs) including HIV, abortion, gynaecological complaints, and low body mass index9–13.
Many studies have highlighted the relationship between spousal violence and other issues14–19. Some recent studies have also related spousal violence to pregnancy termination20–22. However, most of the studies linking spousal violence to pregnancy termination were not conducted in Nigeria. Hence, the relationship has not been adequately explored in the country. The current study addressed this limitation by assessing prevalence of spousal violence among women who had ever experienced pregnancy termination; and examining the relationship between spousal violence and pregnancy termination. By impeding women's physical, sexual, and reproductive health over a long period23, it is expected that spousal violence may influence pregnancy termination.
Further literature
Spousal violence exists in all countries though with varying degrees of prevalence. In a review of 50 population-based studies conducted at various times in 36 countries between 1982 and 1999, it was found that among women who had ever been in an intimate relationship, physical assault on women by a male partner ranged from 10% in Philippines and Paraguay to 69% in Nicaragua24. These rates were similar to those reported in a multi- country study conducted in nine countries (Cambodia, Colombia, the Dominican Republic, Egypt, Haiti, India, Nicaragua, Peru, and Zambia). In the study, the proportion of women who had lifetime experience of spousal physical violence ranged from 16.4% in Cambodia to 40% in Colombia; spousal sexual violence ranged from 3.6% in Cambodia to 17% in Haiti; and spousal emotional violence also ranged from 11.5% in Colombia to 29% in Nicaragua25.
Against the backdrop of growing international concern about violence against women, the WHO in 1997 initiated a multi-country study to assess the prevalence, health consequences, and associated risk factors of violence against women in ten countries (Bangladesh, Brazil, Ethiopia, Japan, Namibia, Peru, Samoa, Serbia and Montenegro, Thailand, and United Republic of Tanzania). It was found in the study that more of the surveyed women had experienced spousal physical violence compared with sexual or emotional violence. Among the countries studied, both physical and sexual violence were less prevalent in Japan compared with Bangladesh, Ethiopia, and Thailand where spousal sexual violence was reported to be more frequent than physical violence26.
The variation across countries in women's experience of spousal violence was further revealed by findings from a couples study conducted in ten demographic and health survey (DHS) countries (Bangladesh, Bolivia, Dominican Republic, Haiti, Kenya, Malawi, Moldova, Rwanda, Zambia, and Zimbabwe). In the study, the prevalence of spousal physical violence ranged from 15% in the Dominican Republic to 71% in Bangladesh which also had the highest rates of spousal sexual violence27. In another study involving men and women in Ghana and Uganda, higher experience of spousal violence among women than men was found. For instance in Uganda, 47.2% of women reported ever experiencing spousal physical violence compared with 19.1% of men who reported ever experiencing spousal physical violence. Similarly while 3.7% of the women had experienced physical and sexual violence only, fewer proportions of men (0.5%) experienced physical and sexual violence28.
In a recent couple study conducted in Kenya, Malawi, Rwanda, Zambia and Zimbabwe, it was found that among women, lifetime experience of spousal physical violence was lowest in Malawi (19.6%) and highest in Rwanda (53.9%); and spousal sexual violence ranges from 11.7% in Rwanda to 16.7% in Zambia29. These rates were comparable to lifetime experience of spousal violence reported in a study conducted in Nepal. In the study, it was found that among currently married women 28% had experienced spousal physical or sexual violence30.
In spite of evident cases of worldwide prevalence of spousal violence, studies have continued to maintain that large cases of spousal violence remain unreported due to wrongful perception of spousal violence as a private or family affair. In Nigeria, substantial proportion of women agreed that a male partner is justified in physically assaulting his wife31–32. Such perception or attitude more often than not encourages the under reporting of the incidence and prevalence of spousal violence. While prevalence of spousal violence even during pregnancy33 is not in doubt in many countries, however, there is insufficient knowledge about the relationship between spousal violence and pregnancy termination in Nigeria. In other climes, studies have provided substantial evidence that exposure to spousal violence is related to pregnancy termination34–36. In one of the few studies conducted in Nigeria, it was found that women exposed to spousal violence had higher likelihood of miscarriages, induced abortions and stillbirths37. Against the backdrop of women's poor sexual and reproductive health, it is expected that more studies will be conducted in the country to further determine the relationship between spousal violence and pregnancy termination.
Materials and methods
Data source
Data on spousal violence among ever married women was extracted from the 2013 NDHS. We analysed a weighted sample of 21,196 from the total of 38,948 women included in the survey having excluded women who were not included in the domestic violence module and those who were unmarried. Unmarried women were excluded from the study for two reasons. On the one hand, out of the 27,634 women selected for the domestic violence module in the 2013 NDHS, 21,196 women were ever married while 6,438 women were unmarried. Comparison of the frequency of pregnancy termination among the two groups of women may be misleading because of the dominance of ever married women. On the other hand, the exclusion of unmarried women who never terminated a pregnancy further reduces the size of unmarried women which affected application of the multivariate analysis.
Variables
The outcome variable in the study is pregnancy termination which is dichotomised into ‘ever’ or ‘never’ experienced pregnancy termination. Pregnancy termination as measured in the study did not distinguish between spontaneous or induced abortion since both could be affected by spousal violence. It was captured in the NDHS by asking women whether they had ever had pregnancy termination or not. The key explanatory variables were the type of spousal violence experienced by the women in the last 12 months preceding the survey.
These are physical, sexual, and emotional violence, with all captured by a number of specific intimate partner violent act. Physical violence was based on women's experience of whether partner had ever: pushed, shook or threw something; slapped; punched with fist or something harmful; kicked or dragged; tried to strangle or burn; threatened with knives, gun or other weapons; and twisted her arm or pull her hair.
Sexual violence was based on women's experience of partner ever physically forcing her to have sex or other sexual acts when not wanted. Emotional violence was measured by women's experience of whether partner had ever: humiliated her; threatened her with harm; and insulted or made her feel bad. A number of background variables cutting across individual, relationship and community/society were also measured. These include woman/partner's education, partner alcoholic consumption, childhood experience of domestic violence, household decision, household wealth, and employment status. These variables were selected for inclusion having been found to be correlates of pregnancy loss, induced abortion and spousal violence in previous studies12, 21 & 34.
Statistical analysis
All statistical analyses were performed using Stata sequel to applying standardised sample weights and adjusting standard errors for both clustering and stratification with the ‘svyset’ command. Frequency table was used to describe sample characteristics and pregnancy termination. The chi-square statistic was used to ascertain the relationship between spousal violence and the background variables. This was done with the view of removing non significant variable from the multivariate analysis. Binary logistic regression was performed to examine the influence of spousal violence on pregnancy termination. The logistic regression was replicated in two models with Model 1 including all the variables and Model 2 including only spousal violence.
Limitation of the study
In understanding the inference made in the study, it is important to note that our analysis did not distinguish between spontaneous or induced abortion. This may exaggerate the number of pregnancy termination associated with spousal violence. Though, we excluded unmarried women in the analysis; the exclusion however does not in any way suggest that partner violence or pregnancy termination do not occur among unmarried women.
Results
Table 1 presents background characteristics of the respondents. Educational attainment is poor among the women. Nearly half of the respondents had no formal education. Among those with educational attainment, secondary education was the dominant educational level attained, while higher education was the least achieved among the women.
Table 1.
Descriptive statistics of married women included in the domestic violence module, by selected background variables and pregnancy termination, NDHS, 2013
| Background variable | Number of women |
Percentage |
| Woman's Education | ||
| None | 9,980 | 47.1 |
| Primary | 4,176 | 19.7 |
| Secondary | 5,472 | 25.8 |
| Higher | 1,568 | 7.4 |
| Partner's Education | ||
| None | 8,410 | 39.7 |
| Primary | 3,858 | 18.2 |
| Secondary | 5,993 | 28.3 |
| Higher | 2,935 | 13.8 |
| Partner alcoholic consumption | ||
| Does not drink | 17,255 | 81.4 |
| Drinks | 3,941 | 18.6 |
| Childhood experience of domestic violence | ||
| Father never beat mother | 17,935 | 84.6 |
| Father ever beat mother | 3,261 | 15.4 |
| Household wealth index | ||
| Lowest | 9,193 | 43.4 |
| Middle | 3,926 | 18.5 |
| Highest | 8,077 | 38.1 |
| Place of residence | ||
| Urban | 7,883 | 37.2 |
| Rural | 13,313 | 62.8 |
| Participation in Household Decision | ||
| Joint dominance | 8,725 | 41.2 |
| Male dominance | 12,471 | 58.8 |
| Employment status | ||
| Woman not working | 6,327 | 29.8 |
| Woman working | 14,869 | 70.2 |
| Pregnancy Termination | ||
| Never terminated pregnancy | 18,277 | 86.2 |
| Ever terminated pregnancy | 2,919 | 13.8 |
| Total | 21,196 | 100.0 |
Source: 2013 NDHS
The pattern of educational attainment by partner's education showed no significant variation from the distribution of women by educational attainment. More than onethird of the women's husbands/partners had no formal education with secondary education been the dominant educational level attained among the partners. Less than two-fifths of the women reported that their husband/partner did not consume alcohol. Majority of the respondent had no childhood experience of domestic violence. More than one-third of the women were either in the lower or highest wealth groups. Slightly more than two-thirds are currently working with most of them resident in rural parts of the country. For more than half of the respondents, household decisions were male dominated. Majority of the sampled women had not experienced pregnancy termination. When pregnancy termination was disaggregated based on the six geo-political zones of the country, pregnancy termination experience was higher among Southern women than Northern women (Table 2). The variations in the rates of termination of pregnancy across the geo-political zones was statistically significant (χ2=13.7, p<0.05).
Table 2.
Distribution of married women who had ever experienced pregnancy termination by geo-political zones, NDHS, 2013
| Geo-political zone | Ever Experienced | Ever Experienced | Total | |||
| Number | % | Number | % | Number | % | |
| North Central (NC) | 291 | 10.0 | 2,638 | 90.0 | 2,929 | 13.8 |
| North East (NE) | 522 | 15.0 | 2,954 | 85.0 | 3,476 | 16.4 |
| North West (NW) | 823 | 11.0 | 6,696 | 89.0 | 7,519 | 35.5 |
| South East (SE) | 356 | 19.0 | 1,514 | 81.0 | 1,870 | 8.8 |
| South South (SS) | 349 | 16.0 | 1,833 | 84.0 | 2,182 | 10.3 |
| South West (SW) | 578 | 18.0 | 2,642 | 82.0 | 3,220 | 15.2 |
| Total | 2,919 | 13.8 | 18,227 | 86.2 | 21,196 | 100.0 |
| Statistic | Df = 5 | χ2 = 13.7 | p<0.05 | |||
Source: Author analysis based on 2013 NDHS
Table 3 presents the prevalence of spousal violence among the sampled women as well as the differentials of spousal violence by pregnancy termination experience. Irrespective of pregnancy termination experience, the dominant type of spousal physical violence was being slapped by a partner (8.2%). The least common types of spousal physical violence were spousal attempt to ever strangle or burn the female partner, and spouse attempt to ever threaten female partner with knives, guns or other weapons with each type accounting for a proportion of 0.7%. After combining all types of spousal physical violence into a composite spousal physical violence, results show that 9.9% of the women had ever experienced at least one type of spousal physical violence. Analysis by pregnancy termination experience reveals that women who had ever terminated a pregnancy consistently had higher prevalence of all types of spousal physical violence compared with those who have never terminated a pregnancy. For instance, 14.8% of women who had ever experienced a pregnancy termination had also experienced at least one type of spousal physical violence compared with 9.1% who had never experienced a pregnancy termination.
Table 3.
Distribution of married women who had ever experienced various forms of spousal violence in the last twelve months preceding the survey by Pregnancy termination, NDHS, 2013
| Type of spousal violence | Never terminated pregnancy Number (%) |
Ever terminated pregnancy Number (%) |
Total Number (%) |
Statistic |
| Physical violence | ||||
| Spouse ever pushed, shook or threw something |
775 (4.2) | 219 (7.5) | 994 (4.7) | χ2=33.0* |
| Spouse ever slapped | 1,374 (7.5) | 361 (12.4) | 1,735 (8.2) | χ2=35.7* |
| Spouse ever punched with fist or something harmful |
374 (2.1) | 125 (4.3) | 499 (2.4) | χ2=31.3* |
| Spouse ever kicked or dragged | 597 (3.3) | 153 (5.2) | 750 (3.5) | χ2=20.6* |
| Spouse ever tried to strangle or burn | 90 (0.5) | 51 (1.8) | 141 (0.7) | χ2=45.6* |
| Spouse ever threatened with knive, gun or other weapons |
109 (0.6) | 47 (1.6) | 156 (0.7) | χ2=22.1* |
| Spouse ever twisted her arm or pull her hair |
341 (1.9) | 129 (4.4) | 470 (2.2) | χ2=42.6* |
| At least one type of physical violence | 1,655 (9.1) | 431 (14.8) | 2,087 (9.9) | χ2=43.1* |
| Sexual violence | ||||
| Spouse ever physically forced sex when not wanted |
571 (3.1) | 160 (5.5) | 731 (3.5) | χ2=23.9* |
| Spouse forced other sexual acts when not wanted |
225 (1.2) | 58 (2.0) | 283 (1.3) | χ2=6.3* |
| At least one type of sexual violence | 647 (3.5) | 170 (5.8) | 817 (3.9) | χ2=19.9* |
| Emotional violence | ||||
| Spouse ever humiliated her | 1,398 (7.6) | 368 (12.6) | 1,766 (8.3) | χ2=38.2* |
| Spouse ever threatened her with harm | 740 (4.1) | 195 (6.7) | 935 (4.4) | χ2=21.9* |
| Spouse ever insult or make feel bad | 2,194 (12.0) | 564 (19.3) | 2,759 (13.0) | χ2=54.6* |
| At least one type of emotional violence | 2,701 (14.8) | 687 (23.6) | 3,388 (16.0) | χ2=65.2* |
| Other types | ||||
| At least one type of physical and sexual violence |
1,942 (10.6) | 499 (17.1) | 2,441 (11.5) | χ2=48.2* |
| At least one type of physical and emotional violence |
3,252 (17.8) | 799 (27.4) | 4,052 (19.1) | χ2=72.6* |
| At least one type of spousal violence | 3,380 (18.5) | 829 (28.4) | 4,209 (19.9) | χ2=75.1* |
Source: Author analysis based on 2013 NDHS,
p<0.05
Sexual violence was least reported among the respondents compared with physical or emotional violence. Analysis by pregnancy termination experience showed that women who had ever experienced pregnancy termination had been more sexually abused by their male partners compared with those who had never experienced pregnancy termination. When the two types of spousal sexual violence were combined, only 3.9% of the respondents had ever been forced to sex or other sexual acts by the male partners. Irrespective of pregnancy termination experience, the dominant type of spousal emotional violence was being insulted or made to feel bad by the male partner (13.0%). The least common type of spousal emotional violence was being ever threatened with harm by a male partner (4.4%). Analysis by pregnancy termination experience revealed that women who had ever terminated a pregnancy consistently had higher prevalence of all types of spousal emotional violence compared with those who have never terminated a pregnancy. After combining all types of spousal emotional violence into a composite spousal emotional violence, result showed that 16.0% of the women had ever experienced at least one type of spousal emotional violence. Overall, 19.9% of the women had experienced at least one type of spousal violence. Disaggregated data of spousal violence revealed that major forms of spousal violence were dominant in the Southern region particularly in the South East geopolitical zone (Table 4).
Table 4.
Percentage distribution of married women who had ever experiences various forms of spousal violence in the last twelve months preceeding the survey by geo-political zone, NDHS, 2013
| Type of spousal violence | Geo-political zone | Total | |||||
| NC | NE | NW | SE | SS | SW | ||
| At least one type of physical violence | 13.8 | 10.7 | 3.6 | 14.6 | 17.1 | 12.1 | 9.9 |
| At least one type of sexual violence | 4.4 | 10.3 | 1.3 | 4.6 | 4.6 | 1.4 | 3.9 |
| At least one type of emotional violence | 21.5 | 23.2 | 8.4 | 26.0 | 18.5 | 13.3 | 16.0 |
| At least one type of physical and sexual violence | 15.0 | 16.6 | 4.5 | 15.5 | 18.1 | 12.5 | 11.5 |
| At least one type of physical and emotional violence | 25.1 | 26.5 | 9.6 | 28.7 | 24.3 | 18.8 | 19.1 |
| At least one type of spousal violence | 25.7 | 28.9 | 10.0 | 29.0 | 25.1 | 19.0 | 19.9 |
Source: 2013 NDHS
Table 5 presents the results of chi-square tests performed to examine the relationship between the background variables and spousal violence. With the exclusion of place of residence, all the variables were significantly associated with spousal physical and emotional violence. However, only three of the selected variables (partner's education, partner's alcoholic consumption, and household wealth) were significantly associated with spousal sexual violence. Table 6 presents results of association between spousal violence and pregnancy termination using multivariate logistic regression. In Model 1, women who had ever experienced spousal physical violence were 9% more likely to experience pregnancy termination than women who had never experienced spousal physical violence (OR=1.09, p<0.05). The likelihood of pregnancy termination was 8% higher among those who had experienced spousal sexual violence (OR=1.08, p<0.05) than women who had never experienced spousal sexual violence. Women who had ever experienced emotional violence were 33% more likely to experience pregnancy termination than women who had never experienced spousal emotional violence (OR=1.33, p<0.05). Similarly, the odds of pregnancy termination were consistently higher for women with exposure to at least one specific form of spousal violence or at least one type of spousal violence. After controlling for the effects of background variables in Model 2, all forms of spousal violence remain consistent predictors of pregnancy termination.
Table 5.
Association of selected background variables with spousal violence
| Background variable | Physical violence χ2-value |
Sexual violence χ2-value |
Emotional violence χ2-value |
| Woman's education | 65 ** | 5.4NS | 30 ** |
| Partner's education | 552 ** | 100 ** | 260 ** |
| Partner alcoholic consumption | 188** | 92 ** | 225 ** |
| Childhood experience of violence | 85** | 5NS | 37 ** |
| Male dominance of household decision | 72 ** | 0.7NS | 86 ** |
| Economic stress | 48 ** | 0.5 NS | 29 ** |
| Household wealth | 10 ** | 9.0 * | 7.2 * |
| Place of residence | 0.9 NS | 5.0 NS | 2 NS |
p<0.05
p<0.01
NS Non Significant
Table 6.
Binary logistic regression analyses identifying spousal violence and background characteristics associated with ever having experienced pregnancy termination
| Variable | Model 1 | Model 2 | ||
| Odds Ratio | 95% CI | Odds Ratio | 95% CI | |
| Physical violence | ||||
| Never experience | Ref. | Ref. | Ref. | Ref. |
| Ever experience | 1.09 ** | 1.03–2.86 | 1.26 ** | 0.77–2.07 |
| Sexual violence | ||||
| Never experience | Ref. | Ref. | Ref. | Ref. |
| Ever experience | 1.08 ** | 0.95–1.39 | 1.04 * | 0.62–2.78 |
| Emotional violence | ||||
| Never experience | Ref. | Ref. | Ref. | Ref. |
| Ever experience | 1.33 ** | 0.97–1.95 | 1.42 ** | 1.03–1.57 |
| Physical/sexual | ||||
| Never experience | Ref. | Ref. | Ref. | Ref. |
| Ever experience | 1.04 * | 1.02–1.75 | 1.26 ** | 0.98–1.28 |
| Physical/sexual/emotional | ||||
| Never experience | Ref. | Ref. | Ref. | Ref. |
| Ever experience | 1.49 ** | 1.02–1.55 | 1.63** | 1.06–1.85 |
| Partner education | ||||
| None | Ref. | Ref. | na | na |
| Primary | 0.74** | 0.61–0.88 | na | na |
| Secondary | 0.89NS | 0.76–1.05 | na | na |
| Higher | 0.73** | 0.60–0.89 | na | na |
| Partner alcoholic drink | ||||
| Does not drink | Ref. | Ref. | na | na |
| Drinks | 1.73** | 0.64–1.84 | na | na |
| Wealth index | ||||
| Lowest | Ref. | Ref. | na | na |
| Middle | 0.95NS | 0.78–1.14 | na | na |
| Highest | 0.79* | 0.68–0.93 | na | na |
p<0.05
p<0.01;
‘Ref’ means reference category, ‘na’ means not available
Discussion
In this study, we further assessed the prevalence of spousal violence and examined its relationship with pregnancy termination using the most recent DHS in Nigeria. The use of Nationally representative sample in the study enhances the validity and analysis of the concepts measured in the study. We excluded unmarried women from the analysis and were unable to separate spontaneous and deliberate pregnancy termination in the study. These may not only under report the extent of pregnancy termination among women in the country, but also prevent assessment of the specific relationships between spousal violence and the two types of pregnancy termination. Our analysis thus relates to the prevalence of pregnancy termination irrespective of types among married women experiencing or not experiencing spousal violence in the country. In spite of these limitations, findings from the study are comparable to findings in existing studies.
Overall, 19.9% of the women had experienced at least one type of spousal violence, and 13.8% of the women had experienced at least one pregnancy termination. The prevalence of spousal violence as found in this study is comparable with the range of prevalence found elsewhere26–28, 33. However, the extent of spousal violence found in the current study differs markedly from findings in a recent study where more than a quarter of the women experienced at least one type of spousal physical violence compared with the one-tenth reported in the current study. The prevalence of sexual violence and other types of spousal violence were also found to be lower than the prevalence found in the study34. This variation may be explained by under reporting of spousal violence in Nigeria and further points to the need to develop means of encouraging women to speak up about spousal violence in the country.
The 13.8% prevalence of termination of pregnancy found in the study also contrasts with the Bangladeshi study where 21% of women surveyed have ever had a pregnancy termination. The proportion is however higher compared with the 5.8% prevalence of pregnancy termination in the last five years preceding the Bangladeshi study34. Our findings confirm that women who experience spousal violence have elevated risk of pregnancy termination as found in an earlier Nigerian study. For instance, we found 5.8% and 3.5% prevalence of spousal sexual violence respectively among women who experienced and never experienced pregnancy termination consistent with the 6% and 3% found in the Nigerian study37.
The study provided additional evidence that women's education, partner's education, partner's alcoholic consumption, and childhood experience of domestic violence were among the multiple factors that predisposed women to spousal violence. Though, women's experience of pregnancy termination in Nigeria is usually under reported due to the existing law in the country which criminalises all pregnancy termination not connected to saving either the life of the mother or the unborn child, however, based on the number of women who reported to have ever terminated a pregnancy, we found in consonance with earlier findings20–22, 36 that spousal violence is significantly associated with pregnancy termination.
Women who had ever had a pregnancy termination were found to have higher experience of all types of spousal violence indicating that spousal violence may aid increase in the likelihood of pregnancy termination among women.
It is easy to speculate why spousal violence influences women's demand for pregnancy termination since studies20–22 have established that partner violence leads to unprotected sex and unwanted pregnancy that may increase the demand for both legal and induced abortion.
In a country like Nigeria where spousal violence has not attracted serious legal sanctions, the prevalence of spousal violence may continue unabated with more likelihood of induced abortion and its associated consequences for women's sexual and reproductive health in the country. Considering the fact that most women in violent relationship may not necessarily desire to quit such relationships, it is easy to speculate that women in such situation may go through pregnancy termination more than once since spousal violence particularly physical or sexual violence more often than not occurs not once, but continuously and over a long period of time. This is an additional reason why policies promoting universal access to contraceptives in the country must be redesigned to target more socio-cultural issues affecting women's health in the country. The demand for pregnancy termination is likely to reduce among women experiencing spousal violence if they have access to effective modern contraceptives. Future studies may identify more socio-cultural correlates of women's reproductive health by augmenting data from the Nationally representative sample with data generated from qualitative studies.
Spousal violence in the country continues to endanger women's health mainly due to the near absence of laws on domestic violence. As noted in the 2006 National Gender Policy, spousal violence particularly spousal physical violence is not recognised as a serious crime in the country unless it leads to grievous hurt defined as emasculation, permanent loss of sight, ability to hear or speak, facial disfigurement, deprivation of any member joint, bone fracture or tooth dislocation. The 2006 National Gender Policy may therefore fail to improve women's sexual and reproductive health in the country if not complimented by the enactment of adequate laws that protect the physical integrity of women's body and reduces their vulnerability to pregnancy termination. The contemporary challenge for the Nigerian Nation is therefore to ensure that within the first decade of the next one hundred years, legal reforms are pursued with new vigor. Women in the country must be fully mobilised to recognize sexual and reproductive rights as basic human rights that must be respected by all men particularly men in intimate relationships. However, this basic right may remain unenforceable even in the next one hundred years if adequate laws are not enacted. In the interim, improving educational opportunities among women in the country will go a long way to improve the reproductive health and general wellbeing of women in the country. The current situation of large proportions of uneducated women particularly in the Northern region of the country may continue to encourage the acceptance of spousal violence as a ‘domestic affair’ between partners.
Conclusion
This study affirms that a relationship exists between spousal violence and pregnancy termination. Improving women's sexual and reproductive health in the country requires fresh initiatives that address spousal violence to further reduce women's exposure to pregnancy termination. It is suggested that the National Assembly expedite actions on the enactment of laws protecting women's sexual and reproductive health. Non government actors such as women groups must step up actions for mobilising women to demand total elimination of all forms of spousal violence in the country.
Acknowledgements
The author appreciates and thanks the National Population Commission (NPC) [Nigeria], ICF International and MEASURE DHS Project for making the datasets available for use.
Conflict of interest
The author declares no conflict of interest
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