Improving the quality of sexual and reproductive health and rights (SRHR) through pre-service training, research, and evidence-based clinical care delivery in Sub-Saharan Africa

Background
Gender-based violence (GBV) against women is a global health issue, affecting one in three women worldwide. Exposure to GBV during pregnancy poses significant health risks to the mother and her foetus, leading to various complications. This study aimed to determine the prevalence, types, and factors associated with GBV among pregnant women in Northern Uganda.

Methods
A cross-sectional study was conducted at Gulu Regional Referral Hospital's antenatal care clinic from June to August 2023. Data were collected using semi-structured questionnaires in English or Acholi. Participants were selected through systematic random sampling. Information on socio-demographic characteristics, partner attributes, and GBV exposure was collected. Descriptive statistics and modified Poisson regression analyses were performed using STATA 18.0. Associations between variables and GBV were reported as adjusted prevalence ratios (aPR), with p<0.05 considered statistically significant.

Results
Among the 339 participants, the mean age (standard deviation) was 26.1(5.5) years. Overall, 73.2% (n=248) of the participants were exposed to GBV in pregnancy. The most common form of GBV was controlling behaviour by male partners (61.9%, n=210), followed by emotional violence (34.8%, n=118), economic violence (29.5%, n=100), sexual violence (28.9%, n=98), and physical violence (16.2%, n=55). Factors associated with GBV included being in a polygynous marriage (aPR: 1.2, 95% CI: 1.03-1.31, p=0.013), having poor (aPR: 1.6, 95% CI: 1.32-1.89, p<0.0001) or good (aPR: 1.2, 95% CI: 1.03-1.51, p=0.026) versus perfect relationship with the husband's family, week of amenorrhea (aPR: 1.01, 95% CI: 1.003-1.02, p=0.006), and maternal age (aPR: 0.98, 95% CI: 0.97-0.99, p=0.003).

Conclusions
GBV during pregnancy, particularly controlling behaviour by male partners, is highly prevalent in Northern Uganda. To mitigate the negative impacts on maternal and foetal health, targeted interventions by the Ministry of Health, development partners, and other stakeholders are urgently needed to prevent and manage GBV in pregnancy.

Keywords: Gender Based Violence, Pregnancy, Antenatal care, Northern Uganda