Hygiene and Environmental Health Advances (Sep 2023)
Access to water sources and intimate partner violence against women in 26 Sub-Saharan African countries
Abstract
Background: Intimate partner violence (IPV) against women is a serious problem in many developing countries. Longer distance traveled to access water services may affect women's ability to meet domestic obligations and results in violence. However, the associations between times spent by women to access water services and intimate partner violence against women in Sub-Saharan Africa (SSA) remain unknown. Methods: We used population-based data collected from demographic and health surveys (DHS) in 26 SSA, to examine the associations between round-trip time to water sources and IPV. We estimated round-trip time to water sources based on the self-reported experience of women through their time spent collecting water during the period of 2008 and 2020 as presented in the DHS surveys. Primary outcomes were all self-reported and were derived from the DHS questionnaires about IPV, especially physical violence. We categorized IPV into two groups (Severe and less severe IPV). Respondents who reported being kicked, strangled, threatened with a knife/gun or other weapons by their husbands, or hurt were pooled together and labelled as having experienced severe IPV. Those who claimed to have been pushed, had their arms twisted, or had their hair pulled were grouped and classified as less severe forms of violence. Multivariable logistic regression was performed by fitting crude models and adjusted models. We also conducted a sensitivity analysis, stratification, and country-specific analysis to examine the contributions of these factors to the associations between round-trip time to water sources and IPV. The estimated results are presented as an odds ratio (OR) and their 95% confidence interval (CI). Results: A total of 14,714 (11.2%) women faced severe IPV and 38,222 (28.9%) faced less severe IPV. Results showed that a 30 min increase in round-trip fetching time was associated with an increase in severe IPV and the crude OR was 1.06 (95% CI: 1.05, 1.07) for all 26 countries. After adjusting for covariates, the association of round-trip time to water sources and severe IPV remained positive and significant with an OR of 1.03 (95% CI: 1.01, 1.05). Furthermore, there were positive and significant associations between round-trip time and less severe IPV before and after adjusting for covariates. There were positive associations between round-trip time to basic access to water sources and severe IPV with an OR of 1.08 (95% CI: 1.05, 1.10). For potential effect modifiers, our results revealed disparities in IPV estimates stratified by husbands who consumed alcohol, level of education of husbands, and age of respective women. There were differences in the estimates between countries, the largest increment in severe IPV was observed in Comoros, Sierra Leone, and Namibia. Conclusions: This cross-sectional study provides persuasive evidence for the association between round-trip time to water sources and IPV. Our results highlight the need to protect women against IPV by ensuring proper access to water services in communities faced with water insecurity.
