The prevalence and social determinants of Intimate partner violence and its association with children under 5 morbidity and mortality in Afghanistan; An implication for global advocacy and women’s rights

Background: Limited knowledge exists concerning the prevalence and drivers of IPV against Afghan women and its association with child morbidity and mortality; thus, further studies are warranted. Methods: : A cross-sectional study, using the data from Afghanistan Demographic and Health Survey (ADHS) conducted in 2015. To estimate the prevalence and associated sociodemographic factors, the analysis was restricted to the women aged 15-49 years who were selected for the IPV module in ADHS 2015 (n=24070). To estimate the morbidity and mortality of children and its association with IPV, the children born in the past 5 years to married women aged 15-49 years who were selected for the IPV module were included (n=22927). The significant level was set at 0.05. Results: : More than half of the Afghan women aged 15-49 years experienced IPV in the past year. Illiteracy (OR= 1.69; 95%CI: 1.19-2.39), living in rural areas (OR= 1.47; 95%CI: 1.19-1.82) being from the Pashtun, Tajik, Uzbak, and Pashai ethnic backgrounds were associated with a higher risk of IPV exposure. In general, the likelihood of child mortality within the first five years was higher among children born to mothers exposed to IPV, particularly physical and sexual even after adjustment for sociodemographic inequalities, the number of antenatal care, and marriage age. In addition, the odds of diarrhea, acute respiratory infection, and fever in the past two weeks were significantly higher among the children of victimized mothers in both adjusted and unadjusted models. Moreover, low birth weight and small birth size were more likely to be observed among the children of a mother who either experienced sexual or physical violence. Conclusion: The findings emphasized the elevated risk of morbidity and mortality among children under 5 born by mothers aged 15-49 years who were exposed to IPV in Afghanistan. A high rate of spousal violence was also observed among Afghan women driven mainly by illiteracy, particularly in rural areas. This calls for immediate action, formulating interventions and protective measures to reduce IPV against Afghan women by engaging all stakeholders. First and foremost could be incorporating IPV screening, as an important predictor of child morbidity and mortality, into maternity and child care programs in Afghanistan.