Trends and Factors Associated with Sexual Spousal Violence in Zambia: A Multilevel Analysis

Background: Sexual violence against women is a major social and public health problem with wide-ranging consequences on the victims. Although there are a few studies examining factors associated with sexual violence in low resource societies, there are limited studies focusing particularly on sexual violence among women who are ever married or living together with a partner. Our study sought out to examine the individual and contextual factors associated with sexual violence among this demographic and how these factors vary across communities and over time. Method We used data from the 2007, 2013/14 and 2018 waves of the Zambia Demographic and Health Surveys (ZDHS) consisting of a total of 21020 women of reproductive age group of 15–49 years old. Trends in sexual spousal violence by selected factors across the three ZDHS phases were analyzed using bivariate statistics and multilevel logistic regression models. Multilevel models were also fitted on the pooled data, including all the survey years, to examine individual and contextual level predictors of sexual spousal violence as well between cluster variations in sexual spousal violence. Results The results show that the prevalence of sexual violence remain high in Zambia, with a slight decrease over time, from 16.3% in 2007 through to 14.7% in 2018. Trends analysis show that the prevalence rate among women who have attained higher education, are in the highest wealth quintile, reside in urban areas, have decision-making authority have decreased significantly between 2007nand 2018. Contrarily, among women who tolerate violence and those who live with alcohol consuming partners, sexual violence prevalence rates have increased over time. In the consolidated multilevel model, having primary education (AOR = 1.18; 95% CI 1.02–1.36), having an alcohol consuming partner (AOR = 1.76; 95% CI 1.61–1.93), having no decision-making authority (AOR = 1.19; 95% CI 1.09–1.31), witnessing parental violence (AOR = 1.47; 95% CI 1.34–1.60), having a controlling partner (AOR = 3.41; CI 2.96–3.92) and being in a polygynous relationship (AOR = 1.31; 95% CI 1.16–1.49) is significantly associated with higher odds of sexual spousal violence. While women who occupy the highest wealth quintile (AOR = 0.72; 95% CI 0.57–0.90) and those who live in rural areas (AOR = 0.83; 95% CI 0.72–0.96) have lower odds of experiencing sexual spousal violence. Conclusion Policy strategies aimed at curbing sexual violence against women should not neglect women who are currently marriage, in partnerships or those who are formerly married. Designing social and public health interventions targeting especially women in lower wealth quintile is vital to reduce sexual spousal violence. Additionally, social and cultural ideologies and practices which privilege men with power over women are still risk factors for sexual violence and policy interventions should be targeted at toning down masculinity undertones.