Introduction

Intimate partner violence (IPV) has gained a lot of attention from human rights, health, and social experts, especially after the United Nations General Assembly passed the Declaration on the Elimination of Violence Against Women in 1993 [1]. To achieve gender equality and women’s empowerment, the Sustainable Development Goal 5 (SDG5) highlights the necessity of eliminating violence against women [2].

IPV against women is a widespread public health issue, a violation of human rights rooted in gender inequity, and a roadblock to long-term development [3, 4]. Nearly one-third (35%) of women worldwide have experienced physical and/or sexual violence by an intimate partner or sexual violence by any perpetrator in their lifetime [5]. IPV is the most common form of violence, with 30% of women in long-term relationships stating that their partner has used physical or sexual violence against them [6]. Low-and middle-income countries have a far greater incidence of IPV than high-income countries, with some of the highest prevalence estimates seen in sub-Saharan Africa (SSA) [7].

Evidence suggests that partner alcohol consumption and IPV prevalence varied significantly between countries (3–62% and 11–60%, respectively) [7]. In all 14 countries studied, partner alcohol consumption was linked to a significant increase in the likelihood of women reporting IPV. Furthermore, whereas partner alcohol use accounted for the majority of the association between alcohol use and IPV, the overall prevalence of alcohol use in a specific country also played a key role [7].

This study builds on the findings of the study by Greene et al. [7] that found partner alcohol use to be strongly associated with IPV in 14 countries in SSA by examining the association between partner’s alcohol consumption and IPV among women in SSA using data from the Demographic and Health Survey (DHS). Dissatisfaction in relationship and behavioural disinhibition are some mechanisms through which alcohol use and IPV is related according to the above study [7]. Though a similar study has been conducted in SSA, we took a holistic look at 21 countries and their respective data as well as included covariates such as partner controlling variables and decision-making variables, which were not included in the study by Greene et al. [7]. Additional feature in the present study is the segregation of the association between partner alcohol consumption and IPV per country. Findings from the study will help bring out interventions targeted at partner’s alcohol consumption as a risk factor to IPV and to help achieve the SDG target 5.2.

Materials and methods

Data source and study design

We utilised a cross-sectional analysis of data from the most recent DHS from 21 countries in SSA. Specifically, the data were pooled from the women’s file (individual recode). We included only countries with datasets from 2012 to 2020 and had data on domestic violence variables, partner alcohol consumption, and selected covariates. DHS used a two-stage cluster sampling method was used to recruit the respondents. A detailed sampling technique and data collection procedure have been highlighted in a previous study [8]. A total of 89,229 currently married and cohabiting women aged 15–49 years with complete cases of variables of interest were included in the final analysis (See Table 1). We relied on the Strengthening Reporting of Observational Studies in Epidemiology reporting guidelines in drafting this paper [9]. The datasets are freely accessible via this link: https://dhsprogram.com/data/available-datasets.cfm.

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Table 1. Description of study sample.

https://doi.org/10.1371/journal.pone.0278196.t001

Results

Descriptive statistics

Prevalence of partner’s alcohol consumption and intimate partner violence among women in sub-Saharan Africa.

Table 2 presents the results of the prevalence of partner alcohol consumption and IPV. The pooled prevalence of partner alcohol consumption was 36.3% [36.0–36.6]. The highest prevalence of partner alcohol consumption was found in Burundi (67.1% [65.1–69.1]) whilst the lowest prevalence was recorded in Mali (3.9% [2.8–5.3]). Similarly, the overall prevalence of physical violence, emotional violence, and sexual violence among the women were 19.7% [19.2–20.2], 25.0% [24.5–25.5], and 9.7% [9.3–10.1], respectively. Sierra Leone recorded the highest prevalence of physical (39.0% [36.3–41.7]) and emotional (39.0% [36.6–41.5]) violence, respectively. Physical violence was lowest in Togo (9.9% [8.8–11.1]) whilst emotional violence was found to be lowest in Chad (14.1% [12.4–16.1]). Sexual violence on the other hand ranged from 4.3% [3.7–5.0] in Nigeria to 20.3% [18.9–21.9] in Burundi (Table 2).

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Table 2. Prevalence of partner’s alcohol consumption and intimate partner violence among women in sub-Saharan Africa.

https://doi.org/10.1371/journal.pone.0278196.t002

Distribution of physical, emotional, and sexual violence across partner alcohol consumption and covariates.

Table 3 shows the results of the distribution of physical, emotional, and sexual violence across partner alcohol consumption and the covariates. The results showed significant relationship between partner alcohol consumption and physical, emotional, and sexual violence (p<0.05). Physical violence in particular was found to be higher among women whose partners drank alcohol (29.7%) compared to those whose partners did not drink alcohol (14.0%). Emotional violence was also more prevalent among women whose partners drank alcohol (34.2%) compared to those who had not been exposed (19.8%). Similarly, sexual violence was found to be higher among women whose partners consumed alcohol (14.6%) than among women whose partners had not been exposed to alcohol consumption (6.9%). Further, there was a significant relationship between all the covariates and physical and sexual violence at p<0.05. Also, all the covariates were significantly associated with emotional violence, except for exposure to listening to radio.

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Table 3. Distribution of intimate partner violence across the explanatory variables.

https://doi.org/10.1371/journal.pone.0278196.t003

Association between exposure to partner’s alcohol consumption and experience of intimate partner violence among women in sub-Saharan Africa.

Table 4 illustrates the association between partner alcohol consumption and each of physical, emotional, and sexual violence, while controlling for the covariates. Women whose partners drank alcohol were 2 times more likely to experience physical violence compared to those whose partners did not drink [aOR = 2.37, 95% CI = 2.24–2.50]. The odds of emotional violence was higher among women whose partners drank alcohol as against those whose partners did not drink [aOR = 1.96, 95% CI = 1.86–2.07]. Also, women whose partners drank alcohol were more likely to experience sexual violence [aOR = 2.03, 95% CI = 1.89–2.18].

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Table 4. Multivariable regression analysis of partner’s alcohol consumption and intimate partner violence among women in sub-Saharan Africa.

https://doi.org/10.1371/journal.pone.0278196.t004

Table 5 presents the results on the association between partner alcohol consumption and physical, emotional, and sexual violence per country, controlling for the covariates. The results show that women whose partners drank alcohol had higher odds for experiencing physical and emotional violence across the 21 countries. Additionally, the odds of sexual violence was higher among women whose partners drank alcohol compared to their counterparts whose partners did not in 20 countries, except Namibia.

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Table 5. Association between partner alcohol consumption and intimate partner violence among women in sub-Saharan Africa segregated by country.

https://doi.org/10.1371/journal.pone.0278196.t005

Discussion

In this study, we examined the association between partner’s alcohol consumption and IPV among women in SSA. We found that women whose intimate partners drank alcohol were more likely to experience all types of IPV (physical, emotional, and sexual violence). Our results corroborate the findings from previous studies [23, 26, 27], which reported that partner alcohol consumption increases women’s likelihood of experiencing violence in their intimate relationships. Our finding is consistent with that of Greene et al. [7], who argued that alcohol intake by partners is a common and well-known risk factor for IPV. Similarly, Tumwesigye et al. [24] found partner’s alcohol use as a strong predictor of physical IPV. Due to the detrimental effects of alcohol consumption, the World Health Organization [25] recommends limiting alcohol access and abusive usage due to its strong association with perpetration of physical IPV. Several factors could plausibly explain the observed association between partner’s alcohol consumption and IPV in our study. First, it is assumed that the influence of alcohol on psychological and physical capacities, as well as relationship dynamics could result in a deterioration of couple’s ability to resolve disagreements and this subsequently leads to violence perpetration in an intimate relationship. Also, intimate partner’s alcohol consumption puts financial burdens on the entire family, which subsequently creates an opportunity for partner abuse [26]. Additionally, alcohol drinking may increase misunderstanding of verbal or non-verbal cues and serves as a source of dispute in unions or relationships [27]. Furthermore, alcohol consumption by the intimate partners could have caused aggression, which might have led the partners to perpetrate violent acts against the women [28, 29].

We found that women aged 20–34 were more likely than those aged 15–19 to encounter physical, emotional, and sexual violence as a result of their partner’s alcohol usage. These findings echo those of Maguele, Taylor, and Khuzwayo [30]. In terms of marital status, our study indicated that cohabiting women were more likely to experience physical violence compared to married women. This finding accords with earlier observations from literature [31, 32], which showed that cohabiting women are more likely to experience violence. For instance, Machado et al. [32] found that dating or cohabiting partners were more likely to report physical violence than married spouses. The absence of children, emotions of higher insecurity, conflict, and interpersonal stress predominantly found among cohabiting women could have accounted for the observed finding in our study [33].

Similar to previous studies [1, 34–36], women with higher education were less likely to encounter IPV compared to those with no formal education. These differences could be explained by the fact that educated women are more likely to be and empowered compared to less educated women. In line with this, we found that higher household wealth status had an inverse relationship with physical and emotional violence against women, implying that women in well-off households have more autonomy and are less likely to experience IPV than women in poor households. In comparison to women in poor households, well-off women may be able to make better economic decisions. Another argument is that women in wealthy households have more resources at their disposal and are more empowered in their relationships, making them less vulnerable to intimate partner abuse. However, the higher odds of sexual violence among women from affluent households could be that the women were more likely to defy cultural expectations that place them below men in close relationships, especially in the African context where women are not supposed to refuse sex [37]. Therefore, any attempt by a woman to refuse sex will probably result in violence, as found in our study [37].

Justification of wife beating was also found as a predictor of IPV, an outcome which is consistent with findings from Saud et al. [38]. This justification and acceptance of IPV may lead to the reduction in the rate at which women are likely to report and seek help, and may increase the risk of women experiencing more episodes of partner abuses in the future. Additionally, the women in SSA may feel that their intimate partners can abuse them due to deep-rooted patriarchal norms and beliefs, which reinforce community tolerance for IPV [12]. Also, IPV is internalized when people have supportive views regarding it, which increases the likelihood of future perpetration as well as relational and overt victimization and this could have accounted for the observed finding in our study [12].

A statistically significant association between exposure to interparental violence and IPV was found in our study and this corroborates the findings in a previous study by Aboagye et al. [39]. This further underpins the fact that children are more likely to pick up trait or emulate the attitude of their parents or caretakers. Also, IPV as a normal component of intimate relationships by women who have experienced interparental abuse is another explanation that has been put forth, particularly in sub-Saharan African settings, where intimate relationships are constructed and dictated by cultural beliefs and concepts [39]. This finding highlights the need for early IPV detection and family support interventions and programs that can reduce children’s risk of becoming victims of IPV or abuse or perpetrators in adulthood.

Relatedly, partner controlling behavior has also been found to be a predictor of IPV. Consistent results have been reported in studies conducted in Vietnam [40] and SSA [41], where partner controlling behaviour was associated with women likelihood of experiencing IPV. Thus, the women reported IPV when their intimate partners exhibited one or more controlling behaviours. From our study, behavioral control by partners may be a significant contributor to the etiology of IPV and, thus, may need to be taken into consideration in future studies and IPV-related therapies [41].

Strengths and limitations

The study has a number of strengths. The first major strength is the use of rigorous statistical methodologies to examine the association between partner alcohol consumption and IPV. Also, using nationally representative data assures that our findings are generalizable and repeatable throughout the 21 countries studied. Furthermore, the findings help to fill in gaps in current research on IPV by examining the relationship between partner alcohol intake and IPV. Despite the strengths, it is important to recognize that there are some inherent limitations in this study. Since the data on IPV were self-reported, there could be a possibility of recall bias, which might have influenced the findings. Given the socio-cultural norms that surround issues of IPV in some countries, the data may be prone to social desirability biases, which could affect the results of our study. It is also possible that some communities will be hesitant to report IPV in general; hence, there is the possibility of under-and over-reporting of data. In addition, the cross-sectional nature of the DHS data limits the study’s ability to draw causal inferences on the association between partner alcohol consumption and IPV.

Conclusion

We found that partner’s alcohol consumption increases women’s physical, emotional, and sexual violence in SSA. There is the need to implement behavioural change interventions such as counseling sessions or therapy, alcohol management treatment, and batterer programs targeted at male partners to reduce alcohol consumption. Also, policies should be implemented to improve women empowerment and reduce coercive control in relationships. The findings call for the need to effectively create and organize support networks in addressing IPV among married and cohabiting women. Governments and non-governmental organizations could create it a conscious effort to make education accessible to community members, especially those living in rural and deprived communities.

Acknowledgments

We thank MEASURE DHS for granting us access to the dataset.