Unraveling the nexus between domestic violence and women’s self-rated health status in sub-Saharan Africa: a multi-country investigation for advancing SDG 3 and 5 – BMC Women’s Health

Report on the Association Between Domestic Violence and Women’s Health in Sub-Saharan Africa: An SDG Perspective

Introduction: Aligning with Sustainable Development Goals

This report assesses the association between Domestic Violence Against Women (DVAW) and their Self-Rated Health Status (SRHS) in Sub-Saharan Africa (SSA). The findings are critically important for achieving several Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality). The study confirms that eliminating violence against women is a prerequisite for ensuring healthy lives and promoting well-being for all.

Key Findings: The Impact of Violence on Health

The study consistently found that DVAW is a statistically significant predictor of poorer SRHS, directly undermining progress towards SDG Target 5.2 (eliminate all forms of violence against all women and girls) and SDG Target 3.4 (promote mental health and well-being).

• Emotional Violence: Encompassing verbal abuse and humiliation, emotional violence was identified as a significant threat to women’s mental well-being. This form of abuse can lead to internalized feelings of worthlessness, hindering personal empowerment and contradicting the core principles of SDG 5.
• Physical Violence: As a direct assault on physical integrity, this form of violence leads to immediate and long-term health consequences, creating barriers to achieving SDG 3.
• Sexual Violence: Women who experienced sexual violence reported an increased risk of poor SRHS. Factors such as lack of support, shame, and fear of judgment prevent victims from seeking care, highlighting systemic failures in justice and support systems relevant to SDG 16 (Peace, Justice and Strong Institutions).

The cumulative psychosocial and physiological trauma from all forms of abuse results in sustained psychological distress and heightened stress responses, leading to women’s negative subjective evaluations of their health.

Correlating Factors and Their SDG Implications

Several socio-demographic and behavioral factors were identified as significant correlates of SRHS, revealing interconnected challenges that span multiple SDGs.

Socio-Demographic Determinants of Health

1. Wealth Status: Women from affluent backgrounds reported better health outcomes, likely due to greater access to healthcare and support services. This disparity underscores the link between poverty and vulnerability to violence, directly impacting SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities). Women in disadvantaged situations face significant barriers to accessing comprehensive healthcare, exacerbating the health consequences of abuse.
2. Marital Status: Unmarried women were less likely to report positive SRHS, potentially due to reduced social support and greater economic vulnerability. This highlights the need for inclusive support systems that cater to all women, irrespective of marital status, to achieve SDG 5.
3. Age: An inverse relationship was noted between age and SRHS, with women aged 45–49 reporting poorer health. This may be linked to the cumulative impact of stress, increased family responsibilities, and social isolation, which compromises well-being as envisioned in SDG 3.

Behavioral and Lifestyle Factors

• Dietary Habits: Consumption of fruits and vegetables was associated with higher odds of reporting good health. This finding connects directly to SDG 2 (Zero Hunger), which emphasizes access to nutritious food, and SDG 3, as good nutrition can mitigate the negative health impacts of stress induced by abuse.
• Cigarette Smoking: Smoking was associated with a lower likelihood of reporting better SRHS. Addressing modifiable health behaviors is crucial for improving the health outcomes of victimized women and achieving the public health targets of SDG 3.

Study Limitations

The report acknowledges certain limitations:

• The use of cross-sectional data prevents the establishment of causal inference.
• Reliance on self-rated health status introduces subjectivity.
• Pooling data from five countries may obscure important national and cultural differences, potentially masking the diverse experiences of women across SSA.

Analysis of Sustainable Development Goals in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being

  The article’s primary focus is on the association between Domestic Violence Against Women (DVAW) and women’s Self-Rated Health Status (SRHS). It explicitly discusses how violence negatively impacts physical and mental health, mentioning “psychosocial and physiological effect of abuse,” “sustained psychological distress, low self-worth,” and “mental well-being.” It also examines health-related behaviors like “fruit and vegetable consumption” and “cigarette smoking” as significant correlates of SRHS.

• SDG 5: Gender Equality

  This goal is central to the article, which investigates violence against women as its core subject. The study analyzes “all four primary forms of violence; emotional, physical, sexual and at least one type of violence” against women in Sub-Saharan Africa. The entire discussion revolves around understanding and highlighting the consequences of gender-based violence, a key concern of SDG 5.

• SDG 10: Reduced Inequalities

  The article connects socioeconomic status to both the incidence of domestic violence and the health outcomes of its victims. It states, “low socioeconomic status is closely linked to a higher incidence of DV” and that “women from more affluent backgrounds exhibited greater odds of rating their health status relatively better.” This highlights inequalities in health outcomes based on wealth, as poorer women “face barriers to accessing comprehensive healthcare.”

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 5.2: Eliminate all forms of violence against all women and girls in the public and private spheres.

   The article directly addresses this target by studying the prevalence and impact of “emotional, physical, and sexual violence” against women. Its objective is to assess the association between DVAW and women’s health, contributing to the body of knowledge needed to tackle and eliminate such violence.

2. Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.

   The article strongly connects to the “promote mental health and well-being” aspect of this target. It details how violence leads to “sustained psychological distress, low self-worth, social withdrawal,” and notes that emotional violence is a “significant threat to women’s health, especially their mental well-being.” The use of SRHS as a metric is a direct measure of perceived well-being.

3. Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services…

   The article implies this target by discussing disparities in healthcare access. It notes that “recent health facility use” is a significant correlate of health and that wealthier women have better health outcomes because they can “access essential healthcare services, counselling, and health-enhancing products.” Conversely, it points out that women from disadvantaged backgrounds “may face barriers to accessing comprehensive healthcare.”

4. Target 3.a: Strengthen the implementation of the World Health Organization Framework Convention on Tobacco Control in all countries, as appropriate.

   This target is relevant as the study identifies “cigarette smoking” as a factor associated with a “lower likelihood of reporting better SRHS among victimised women.” This underscores the importance of addressing modifiable health behaviors like smoking in interventions for this vulnerable group.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

• Prevalence of different forms of violence against women (emotional, physical, sexual).

  This is a direct indicator for Target 5.2. The study’s methodology is based on assessing these specific forms of violence, which aligns with the official SDG indicator 5.2.1 (Proportion of ever-partnered women and girls subjected to physical, sexual or psychological violence).

• Self-Rated Health Status (SRHS).

  The article uses SRHS as its main outcome variable to measure the impact of violence. This serves as an implied indicator for Target 3.4, as it captures a subjective but holistic measure of an individual’s physical and mental well-being. The finding that violence leads to “poorer SRHS” provides a metric to assess the state of women’s well-being.

• Prevalence of tobacco use.

  The article’s finding that “smoking was associated with a lower likelihood of reporting better SRHS” points to the prevalence of smoking as a relevant health indicator for Target 3.a. This aligns with indicator 3.a.1 (Age-standardized prevalence of current tobacco use).

• Access to and use of healthcare facilities.

  The article mentions “recent health facility use” and barriers to accessing “essential healthcare services” as key factors. This implies an indicator for Target 3.8, measuring the proportion of the population, particularly vulnerable women, that can access necessary health services, which relates to indicator 3.8.1 (Coverage of essential health services).

4. Summary Table of SDGs, Targets, and Indicators

Source: bmcwomenshealth.biomedcentral.com