The shadow of violence: How intimate partner violence shapes contraceptive and maternal health service use across 25 African countries

Despite increasing efforts to improve reproductive health outcomes in sub-Saharan Africa (SSA), disparities persist in the use of modern contraceptives and maternal health services (MHS). Evidence suggests that exposure to intimate partner violence (IPV) may influence women's health-seeking behaviours, yet few studies have examined this relationship across multiple SSA countries. Using cross-sectional data from the most recent Demographic and Health Surveys (2015-2024) in 25 SSA countries, we analyzed 122,144 women aged 15-49 with complete information on IPV, contraceptive use, and MHS utilization. The primary outcome variables were current use of any modern contraceptive method and adequate MHS use. IPV exposure was measured using standardized DHS indicators for emotional, physical, and sexual violence. Multivariable logistic regression models adjusted for socio-demographic covariates and survey design were used to examine associations. Overall, 29.2% of women used modern contraceptives, and 39.2% received adequate MHS. About 34.3% of women had experienced at least one form of IPV. Women who experienced emotional (AOR = 1.15; 95% CI: 1.11-1.20), physical (AOR = 1.14; 95% CI: 1.07-1.20), or sexual violence (AOR = 1.09; 95% CI: 1.03-1.15) were significantly more likely to use modern contraceptives than those who had not. However, they were less likely to receive adequate MHS: emotional (AOR = 0.95; 95% CI: 0.91-0.99), sexual (AOR = 0.88; 95% CI: 0.83-0.95), and at least one form of IPV (AOR = 0.94; 95% CI: 0.90-0.98). Key predictors such as parity, education, household wealth, residence, distance to a health facility, employment, and media exposure significantly influenced the outcomes. While exposure to IPV may increase contraceptive use, possibly as a protective strategy, it simultaneously reduces uptake of comprehensive maternal healthcare. Integrating IPV screening, counselling, and support services into reproductive and maternal health programs is critical for improving women's health outcomes.