Sub-national analysis of intimate partner violence and termination of pregnancy among ever-in-union women in South Africa

South Africa has one of the highest intimate partner violence (IPV) prevalence in Africa. Studies have linked IPV with negative health and socio-economic outcomes, especially during pregnancy which often led to termination of pregnancy (TOP). However, sub-national differences in the relationship between IPV and TOP have not been adequately examined in South Africa. The study aimed to examine subnational variations of the association between IPV and TOP in South Africa. Data were extracted for 2354 ever-in-union women aged 15–49 years with valid and complete information on the domestic violence module in the 2016 South African Demographic and Health Surveys dataset. The exposure variable was IPV, operationally defined as ever-experienced at least one of the physical, sexual, emotional violence, and partner controlling behaviour IPV forms. The logistic regression analysis was employed, to examine the association between IPV and TOP, while the odds ratios including their 95% confidence interval were reported. Overall, 15.3% had ever terminated pregnancy ranging from 9.5% in Northern Cape to 21.2% in Kwazulu-Natal. About 55.8% of the women had experienced IPV. The IPV, was strongly associated with about a 2-fold increase in TOP at national-level (aOR = 1.62; CI: 1.27–2.07). At subnational-level, women who had experienced IPV were associated with as high as a 2- and 8-fold significant increase in Limpopo and Kwazulu-Natal. The tendency of having a pregnancy terminated was significantly higher among ever-experienced physical violence women resident in Northern Cape (aOR = 4.26; CI: 1.28–14.16) and Kwazulu-Natal (aOR = 4.99; CI: 1.60-15.58) relative to their counterparts who had never experienced physical violence. Among women who had ever experienced emotional and partner control, Northern Cape and North West, and Kwazulu-Natal residents were at higher risk of pregnancy termination, respectively. There was evidence of varying strong associations between IPV, including its forms, and pregnancy termination in multiple provinces. Context-specific maternal health interventions targeted at curbing intimate partner violence may substantially reduce the burden of pregnancy termination in South Africa and other similar settings.