Prevalence and Determinants of Physical Violence During Pregnancy and Its Impact on Birth Outcomes in Tanzania: Insights from multilevel analysis of the 2022 demographic and health survey

Background Physical violence during pregnancy is a critical public health issue with detrimental consequences for maternal and infant health. Understanding its prevalence, determinants, and impact is crucial for effective interventions. This study assessed the prevalence and determinants of physical violence during pregnancy in Tanzania and its association with birth outcomes. Method We used data from the 2022 Tanzania Demographic and Health Survey, conducted between February 24 and July 21, 2022. A two-stage stratified sampling method was used. Multilevel logistic regression, accounting for the complex survey design was used to identify individual and community determinants of physical violence. Adjusted Odds ratios (AOR) and 95% Confidence intervals (CI) were used to estimate the strength of association. Results The overall prevalence of physical violence during pregnancy was 3.1%. Individual factors associated with higher likelihood of violence included, primary education (AOR = 2.13, 95% CI: 1.14–3.99), being employed (AOR = 2.22, 95% CI: 1.36–3.62), living in a female-headed household (AOR = 1.70, 95% CI: 1.07–2.70), and partner alcohol use (AOR = 2.40, 95% CI: 1.60–3.59). Conversely, middle (AOR = 0.57, 95% CI: 0.33–0.97) and rich (AOR = 0.51, 95% CI: 0.29–0.92) wealth quintiles were associated with a lower likelihood. At the community level, women in the Southern (AOR = 0.15, 95% CI: 0.03–0.69), South-West Highlands (AOR = 0.15, 95% CI: 0.05–0.45), and Lake (AOR = 0.44, 95% CI: 0.20–0.93) zones had a lower likelihood of experiencing physical violence. Importantly, physical violence during pregnancy significantly associated with adverse birth outcomes (p < 0.001), with 6.0% experiencing miscarriage and 3.6% having a stillbirth. Conclusion Physical violence during pregnancy is a significant concern in Tanzania, affecting 3.1% of women and associated with lower education, being employed, living in female-headed households and partner alcohol use. Critically, physical violence significantly increases the risk of adverse birth outcomes, including miscarriage and stillbirth, underscoring the urgent need for targeted interventions and policies to protect pregnant women.