Beyond Healthcare Access: How Intimate Partner Violence Undermines Uganda's Progress Toward Universal Maternal Health Coverage Through Reduced Maternal Health Service Utilization

Background Evidence suggests that Intimate Partner Violence (IPV) is associated with reduced use of maternal health services (MHS), including ANC, institutional deliveries, and use of modern contraception. The effects of IPV on MHS work through mechanisms such as psychological barriers, alongside restricted decision-making and movement related to financial dependence, and fear of further abuse. We assessed trends in IPV and its effects on accessing healthcare, and two maternal health services (ANC and institutional delivery) among women of reproductive age (15–49 years) in four nationally representative surveys in Uganda. Methods In this study, we conducted a cross-sectional analysis of secondary data, utilizing information from four Uganda Demographic and Health Surveys (UDHS) that were carried out in 2006, 2011, 2016, and 2022. The UDHS uses a multistage stratified sampling methodology to select households from both urban and rural areas across regions in Uganda. Women between the ages of 15 and 49 years who were either residents or visitors in these households were eligible for interviews. Data for this analysis are drawn from the domestic violence module that generates information on spousal/intimate partners violence among ever-married women. Both exploratory and inferential data analyses were conducted to generate descriptive statistics for key variables, and a modified Poisson regression model to provide evidence for the association between maternal health services and IPV using prevalence ratios (PRs) with 95% confidence intervals as measures of association. Analyses were weighted and accounted for a multi-stage cluster design, conducted using svyset command in STATA version 18. Results Trends in the women experiencing intimate partner violence (IPV) in the 12 months prior to the survey, and women reporting serious problems accessing healthcare (SPAHC) varied over the four UDHS. Overall, SPAHC dropped from 83.1% in 2006 to 60% in 2022, p-for-trend < 0.000. Similarly, IPV declined in the same period, dropping from 52.6% in 2006 to 39.2% in 2016, but increased to 45% in 2022. The overall pooled effect of IPV on SPAHC across the four DHS was about 8% higher among the ever-married women reporting IPV. The effects of IPV the two maternal health service; women’s place of delivery of the last birth in the past 5 years, comparing delivery at a public/ private health facility versus delivery at home, and timely (0–3 months) first ANC visit for the last birth tended to lower when women experienced IPV. Conclusion The study emphasizes the links between social determinants of health, serious problems in accessing healthcare and maternal services, and IPV as a major risk factor. Policymakers should enhance strategies to prevent IPV, which negatively impacts women's health and pregnancies, focusing on disadvantaged women, especially those in rural, low-education, and poorer communities.