Rural-Urban Differences in Factors Associated with Help-seeking Behaviour Among Women Who Experienced Physical, Sexual and Emotional Violence in Zambia

Background Violence against women and girls (VAWG) is very prevalent in Zambia, and it is regarded as a major social and public health challenge with a number of negative impacts on the victims. While there are various studies focusing on factors contributing to VAWG in Zambia, few studies focus on help-seeking behaviour, and none of these studies analyse rural-urban differences and trends across multiple Zambia Demographic and Health Survey (ZDHS) cycles. Our study sought out to examine factors associated with help-seeking behaviour among women who experience physical, sexual and emotional violence in Zambia and by rural-urban differences over time. Method We used data from the three cycles (2007, 2013/14 and 2018/19) of the ZDHS comprising a total of 26,517 women of reproductive age group of 15-49 years old. R and Rstudio statistical software was used in data analysis. Trends in help-seeking behaviour by selected variables across the three ZDHS waves and by rural-urban residence were analysed using mainly bivariate statistics and multilevel logistic regression models on each of the three survey years and on pooled data, to examine individual and community level correlates of help-seeking behaviour. Results The results show that the prevalence of help-seeking behaviour remains low in Zambia. Overall, help-seeking behaviour declined between 2007 and 2018, more especially in urban areas (56.6% to 45%). Trends analysis show that the prevalence rates of help-seeking behaviour in rural areas among women aged 15-24 dropped from around 54% in 2007 and 2013 to around 47% in 2018 while in urban areas the prevalence rate decreased from around 51% in 2007 and 2013 to 37.8% in 2018. The highest prevalence rate is in urban for 25-34 olds (63.5%) in 2007 and the 35-49 olds (60.8%) in 2013. Many other factors displayed the similar trends. In the pooled data multilevel models, women in the age group 25-34 have higher odds in rural (AOR = 1.27, 95% CI = 1.10, 1.44, p<0.001) and urban (AOR = 1.22, 95% CI = 1.04, 1.43, p<0.05). Being married has lower odds across areas, divorced increases odds in rural by 2.02 times (CI=1.52,2.68) and 2.3 times (CI=1.74,3.10) in urban, separated (AOR = 1.68, 95% CI = 1.14, 2.48, p<0.01). Being employed was strongly significant by 1.22 times in rural and 1.19 times in urban. In rural, emotional violence increases the odds by 1.3 times and physical violence by 1.21 times, while wife beating justification reduces the odds by 0.73 times. In urban, emotional violence is significant. VPCs were significantly low, suggesting that most variations is at individual level. Conclusion This study underscores the low help-seeking behaviour among women who experience physical, sexual and emotional violence in Zambia. Findings indicate that being married and wife beating justification reduce the odds of help-seeking behaviour. Divorced and separated women, employment and type of violence increase the likelihood of seeking help. The findings imply that there is need for targeted policy interventions and strategies to address underlying factors that hinder help-seeking behaviour and promoting gender equality and empowerment among women in Zambia.