Purpose: We examined the potential association between African couples’ concordance on attitudes toward violence (ATV) and risk for intimate partner violence (IPV). Method: Analyses included 13,837 couples from Demographic and Health Surveys conducted between 2003 and 2007, from six African countries. Concordance on ATV was defined as both spouses justifying physical abuse, and IPV was defined as incidence of a physically violent act against the wife. We constructed a concordance measure from the surveys to assess overall and country-level differences in couple’s ATV concordance rates and assessed the association between concordance in ATV and IPV using hierarchical regression modeling that adjusted for multilevel influences on risk estimates. Negative concordance (perfect agreement in negative ATV) was used as referent category in all analyses. Findings: Overall, spousal ATV concordance was associated with higher likelihood for IPV (adjusted odds ratio [AOR] = 2.27, 95% confidence interval [CI] = [2.01, 2.56]). The level of wealth, educational attainment, rural/urban residence, presence of a cowife, religion, maternal age, and parity were characteristics that predicted the occurrence of IPV within couples. Spousal ATV concordance was significantly associated with violence in every African nation included in the analysis except Rwanda. Conclusions: African couples with high rates of ATV concor- dance experience higher risks for IPV, with some variation in magnitude of risk across countries. In African settings, ATV positive concordance could serve as a supplemental screening tool to detect spousal violence. Understanding ATV could potentially enhance our ability to formulate public health intervention to detect and prevent spousal abuse.
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