Multilevel Analysis of Intimate Partner Violence and Associated Factors Among Reproductive-Age Women: Lesotho Demographic and Health Survey 2023 to 2024 Data

Abstract

Intimate partner violence (IPV) is a major public health issue, particularly in low- and middle-income countries, where factors such as gender inequality, economic dependence, and limited legal protections contribute to its high prevalence. Despite the serious health consequences of IPV for survivors, there is a lack of research on it and its associated factors among women in Lesotho. This study used data from the 2023 to 2024 Lesotho Demographic and Health Survey, a nationally representative cross-sectional survey, to determine the prevalence of IPV among reproductive-age women in Lesotho and its associated factors. A total of 1,687 women aged 15 to 49 who had ever been married were included in the study. To ensure representativeness, weighted estimates were applied in the analysis using STATA version 17. A cross-sectional study design was used, and data were analyzed using descriptive statistics and multilevel logistic regression to examine individual and community-level factors associated with IPV. Statistically significant variables were identified using adjusted odds ratios (AOR) with a 95% confidence interval (CI). The overall prevalence of IPV was found to be 41.68% (95% CI [39.35, 44.05]). Factors associated with IPV included depressive symptoms (AOR = 1.55 [1.04, 2.30]), current tobacco smoking (AOR = 1.71 [1.10, 2.64]), having an alcoholic partner (AOR = 2.07 [1.58, 2.71]), having a jealous partner (AOR = 4.1 [3.13, 5.36]), and women justifying wife-beating (AOR = 1.57 [1.11, 2.21]). The prevalence of IPV among reproductive-age women in Lesotho is high. Individual and partner-related factors contribute significantly to its occurrence. Strengthening legal protections addressing issues such as women’s justification of wife beating, expanding access to mental health services, and implementing community-based education programs on substance use are recommended to reduce IPV in Lesotho.

Keywords

intimate partner violence risk factors Lesotho women multilevel analysis

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References

Aboagye

R. G.

Essuman

M. A.

Dzirasah

K. D.

Seidu

A.-A.

Adnani

Q. E. S.

Ahinkorah

B. O.

(2025). Association between polygyny and justification of violence among women in sexual unions in sub-Saharan Africa. BMC Public Health, 25(1), 1719. https://doi.org/10.1186/s12889-025-22581-y

Aboagye

R. G.

Seidu

A.-A.

Asare

B. Y.-A.

Peprah

Addo

I. Y.

Ahinkorah

B. O.

(2021). Exposure to interparental violence and justification of intimate partner violence among women in sexual unions in sub-Saharan Africa. Archives of Public Health, 79(1), 162. https://doi.org/10.1186/s13690-021-00684-3

Abota

T. L.

Gashe

F. E.

Deyessa

(2022). Multilevel analysis of factors associated with perinatal intimate partner violence among postpartum population in Southern Ethiopia. Scientific Reports, 12(1), 19013.

Antai

Adaji

(2012). Community-level influences on women’s experience of intimate partner violence and terminated pregnancy in Nigeria: A multilevel analysis. BMC Pregnancy and Childbirth, 12, 128.

Atteraya

M. S.

Gnawali

Song

I. H.

(2015). Factors associated with intimate partner violence against married women in Nepal. Journal of Interpersonal Violence, 30(7), 1226–1246.

Barbier

Chariot

Lefèvre

(2022). Intimate partner violence against ever-partnered women in Europe: Prevalence and associated factors—Results from the violence against women EU-wide survey. Frontiers in Public Health, 10, 1033465.

Black

Worth

Clarke

Obol

J. H.

Akera

Awor

Shabiti

M. S.

Fry

Richmond

(2019). Prevalence and correlates of intimate partner violence against women in conflict affected northern Uganda: A cross-sectional study. Conflict and Health, 13, 35. https://doi.org/10.1186/s13031-019-0219-8

Boy

Salihu

H. M.

(2004). Intimate partner violence and birth outcomes: A systematic review. International Journal of Fertility and Women’s Medicine, 49(4), 159–164.

Bramhankar

Reshmi

(2021). Spousal violence against women and its consequences on pregnancy outcomes and reproductive health of women in India. BMC Women’s Health, 21, 382.

10.

Buunk

A. P.

Massar

(2021). Intimate partner violence in Nicaragua: The role of possessive jealousy, intrasexual competitiveness, life history, mate value, and stress. Journal of Interpersonal Violence, 36(15–16), NP8101–NP8123. https://doi.org/10.1177/0886260519842854

11.

Campbell

J. C.

(2002). Health consequences of intimate partner violence. Lancet, 359(9314), 1331–1336. https://doi.org/10.1016/s0140-6736(02)08336-8

12.

Cepeda

Lacalle-Calderon

Torralba

(2022). Measuring violence against women: A global index. Journal of Interpersonal Violence, 37(19–20), NP18614–NP18638.

13.

Chirwa

E. D.

Sikweyiya

Addo-Lartey

A. A.

Ogum Alangea

Coker-Appiah

Adanu

R. M. K.

Jewkes

(2018). Prevalence and risk factors of physical or sexual intimate violence perpetration amongst men in four districts in the central region of Ghana: Baseline findings from a cluster randomised controlled trial. PLoS One, 13(3), e0191663. https://doi.org/10.1371/journal.pone.0191663

14.

Coll

C. V.

Ewerling

García-Moreno

Hellwig

Barros

A. J.

(2020). Intimate partner violence in 46 low-income and middle-income countries: An appraisal of the most vulnerable groups of women using national health surveys. BMJ Global Health, 5(1), e002208.

15.

Dalal

Wang

Svanström

(2014). Intimate partner violence against women in Nepal: An analysis through individual, empowerment, family and societal level factors. Journal of Research in Health Sciences, 14(4), 251–257.

16.

Dartnall

Jewkes

(2013). Sexual violence against women: The scope of the problem. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(1), 3–13.

17.

Devries

K. M.

Mak

J. Y.

Bacchus

L. J.

Child

J. C.

Falder

Petzold

Astbury

Watts

C. H.

(2013). Intimate partner violence and incident depressive symptoms and suicide attempts: A systematic review of longitudinal studies. PLoS Medicine, 10(5), e1001439. https://doi.org/10.1371/journal.pmed.1001439

18.

Enaifoghe

Dlelana

Durokifa

A. A.

Dlamini

N. P.

(2021). The prevalence of gender-based violence against women in South Africa: A call for action. African Journal of Gender, Society & Development, 10(1), 117.

19.

Faramarzi

Esmaelzadeh

Mosavi

(2005). Prevalence, maternal complications and birth outcome of physical, sexual and emotional domestic violence during pregnancy. Acta Medica Iranica, 43(2), 115–122.

20.

Gao

Wang

Zhou

Zou

Zhou

(2021). Intimate partner violence against women living in inadequate conditions in Sub-Saharan Africa: A meta-analysis of demographic and health survey data. International Journal of Environmental Research and Public Health, 18(19), 10138.

21.

García-Moreno

Pallitto

Devries

Stöckl

Watts

Abrahams

(2013). Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization.

22.

García-Moreno

Zimmerman

Morris-Gehring

Heise

Amin

Abrahams

Montoya

Bhate-Deosthali

Kilonzo

Watts

(2015). Addressing violence against women: A call to action. Lancet, 385(9978), 1685–1695. https://doi.org/10.1016/s0140-6736(14)61830-4

23.

Garg

Singh

Rustagi

Engtipi

Bala

(2019). Magnitude of domestic violence and its socio-demographic correlates among pregnant women in Delhi. Journal of Family Medicine and Primary Care, 8(11), 3634–3639.

24.

Gedefa

A. G.

Abdi

Chilo

Debele

G. R.

Girma

Abdulahi

(2024). Intimate partner violence, prevalence and its consequences: A community-based study in Gambella, Ethiopia. Frontiers in Public Health, 12, 1412788.

25.

Grosso

Busch

Mothopeng

Sweitzer

Nkonyana

Mpooa

Taruberekera

Baral

(2018). HIV risks and needs related to the Sustainable Development Goals among female sex workers who were commercially sexually exploited as children in Lesotho. Journal of the International AIDS Society, 21, e25042.

26.

Hapazari

(2023a). The construction of regional masculinities as drivers of sexual violence against women in Lesotho. South African Review of Sociology, 53(3), 297–312. https://doi.org/10.1080/21528586.2023.2253526

27.

Hapazari

(2023b). An investigation of the dominant forms of gender-based violence in Maseru district, Lesotho. Journal of Social Development in Africa, 38(1), 115–135.

28.

Heise

L. L.

(1998). Violence against women: An integrated, ecological framework. Violence Against Women, 4(3), 262–290.

29.

Hicks

M. H.

Mohsin

Silove

Fisher

Moussa

Steel

Nancarrow

Nadar

Klein

Hasoun

Yousif

Khalil

Krishna

Rees

S. J.

(2021). Attitudes towards gender roles and prevalence of intimate partner violence perpetrated against pregnant and postnatal women: Differences between women immigrants from conflict-affected countries and women born in Australia. PLoS One, 16(7), e0255105. https://doi.org/10.1371/journal.pone.0255105

30.

Ho-Foster

Machisa

M. T.

Moalusi

L. R.

Christofides

(2025). Gender beliefs and norms underlying intimate partner violence stigma among women living in Botswana: Results of an exploratory factor analysis. PLOS Global Public Health, 5(2), e0004113. https://doi.org/10.1371/journal.pgph.0004113

31.

Homish

G. G.

Leonard

K. E.

(2007). The drinking partnership and marital satisfaction: The longitudinal influence of discrepant drinking. Journal of Consulting and Clinical Psychology, 75(1), 43.

32.

Iman’ishimwe Mukamana

Machakanja

Adjei

N. K

. (2020). Trends in prevalence and correlates of intimate partner violence against women in Zimbabwe, 2005–2015. BMC International Health and Human Rights, 20(1), 2. https://doi.org/10.1186/s12914-019-0220-8

33.

Ipekten Alaman

Yıldız

. (2014). Domestic sexual violence and sexual problems among gynecology outpatients: An example from Turkey. Women & Health, 54(5), 439–454.

34.

Jewkes

(2002). Intimate partner violence: Causes and prevention. Lancet, 359(9315), 1423–1429. https://doi.org/10.1016/s0140-6736(02)08357-5

35.

Joseph Davey

D. L.

Le Roux

S. M.

Brittain

Dovell

Shoptaw

Miller

A. P.

Phillips

T. K.

Zerbe

Abrams

E. J.

Myer

. (2022). Alcohol use and intimate partner violence in HIV-uninfected pregnant women in Cape Town, South Africa. AIDS Care, 34(2), 214–219. https://doi.org/10.1080/09540121.2021.1975626

36.

Kebede

S. A.

Weldesenbet

A. B.

Tusa

B. S.

(2022). Magnitude and determinants of intimate partner violence against women in East Africa: Multilevel analysis of recent demographic and health survey. BMC Women’s Health, 22(1), 74.

37.

Keynejad

R. C.

Bitew

Sorsdahl

Myers

Honikman

Mulushoa

Demissie

Deyessa

Howard

L. M.

Hanlon

(2024). Adapting brief problem-solving therapy for pregnant women experiencing depressive symptoms and intimate partner violence in rural Ethiopia. Psychotherapy Research, 34(4), 538–554. https://doi.org/10.1080/10503307.2023.2222899

38.

King Moshoeshoe

. (2020). GDP (PPP). Ethnic groups, 99.97.

39.

Kiss

Schraiber

L. B.

Heise

Zimmerman

Gouveia

Watts

(2012). Gender-based violence and socioeconomic inequalities: Does living in more deprived neighbourhoods increase women’s risk of intimate partner violence? Social Science & Medicine, 74(8), 1172–1179. https://doi.org/10.1016/j.socscimed.2011.11.033

40.

Kwagala

Wandera

S. O.

Ndugga

Kabagenyi

(2013). Empowerment, partner’s behaviours and intimate partner physical violence among married women in Uganda. BMC Public Health, 13, 1112. https://doi.org/10.1186/1471-2458-13-1112

41.

Lamela

Pinto

T. M.

Jongenelen

(2024). Cigarette smoking in women victims of police-reported intimate partner violence: The role of childhood maltreatment, type of partner abuse, and psychological distress symptoms. Journal of Trauma Dissociation, 25(5), 643–655. https://doi.org/10.1080/15299732.2024.2383188

42.

Leemis

R. W.

Friar

Khatiwada

Chen

M. S.

Kresnow

M.-j.

Smith

S. G.

Caslin

Basile

K. C.

(2022). The national intimate partner and sexual violence survey: 2016/2017 report on intimate partner violence. CDC.

43.

Lesotho Statistics Bureau, Ministry of Health. (2023–2024). Lesotho Demographic and Health Survey 2023–24 dataset. https://dhsprogram.com/data/dataset/Lesotho_Standard-DHS_2023.cfm

44.

Kirby

R. S.

Sigler

R. T.

Hwang

S.-S.

LaGory

M. E.

Goldenberg

R. L.

(2010). A multilevel analysis of individual, household, and neighborhood correlates of intimate partner violence among low-income pregnant women in Jefferson County, Alabama. American Journal of Public Health, 100(3), 531–539.

45.

Liyew

A. M.

Alem

A. Z.

Ayalew

H. G.

(2022). Magnitude and factors associated with intimate partner violence against pregnant women in Ethiopia: A multilevel analysis of 2016 Ethiopian demographic and health survey. BMC Public Health, 22(1), 284.

46.

Lowe

Mannell

Faumuina

Sinclair

Tamanikaiyaroi

Brown

(2024). Violence in childhood and community contexts: A multi-level model of factors associated with women’s intimate partner violence experience in Samoa. The Lancet Regional Health – West Pacific, 42, 100957. https://doi.org/10.1016/j.lanwpc.2023.100957

47.

Mahlehle

M. P.

(2024). A legal analysis of discrimination and women’s right to inheritance to chieftainship in Lesotho. National University of Lesotho.

48.

Malephane

(2022). In Lesotho, gender-based violence tops the list of women’s-rights issues to be addressed. AFRO BAROMETER.

49.

McCloskey

L. A.

Boonzaier

Steinbrenner

S. Y.

Hunter

(2016). Determinants of intimate partner violence in sub-Saharan Africa: A review of prevention and intervention programs. Partner Abuse, 7(3), 277–315.

50.

Melkam

Fentahun

Rtbey

Andualem

Nakie

Tinsae

Kassa

M. A.

Fente

B. M.

(2024). Multilevel analysis of intimate partner violence and associated factors among reproductive-age women: Kenya demographic and health survey 2022 data. BMC Public Health, 24(1), 1476. https://doi.org/10.1186/s12889-024-19012-9

51.

Merlo

Yang

Chaix

Lynch

Råstam

(2005). A brief conceptual tutorial on multilevel analysis in social epidemiology: Investigating contextual phenomena in different groups of people. Journal of Epidemiology & Community Health, 59(9), 729–736.

52.

Mthembu

Mabaso

Reis

Zuma

Zungu

(2021). Prevalence and factors associated with intimate partner violence among the adolescent girls and young women in South Africa: Findings the 2017 population based cross-sectional survey. BMC Public Health, 21(1), 1160. https://doi.org/10.1186/s12889-021-11183-z

53.

Ogum Alangea

Addo-Lartey

A. A.

Sikweyiya

Chirwa

E. D.

Coker-Appiah

Jewkes

Adanu

R. M. K

. (2018). Prevalence and risk factors of intimate partner violence among women in four districts of the central region of Ghana: Baseline findings from a cluster randomised controlled trial. PLoS One, 13(7), e0200874. https://doi.org/10.1371/journal.pone.0200874

54.

Payton

Eluka

Brown

Dudley

W. N.

(2019). Women’s perceptions of intimate partner violence in Zambia. Violence and Gender, 6(4), 219–226.

55.

Phiri

Namayawa

Sianyeuka

Sikanyiti

Lemba

(2023). Determinants of spousal physical violence against women in Zambia: A multilevel analysis. BMC Public Health, 23(1), 934. https://doi.org/10.1186/s12889-023-15927-x

56.

Pichon

Treves-Kagan

Stern

Kyegombe

Stöckl

Buller

A. M.

(2020). A mixed-methods systematic review: Infidelity, romantic jealousy and intimate partner violence against women. International Journal of Environmental Research and Public Health, 17(16), 5682. https://doi.org/10.3390/ijerph17165682

57.

Robbins

H. A.

Hurley

E. A.

Liu

Chao

S. M.

(2015). Multilevel correlates of broadly-and narrowly-defined intimate partner violence among pregnant women in Los Angeles. Maternal and Child Health Journal, 19, 1643–1651.

58.

Shaikh

M. A.

(2023). Prevalence, correlates, and trends of intimate partner violence against women in Gambia: Results from 2 National Cross-Sectional Health Surveys. Inquiry, 60, 469580231172879. https://doi.org/10.1177/00469580231172879

59.

Stöckl

March

Pallitto

Garcia-Moreno

(2014). Intimate partner violence among adolescents and young women: Prevalence and associated factors in nine countries: A cross-sectional study. BMC Public Health, 14, 751.

60.

Straus

M. A.

Hamby

S. L.

Boney-McCoy

Sugarman

D. B.

(1996). The revised conflict tactics scales (CTS2) development and preliminary psychometric data. Journal of Family Issues, 17(3), 283–316.

61.

Sullivan

T. P.

Flanagan

J. C.

Dudley

D. N.

Holt

L. J.

Mazure

C. M.

McKee

S. A.

(2015). Correlates of smoking status among women experiencing intimate partner violence: Substance use, posttraumatic stress, and coping. The American Journal of Addiction, 24(6), 546–553. https://doi.org/10.1111/ajad.12261

62.

Tsedal

D. M.

Yitayal

Abebe

Tsegaye

A. T.

(2020). Effect of intimate partner violence of women on minimum acceptable diet of children aged 6–23 months in Ethiopia: Evidence from 2016 Ethiopian demographic and health survey. BMC Nutrition, 6, 28.

63.

Tsega

N. T.

Belay

D. G.

Aragaw

F. M.

Asratie

M. H.

Gashaw

Endalew

(2022). Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: Multilevel analysis based on 2016 Ethiopian Demographic and Health Survey. BMC Women’s Health, 22(1), 549. https://doi.org/10.1186/s12905-022-02143-9

64.

Tsegaw

Mulat

Shitu

(2022). Intimate partner violence and associated factors among reproductive age women in Liberia: A cross-sectional study using a recent Liberian demographic and health survey. BMC Women’s Health, 22(1), 238.

65.

UN Lesotho. (2023). Ending gender-based violence in Lesotho and beyond. https://lesotho.un.org/en/250010-ending-gender-based-violence-lesotho-and-beyond

66.

UNAIDS Joint United Nations Programme. (2021). Navigating Lesotho’s legal system to address gender-based violence. https://www.unaids.org/en/resources/presscentre/featurestories/2021/march/20210308_lesotho-legal-system-curb-gender-based-violence

67.

United States Agency for International Development, & The Demographic and Health Surveys Program. (2023). Guide to e Demographic and Health Surveys Program Statistics. DHS-8. https://www.dhsprogram.com/pubs/pdf/DHSG1/Guide_to_DHS_Statistics_DHS-8.pdf

68.

Vollmer

(2022). Global perspectives of Africa: Harnessing the universal periodic review to process sexual and gender-based violence in SADC member states. Stellenbosch Law Review, 33(1), 8–41.

69.

WHO. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. WHO.

70.

WHO. (2012). Understanding and addressing violence against women: Intimate partner violence. WHO.

71.

WHO. (2019). Violence against women: Intimate partner and sexual violence against women: evidence brief. WHO.

72.

Yaya

Anjorin

S. S.

Adenini

S. A.

(2020). Intimate partner violence, contextual factors and under-5 mortality: a multilevel analysis of cross-sectional surveys from 20 Sub-Saharan African countries. BMJ Global Health, 5(12), e003531. https://doi.org/10.1136/bmjgh-2020-003531

73.

Yaya

Hudani

Buh

Bishwajit

(2021). Prevalence and predictors of intimate partner violence among married women in Egypt. Journal of Interpersonal Violence, 36(21–22), 10686–10704. https://doi.org/10.1177/0886260519888196

74.

Zacarias

A. E.

Macassa

Svanström

Soares

J. J. F.

Antai

(2012). Intimate partner violence against women in Maputo city, Mozambique. BMC International Health and Human Rights, 12(1), 35. https://doi.org/10.1186/1472-698X-12-35