Prevalence and predictors of domestic violence among pregnant women in Ethiopia: Evidence from a systematic review and meta-analysis

Abstract

Introduction

Domestic violence remains a major global health and human rights issue, with pregnant women being among the most affected groups. In Ethiopia, evidence from individual studies on violence during pregnancy has been inconsistent. Therefore, this review aimed to estimate the combined prevalence of domestic violence among pregnant women in Ethiopia and to identify determinants contributing to its occurrence.

Methods

A comprehensive literature search was performed across multiple databases, including PubMed, HINARI, Scopus, EMBASE, Web of Science, Global Health, African Journals Online (AJOL), and Google Scholar. Study quality was evaluated using the Joanna Briggs Institute (JBI) checklist for analytical cross-sectional studies. Heterogeneity among studies was assessed using the Cochrane Q and I² statistics, and a random-effects model was applied to compute the pooled prevalence.

Results

The overall pooled prevalence of domestic violence during pregnancy in Ethiopia was found to be 44% (95% CI: 29.86–58.15). The likelihood of experiencing violence was significantly higher among women with partners who consumed alcohol frequently (POR = 1.63; 95% CI: 1.43–1.85), those with low educational attainment (AOR = 6.3; 95% CI: 2.78–14.44), and women with unintended pregnancies (POR = 4.99; 95% CI: 2.96–8.43).

Conclusion

Nearly half of pregnant women in Ethiopia face domestic violence; influenced primarily by low educational status, partner alcohol use, and unintended pregnancy. Addressing this public health challenge requires integrated interventions focusing on women’s empowerment, male partner behavior, reproductive health services, and routine screening in antenatal care.

Keywords

prevalence violence factors pregnancy Ethiopia

Introduction

Violence against women remains one of the most serious global human rights challenges.¹ It also contributes substantially to mortality worldwide and continues to affect a growing number of intimate partners, despite progress in social and human development.² According to the United Nations, violence against women refers to any form of gender-based violence that causes, or has the potential to cause, physical, sexual, or psychological harm. This includes threats, coercion, or unjust restriction of freedom, whether occurring in public or private settings.^3–5

Globally, domestic violence against women remains alarmingly common.^6,7 The reported prevalence varies widely across regions and populations, ranging from 15% to 71% for physical and/or sexual violence.^8,9 This violence can be even more common during pregnancy, ranging from 1% to 57% depending on the location.¹⁰

In Ethiopia, cultural norms and religion seem to play a role in the high prevalence of domestic violence.¹¹ Wife beating is widely accepted, and recent surveys show a significant number of women experiencing physical, emotional, or sexual abuse.^12,13 This violence is more common against older women, those who are divorced or widowed, those living in rural areas, and those with lower levels of education.¹⁴ Other studies in Ethiopia found even higher rates of domestic violence, with some reporting abuse in over half of all women.^14–16 Pregnant women are especially vulnerable, with reported prevalence ranging from 32% to 44.5%.^17–19

Domestic violence has devastating consequences for women, harming their physical and mental well-being, and limiting their ability to live full lives.^8,11 It can affect their self-esteem, job performance, and independence, ability to care for themselves and their families, and social life. In the worst cases, it can even be fatal. For pregnant women, domestic violence poses an even greater danger.^10,17,20 Such abuse can negatively affect both the mother and the baby, potentially resulting in complications such as placental damage, uterine rupture, fetal harm, miscarriage, bleeding, premature delivery, low birth weight, or even death.^18,21 These dangers are not limited to specific regions; studies from developed and developing countries alike show high rates of domestic violence and its severe consequences.^10,20

Multiple factors have been identified as contributors to domestic violence during pregnancy. Studies indicate that partner alcohol consumption, women’s low educational status, and unplanned pregnancy are among the most consistently reported determinants.^22–25 These factors create a challenging environment that can exacerbate tensions within the household, leading to an increased risk of violence against women. Addressing these issues through targeted interventions and education could help mitigate the prevalence of domestic violence.

Despite the growing body of primary studies examining domestic violence during pregnancy in Ethiopia, evidence remains fragmented, region-specific, and methodologically heterogeneous, leading to inconsistent estimates and limited generalizability. To date, no systematic review and meta-analysis has synthesized national-level evidence on the prevalence of domestic violence among pregnant women in Ethiopia while simultaneously quantifying its key determinants. This study addresses this critical gap by providing the first pooled national estimate of domestic violence during pregnancy in Ethiopia using rigorous meta-analytic methods. In addition, it systematically synthesizes and quantifies the effects of major predictors including partner alcohol consumption, women’s educational status, and pregnancy intention thereby offering comparative effect sizes that individual studies could not provide. By integrating evidence across diverse regions and study settings, this review enhances precision, reduces uncertainty, and generates policy-relevant evidence to inform antenatal care practices, violence screening strategies, and multisectoral prevention interventions. The findings therefore make a novel and substantial contribution to the existing literature and provide a stronger empirical foundation for national maternal health and gender-based violence prevention policies in Ethiopia.

Materials and methods

This systematic review and meta-analysis followed a rigorous and transparent methodology based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines²⁶ S1file. Additionally, the review was registered in the Prospective Register of Systematic Reviews (PROSPERO) with the registration number CRD42024563931.

Search strategy

A systematic and exhaustive literature search was undertaken to locate studies examining domestic violence among pregnant women in Ethiopia. Electronic databases including PubMed, HINARI, Scopus, EMBASE, Web of Science, Global Health, African Journals Online (AJOL), and Google Scholar were explored between September 24 and December 25, 2024. The search targeted research reporting the prevalence and determinants of domestic violence during pregnancy in Ethiopia. A combination of Medical Subject Headings (MeSH) and free-text terms was used, such as “domestic,” “home,” “violence,” “abuse,” “assault,” “aggression,” “factors,” “determinants,” “predictors,” “pregnant,” “women,” and “Ethiopia.” Boolean operators (AND, OR) were applied to enhance the search breadth and precision. Additionally, reference lists of identified articles were screened to capture any relevant studies not retrieved through database searches.

Inclusion criteria

This review included original research studies that specifically examined domestic violence and/or its associated factors among pregnant women in Ethiopia. Only studies published in English were considered, and publications up to December 25, 2024, were included.

Exclusion criteria

Studies were excluded if they lacked full texts or abstracts or were non-research publications such as editorials, letters, reviews, or commentaries. Additional exclusion criteria included the absence of data on the prevalence of domestic violence among pregnant women, failure to assess or report associated factors, inaccessibility of the full text despite repeated attempts to contact the authors or affiliated institutions, study populations not limited to pregnant women, and research conducted outside the Ethiopian context.

Study selection

All studies retrieved from various electronic databases were imported into Endnote X7. After eliminating duplicates, three reviewers (YAF, ADA, and WCT) independently screened the abstracts and full texts to determine their eligibility for inclusion.

Data extraction

Four authors (YAF, AMT, FAW, and AMZ) extracted data on the prevalence of domestic violence among pregnant women and its associated factors from each study using a standardized data extraction form adapted from the Joanna Briggs Institute (JBI) tool for prevalence studies. The information collected included the first author’s name, year of publication, study region, study design, sample size, sampling method, reported prevalence of domestic violence, and identified associated factors with their corresponding odds ratios. Any disagreements during the title/abstract screening, full-text review, data extraction, or quality assessment stages were resolved through discussion and consensus. When consensus could not be reached, a senior member of the team (YAF) made the final decision.

Risk of bias assessment

The methodological quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for analytical cross-sectional studies, which contains nine assessment items. These items examine whether¹: the sampling frame accurately represents the target population,² participants were appropriately selected,³ the sample size was adequate,⁴ the study population and setting were clearly described,⁵) data analysis accounted for the identified sample,⁶ valid measurement tools were used to determine the condition,⁷ a uniform and reliable assessment method was applied across participants,⁸ appropriate statistical analyses were conducted, and ⁹ the response rate was satisfactory. Each criterion was scored 1 for “yes” and 0 for “no” or “not reported,” producing a total possible score between 0 and 9. Studies were classified as low quality (0–4), moderate quality,^5–7 or high quality^8,9 based on their overall scores.

Outcome measurement

The primary outcome variable in this review was domestic violence. In the original studies, this was defined as a woman having experienced at least one type of violence (sexual, physical, or emotional/psychological) perpetrated by her husband or intimate partner.^{12,19,22,23,27} To determine the determinants of domestic violence, odds ratios (ORs) were used as the principal measure of association. These values were derived from binary outcome data in the original studies, comparing the probability of experiencing domestic violence among women exposed to specific factors (e.g., age, education, income) with those unexposed. Preference was given to adjusted ORs that accounted for potential confounders, as well as to associations that were statistically significant and consistently observed across studies. Finally, the extracted ORs were synthesized using a meta-analysis, producing pooled estimates that quantify the overall relationship between each factor and domestic violence among pregnant women in Ethiopia.

Data synthesis and analysis

Data were first extracted into a Microsoft Excel spreadsheet and then transferred to STATA version 11 for further analysis. The original studies were summarized, and key results were presented using tables, charts, and forest plots. Due to variability among studies, a random-effects model was applied to calculate the pooled prevalence estimate.

Heterogeneity was assessed using Cochrane’s Q test and the I² statistic, with levels classified as none (I² = 0.0%), low (I² < 25%), moderate (25% ≤ I² ≤ 75%), and high (I² ≥ 75%).²⁸ The strength of associations between various factors and domestic violence among pregnant women was expressed using odds ratios with 95% confidence intervals (CIs). Subgroup analyses were performed to explore potential sources of heterogeneity.

Publication bias was evaluated using a funnel plot and Egger’s test.²⁹ To identify factors associated with domestic violence among pregnant women, the pooled odds ratio (POR) and 95% CI were computed.

Results

Study selection

An initial search yielded 29,700 records concerning domestic violence and its determinants among pregnant women in Ethiopia. After removing 4,325 duplicates, 25,314 studies were excluded based on title and abstract screening. The remaining 61 articles underwent a full-text review, of which 54 were excluded due to the absence of relevant outcomes or differences in study populations. Ultimately, seven studies met the inclusion criteria and were incorporated into the final meta-analysis (Figure 1).

Figure 1.

Flow chart of study selection for systematic review and meta-analysis of domestic violence and associated factors among pregnant women in Ethiopia, 2024

Characteristics of the included studies

Among the included studies, five were institutional-based cross-sectional designs, one was a community-based cross-sectional study, and one employed a community-based prospective cohort approach to assess domestic violence. All studies were published between 2014 and 2022 and utilized systematic sampling methods. In total, the studies involved 3,139 participants out of an estimated 3,174 pregnant women, with individual sample sizes ranging from 299²³ to 774.³⁰ The reported prevalence of domestic violence among pregnant women varied between 24.5%³⁰ to 65.76%.³¹ Geographically, four studies were conducted in the Amhara region,^22,30,32 two in the Oromia region,^23,30 and one in Addis Ababa³³ (Table 1).

Table 1.

Descriptive summary of primary studies included in the meta-analysis of domestic violence among pregnant women in Ethiopia, 2024.

Id	Author	Pub year	Region	Study design	Study population	Sample size	Prevalence (%)	Sampling technique
1	Subah Yesuf²²	2022	Addis Ababa	institutional based cross-sectional	pregnant women	410	30.9	Systematic sampling
2	Fekadu et al.²³	2018	Amhara	institutional based cross-sectional	pregnant women	450	58.7	Systematic sampling
3	M.H. Asratie²⁴	2022	Amhara	community based prospective cohort	pregnant women	774	65.76	Systematic sampling
4	Berhanu Boru Bifftu⁷	2017	Amhara	institutional based cross-sectional	pregnant women	422	25.4	Systematic sampling
5	Tenaw Yimer¹³	2014	Amhara	community based cross-sectional	pregnant women	434	32.2	Systematic sampling
6	Tulu C, et al.¹⁹	2019	Oromia	institutional based cross-sectional	pregnant women	385	24.5	Systematic sampling
7	Yohannes et al.¹⁷	2019	Oromia	institutional based cross-sectional	pregnant women	299	64.6	Systematic sampling

Meta-analysis

Risk of bias assessment for the included studies

The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for cross-sectional studies.³⁴ Based on this assessment, the majority of studies (6 out of 7, 85.7%) were rated as high quality, while one study (14.3%) was classified as moderate quality S2 file.

Prevalence of domestic violence

The pooled prevalence of domestic violence among pregnant women in Ethiopia was estimated at 44% (95% CI: 29.86–58.15). Considerable heterogeneity was observed across the included studies (I² = 85.6%, p < 0.001), leading to the use of a random-effects model for the meta-analysis to calculate the combined prevalence (Figure 2).

Figure 2.

Forest plot of the pooled prevalence of domestic violence among pregnant women in Ethiopia, 2024.

Subgroup analysis

A subgroup analysis was performed based on the geographic location of the primary studies. The highest prevalence of domestic violence was observed in the Amhara region at 46.3% (95% CI: 27.40–65.20), while the lowest prevalence was reported in Addis Ababa at 30.9% (95% CI: 14.64–47.19) (Figure 3).

Figure 3.

Subgroup analysis of domestic violence among pregnant women in Ethiopia, 2024.

Publication bias

Presence of publication bias was evaluated using Egger’s regression test and visual inspection of funnel plot symmetry. Both assessments indicated bias among the included studies. Egger’s test was statistically significant (p < 0.001), confirming the presence of publication bias. Additionally, the funnel plot showed an asymmetrical distribution, further supporting the likelihood of bias in the analyzed studies (Figure 4).

Figure 4.

Showing pulication bias using funnel plot, 2024.

Trim and fill analysis

A trim-and-fill analysis was conducted to identify and adjust for potential publication bias in the meta-analysis. This analysis detected one potentially missing study, indicating that publication bias may have notably influenced the overall results.

Associated factors

This meta-analysis examined several factors linked to domestic violence among pregnant women, though some variables could not be pooled due to inconsistent classification across studies.

Partner’s Alcohol Consumption: Four studies reported a significant association between frequent alcohol use by partners and domestic violence. Pregnant women whose partners drank alcohol frequently had 3.87 times higher odds of experiencing domestic violence compared with those whose partners did not drink (POR = 3.87; 95% CI: 2.59–5.78). No heterogeneity was observed among these studies (I² = 0.0%, P = 0.487), and a fixed-effect model was applied (Figure 5).

Figure 5.

Showing the forest plot of the association between partner alcohol drinker and domestic violence in Ethiopia, 2024.

Women’s Educational Level: Two studies showed that lower maternal education was significantly associated with domestic violence. Women with low educational attainment had 6.33 times higher odds of experiencing domestic violence compared with those with college-level education or higher (AOR = 6.33; 95% CI: 2.78–14.44). Moderate heterogeneity was observed (I² = 56.7%, P = 0.129), and a random-effects model was used for this analysis (Figure 6).

Figure 6.

Showing the forest plot of the association between women educational level and domestic violence in Ethiopia, 2024.

Pregnancy Planning: Four studies indicated that unplanned pregnancies were significantly associated with domestic violence. Women with unplanned pregnancies had 4.99 times higher odds of experiencing domestic violence than those with planned pregnancies (POR = 4.99; 95% CI: 2.96–8.43). Heterogeneity was substantial (I² = 73.2%, P = 0.011), and a random-effects model was employed (Figure 7).

Figure 7.

Showing the forest plot of the association between plan of current pregnancy and domestic violence in Ethiopia, 2024.

Discussion

The purpose of this meta-analysis was to estimate the prevalence of domestic violence among pregnant women in Ethiopia and to identify key contributing factors. To our knowledge, this is the first systematic review and meta-analysis to synthesize national-level evidence on domestic violence during pregnancy and its associated predictors in Ethiopia.

The pooled prevalence of domestic violence among pregnant women was 44% (95% CI: 29.86–58.15), reflecting a substantial public health concern. This prevalence is comparable to findings from Rwanda³⁵ and Pakistan (51%),³⁶ but higher than the global prevalence of 34.1% reported by the World Health Organization across 80 countries,³⁷ and higher than the prevalence in South Africa (31%).³⁸ Conversely, it is lower than the prevalence reported in Tehran (59%)³⁹ and Bahrain (59%).⁴⁰These differences may be influenced by sociocultural norms, urbanization, levels of education, awareness of gender rights, and reproductive health, as well as potential underreporting due to fear or social stigma. Within Ethiopia, the variation in prevalence across regions higher in Amhara and lower in Addis Ababa likely reflects cultural differences, rural-urban disparities, and access to education and social support⁴¹).

This meta-analysis identified three major predictors of domestic violence during pregnancy: partner alcohol use, unplanned pregnancy, and low maternal education. Pregnant women whose partners frequently consumed alcohol were nearly four times more likely to experience violence compared to those with non-alcoholic partners (POR = 3.87; 95% CI: 2.59–5.78). This finding aligns with studies from Turkey, Brazil, and Tehran^39,42,43 and reflects the impact of alcohol on cognitive and behavioral control, which may increase aggression and heighten power imbalances in intimate relationships.²²

Unplanned pregnancy was also significantly associated with domestic violence. women experiencing unplanned pregnancies having five times higher odds of facing abuse compared to those with planned pregnancies (POR = 4.99; 95% CI: 2.96–8.43). This association may result from the intersection of reproductive autonomy and gendered power dynamics, where men’s control over fertility decisions can contribute to conflict and abuse.^40,44 Moreover, intimate partner violence itself may contribute to unplanned pregnancies through coercive sex or restricted access to contraception.^40,45

Low maternal education emerged as another important predictor. Women with limited formal education were six times more likely to experience domestic violence compared to those with college-level education or higher (AOR = 6.33; 95% CI: 2.78–14.44). This aligns with previous research suggesting an association between low education and increased risk of domestic violence during pregnancy.^18,46–49 One possible explanation is that limited education may reduce a woman’s ability to communicate effectively with her partner to resolve conflicts, potentially escalating disagreements and limiting her capacity to make informed decisions about the relationship, including leaving an abusive situation. Research showed that women are more likely to experience domestic abuse during pregnancy when they have poor educational attainment and less decision-making authority.¹⁵

Substantial heterogeneity was observed across studies (I² = 85.6%), likely reflecting differences in study populations, geographical regions, definitions of domestic violence, and data collection methods. Facility-based studies may underestimate prevalence due to social desirability bias, while community-based studies may capture higher rates. Regional differences in cultural norms, urbanization, and access to education and social services may also contribute to observed variability.

The findings have important policy and practice implications. First, the high prevalence of domestic violence during pregnancy highlights the need for routine screening within antenatal care settings. Healthcare providers should be trained to identify, counsel, and support women experiencing violence. Second, addressing partner-related risk factors, such as alcohol misuse, through public health campaigns and community interventions could reduce the incidence of violence. Third, promoting female education and reproductive autonomy, including access to family planning services, can help mitigate risks associated with low education and unplanned pregnancies. Finally, multisectoral collaboration involving the Ministry of Health, NGOs, and community leaders is essential to implement culturally sensitive and sustainable interventions.

Limitation of the study

Despite being the first systematic review and meta-analysis on domestic violence among pregnant women in Ethiopia, this study has several limitations. First, only English-language full-text articles were included, potentially excluding relevant studies in local or other languages and introducing publication bias. Second, variations in the definition and measurement of variables across studies limited the ability to pool odds ratios for all associated factors. Third, most studies (five out of seven) were conducted in health facility settings, which may limit the generalizability of the results to the broader population. Additionally, since the studies originated from only three regions, the pooled prevalence may not accurately represent the national burden of domestic violence among pregnant women.

To overcome these limitations, future research should include studies published in local languages, increase the number of community-based studies, and cover all regions of Ethiopia to produce more representative and comprehensive findings. Additionally, although we attempted subgroup analyses to explore sources of heterogeneity, the limited number of studies per subgroup constrained our ability to draw strong conclusions. We have explicitly acknowledged this as a limitation and recommend that future meta-analyses utilize meta-regression or stratified analyses when a larger body of literature becomes available.

Conclusion

Domestic violence during pregnancy is highly prevalent in Ethiopia, with nearly half of pregnant women affected. Low educational attainment, partner alcohol consumption, and unplanned pregnancy are key determinants. Addressing this public health challenge requires integrated interventions focusing on women’s empowerment, male partner behavior, reproductive health services, and routine screening in antenatal care. Strengthening research and surveillance systems to monitor trends and evaluate interventions will further inform effective evidence-based policies to protect pregnant women from domestic violence.

Supplemental material

Supplemental material - Prevalence and predictors of domestic violence among pregnant women in Ethiopia: Evidence from a systematic review and meta-analysis

Supplemental material for Prevalence and predictors of domestic violence among pregnant women in Ethiopia: Evidence from a systematic review and meta-analysis by Yeshiwas Ayale Ferede, Worku Chekol Tassew, Ayanaw Dinku Abebe, Asrat Mekonn Tegegne, Fentahun Agegnehu Worku, Agerie Mengistie Zeleke in Journal of Public Health Research

Supplemental material

Supplemental material - Prevalence and predictors of domestic violence among pregnant women in Ethiopia: Evidence from a systematic review and meta-analysis

Footnotes

Acknowledgments

The authors extend their gratitude to the researchers of the primary studies that provided the data used in this analysis.

ORCID iDs

Yeshiwas Ayale Ferede

Agerie Mengistie Zeleke

Ethical considerations

Ethical approval and informed consent were not required, as the study utilized anonymized, publicly available secondary data, in line with standard ethical practices for secondary data analyses.

Author contributions

YAF: Conceptualization, Formal Analysis, Investigation, Methodology, Visualization.

WCT: Methodology, Supervision, Writing – Original Draft, Writing – Review & Editing.

ADA: Supervision, Writing – Original Draft, Writing – Review & Editing.

AMT: Methodology, Writing – Original Draft, Writing – Review & Editing.

FAW: Formal Analysis, Writing – Original Draft, Writing – Review & Editing.

AMZ: Formal Analysis, Supervision, Writing – Original Draft, Writing – Review & Editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All relevant data generated and analyzed are included within this article.*

Supplemental material

Supplemental material for this article is available online.

Appendix

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