Umeå University's logo

Background and objective: Intimate partner violence (IPV) represents a critical breach of human rights and a significant global public health challenge, with profound consequences for maternal health. In Nigeria, where maternal mortality remains high, understanding the intricate pathways through which IPV influences obstetric outcomes is essential. While existing literature links IPV to complications like preterm birth and low birth weight, its specific relationship with caesarean section (C-section) a procedure increasingly common yet stratified by access is poorly understood within Nigeria's unique socio-cultural context. This study investigates this association to inform equitable maternal health policies.

Methods: Utilizing a nationally representative sample from the 2018 Nigeria Demographic and Health Survey (NDHS), this cross-sectional study analyzed data from 5,835 ever-partnered women aged 15–49 who experienced a live birth. IPV exposure was meticulously categorized into no IPV, physical/sexual violence only, and multiple forms of violence. The primary outcome was mode of delivery (C-section vs. vaginal). Employing a survey-weighted multivariable logistic regression model, the analysis controlled for key confounders including education, wealth quintile, residence, and parity to isolate the effect of IPV.

Results: The national C-section rate was 3.9%. Contrary to hypotheses and evidence from other regions, this study found no statistically significant association between exposure to IPV and delivery via C-section after adjusting for covariates (physical/sexual only: Adjusted Odds Ratio (AOR)=1.08, 95% CI: 0.43–2.69; multiple types: AOR=1.43, 95% CI: 0.29–7.05). Instead, the analysis revealed that profound socioeconomic disparities are the paramount drivers of C-section utilization. Women with higher education had over three times the odds of a C-section compared to those with no education (AOR=3.52, 95% CI: 1.57–7.86), and women in the richest wealth quintile had over five times the odds of those in the poorest (AOR=5.35, 95% CI: 1.82–15.8).

Conclusion: This research concludes that in Nigeria, the likelihood of a Caesarean delivery is not significantly predicted by experiences of IPV but is overwhelmingly determined by structural determinants of health specifically, educational attainment and economic status. The non-significant relationship with IPV may reflect underreporting due to stigma or, more critically, a health system failure where women experiencing IPV face insurmountable barriers to accessing even essential surgical care. These findings underscore an urgent need to refocus policy efforts beyond biomedical models towards dismantling the systemic inequalities in education, economic empowerment, and geographic access that dictate maternal health outcomes. Ensuring equitable access to safe obstetric care for all Nigerian women requires addressing these foundational inequities.