Women's empowerment and intimate partner violence among pregnant women in Northern Ghana: evidence from coarsened exact matching and double-selection LASSO analyses.

BACKGROUND

Intimate partner violence (IPV) is a major public health problem in sub-Saharan Africa. Its relationship with women's empowerment is theoretically contested, and most studies collapse empowerment into a single composite score, which may mask dimension-specific associations. We examined three empowerment dimensions including reproductive autonomy, household decision-making, and economic empowerment against physical, sexual, and emotional IPV among pregnant women in Northern Ghana.

METHODS

We surveyed 260 pregnant women attending antenatal care (April-May 2023). Coarsened Exact Matching (CEM) balanced high- and low-empowerment women on age, education, and number of children, retaining n = 246 for the pre-specified primary analysis. Double-Selection LASSO (DSL) logistic regression, applied to the full analytical sample (n = 260), served as a complementary sensitivity analysis. Balance after matching was assessed by standardised mean differences (SMDs) and variance ratios.

RESULTS

Any-IPV prevalence was 59.6%. Two associations showed convergent evidence across both

Methods

(1) reproductive autonomy was protective against sexual IPV (CEM OR = 0.34, 95% CI 0.19-0.61; DSL OR = 0.36, 95% CI 0.20-0.63) and emotional IPV (CEM OR = 0.29, 95% CI 0.16-0.54; DSL OR = 0.36, 95% CI 0.20-0.64); and (2) household decision-making was positively associated with physical IPV in a backlash-direction pattern (CEM OR = 1.34, 95% CI 1.07-1.66, p = 0.009; DSL OR = 1.26, 95% CI 1.03-1.55, p = 0.028). Economic empowerment and the composite empowerment index were not significantly associated with any IPV outcome in either analysis.

CONCLUSIONS

Reproductive autonomy showed a protective association with sexual and emotional IPV in the two different analytic approaches. Household decision-making showed a convergent positive association with physical IPV consistent with the backlash hypothesis. Composite empowerment scores obscured all dimension-specific patterns. Interventions strengthening reproductive autonomy, particularly contraceptive access and sexual-consent education, may reduce IPV vulnerability more directly than broad aggregated empowerment measures.