Discussion
This is the first study to explore the association between Zimbabwean women’s exposure to IPV and nutritional status using ZDHS data collected from 2005–2015. Although prior studies in Zimbabwe have examined trends in prevalence of overweight and obesity [33] as well as associations between demographic characteristics, socioeconomic status and IPV against women [1], no study has investigated the complex relationship between IPV and nutritional status (i.e., underweight, overweight, and obesity) of women in the country. Moreover, the prevalence of both IPV and overweight is high in Zimbabwe [1, 33, 54, 55], which makes the country an appropriate setting for this study.
Overall, the findings revealed that more than one-third (43%) of women reported to have ever experienced at least one form of intimate partner violence, which is higher than the global estimated prevalence of 30% [1, 56]. Nevertheless, this finding is consistent with previous studies in Zimbabwe [1, 54, 57–59] and other Sub-Saharan African countries [60, 61]. Some of the risks for the high and increasing prevalence of IPV in developing countries have been attributed to cohabitation [62], rural residence [63, 64] and low economic status [65–67]. Poverty on the other hand has been shown to be a determinant of IPV [68, 69] as poor women tend to heavily depend on their partners [66, 69, 70], which may limit their bargaining powers.
Regarding the various forms of IPV, we found emotional and sexual violence to be the most popular forms of violence against women [54, 58]. Sexual violence may be low due to underreporting of such abuses in Africa [64, 71], stemming from traditional norms and beliefs [72].
The findings further revealed that women of reproductive age are at high risk of excess weight [31, 73, 74], as more than one-fifth reported being overweight and about 12% obese. Several studies have reported overweight and obesity to be on the rise in developing countries [29, 31, 33], and risk factors such as high economic status, urban residence [75, 76], and, indeed, intimate partner violence [77, 78] have been implicated.
Both intimate partner violence against women and obesity are growing health problems in low and middle-income countries (LMICs) [29–31, 49, 61, 73, 78]. Our findings showed that women who had ever experienced any form of IPV were more likely to be obese. Prior studies suggest that women who have been exposed to violence may experience negative psychological impacts [79, 80], which can lead to unhealthy food consumption and obesity [18]. Obesity affects women’s participation in daily routines and other physical activities [81–83] which can affect their participation in the labour market [80], and also impact on other health outcomes [79, 84].
Surprisingly, we did not find any significant association between IPV and underweight, relative to normal weight. While this finding is consistent with some studies [74, 85], others suggest that exposure to IPV increases the odds of being underweight [85, 86]. These inconsistent findings may be attributed to study population, demographic and socioeconomic contexts [18, 26, 85]. Meanwhile, the positive association between IPV and underweight has been associated with dietary behaviours characterized by substance abuse, insufficient calorie intake, or reduced food intake [26]. Furthermore, abusive partners may withhold food from victims, as a form of punishment which can negatively affect their weight [18, 26].
IPV and poor nutrition (underweight and overweight) are major determinants of health [87, 88], especially among women of reproductive age [89, 90]. While obesity has been shown to be a risk factor for non-communicable diseases such as diabetes and hypertension [91–93], IPV has been linked with mental health problems including traumatic stress [15, 94, 95] and injury [5, 20, 96]. These findings, including the results presented in the current study, should be taken into account for the development of policies aiming for the promotion of peace and security of women. Such policies need to address gender related health issues as well as opportunities and pathways to reduce gender inequity and gendered social and health problems including IPV.