Intimate Partner Violence and Barriers to Healthcare Access Among Currently Women In Zambia

Background and Purpose: Intimate partner violence (IPV) is an important public health and human rights issue that disproportionately affects women in Zambia. Beyond its direct physical and psychological consequences, IPV may also limit women’s ability to access healthcare services due to fear, restricted autonomy, financial control, and social isolation. Barriers to healthcare access, such as lack of money, distance to facilities, and needing permission to seek care, remain persistent challenges for married women in Zambia. Despite growing attention to IPV, limited nationally representative studies have examined its association with healthcare access barriers. Guided by the social determinants of health framework, this study examined the relationship between IPV and barriers to healthcare access among currently married women in Zambia.

Methods: This cross-sectional study used data from the 2024 Zambia Demographic and Health Survey (ZDHS), a nationally representative survey of married women aged 15–49 years who completed the domestic violence module and healthcare access questions (N ≈ 5,904). The outcome variable included barriers to healthcare access, measured using three indicators: difficulty getting money for treatment, distance to a health facility, and needing permission to seek care, and dichotomized as “not a major problem” vs “major problem.” The primary independent variable included IPV (emotional, physical, and/or sexual violence) experienced during the past 12 months (yes/no). Covariates included women’s characteristics (age, marital duration, education, work status, household wealth index, residence, health status, health insurance, and media exposure) and partner characteristics (age group, education level, work status, and alcohol use). Weighted descriptive statistics were used to calculate frequencies and percentages, and multivariate logistic regression models were conducted to assess associations between IPV and healthcare access barriers while adjusting for potential confounders using SPSS vs 31.0 (p<.05).

Results: Out of 5,904 married women, 67.0% experienced barriers in accessing healthcare, 20.2% experienced emotional violence, 27.8% physical violence, 9.2% sexual violence, and 36.6% any of these IPV. After covariate adjustment, married women who experienced any IPV had higher odds of barriers in accessing healthcare compared to those without IPV exposures (OR=1.42;p<.001). Specific types of IPV including experiencing emotional violence (OR=0.78; p<.003) and sexual violence (OR=0.67; p<.001) were associated with lower odds of barriers in accessing healthcare compared to those without these violence exposures. However, experiencing physical violence was marginally significantly associated with barriers to accessing healthcare compared to those who never experienced physical violence (OR=0.87; p<.061).

Conclusions and Implications: This study has shown that IPV increases barriers to healthcare access among married women, underscoring the need for integrated responses within health and violence prevention systems. Clinical practice should incorporate routine IPV screening and trauma-informed care, alongside strengthened referral pathways to ensure safe and equitable access to healthcare services. Policy efforts must prioritize the integration of IPV prevention and response into primary healthcare and expand financial and structural support systems to reduce access barriers for vulnerable women. Additionally, multisectoral strategies addressing gender inequality, partner controlling behaviors, and economic dependence are essential to improving both safety and healthcare access outcomes in Zambia.