literature review on gender based violence in south africa

• Open access
• Published: 21 May 2024

Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence

• Desmond Kuupiel 1 , 2 ,
• Monsurat A. Lateef 1 ,
• Patience Adzordor 3 , 4 ,
• Gugu G. Mchunu 1 &
• Julian D. Pillay 1  

Archives of Public Health volume  82 , Article number:  78 ( 2024 ) Cite this article

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Sexual and gender-based violence (SGBV) is a prevalent issue in sub-Saharan Africa (SSA), causing injuries and trauma with severe consequences for survivors. This scoping review aimed to explore the range of research evidence on injuries and trauma resulting from SGBV among survivors in SSA and identify research gaps.

The review employed the Arksey and O’Malley methodological framework, conducting extensive literature searches across multiple electronic databases using keywords, Boolean operators, medical subject heading terms and manual searches of reference lists. It included studies focusing on injuries and trauma from SGBV, regardless of gender or age, published between 2012 and 2023, and involved an SSA countries. Two authors independently screened articles, performed data extraction and quality appraisal, with discrepancies resolved through discussions or a third author. Descriptive analysis and narrative synthesis were used to report the findings.

After screening 569 potentially eligible articles, 20 studies were included for data extraction and analysis. Of the 20 included studies, most were cross-sectional studies ( n  = 15; 75%) from South Africa ( n  = 11; 55%), and involved women ( n  = 15; 75%). The included studies reported significant burden of injuries and trauma resulting from SGBV, affecting various populations, including sexually abused children, married women, visually impaired women, refugees, and female students. Factors associated with injuries and trauma included the duration of abuse, severity of injuries sustained, marital status, family dynamics, and timing of incidents. SGBV had a significant impact on mental health, leading to post-traumatic stress disorder, depression, anxiety, suicidal ideations, and psychological trauma. Survivors faced challenges in accessing healthcare and support services, particularly in rural areas, with traditional healers sometimes providing the only mental health care available. Disparities were observed between urban and rural areas in the prevalence and patterns of SGBV, with rural women experiencing more repeated sexual assaults and non-genital injuries.

This scoping review highlights the need for targeted interventions to address SGBV and its consequences, improve access to healthcare and support services, and enhance mental health support for survivors. Further research is required to fill existing gaps and develop evidence-based strategies to mitigate the impact of SGBV on survivors in SSA.

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The World Health Organization (WHO) reports that injuries are a growing global public health problem [ 1 ]. In 2021, unintentional and violence-related injuries were estimated to cause over 4 million deaths worldwide, accounting for nearly 8% of all deaths [ 1 ]. Additionally, injuries are responsible for approximately 10% of all years lived with disability each year [ 1 ]. While injuries can result from various causes such as road traffic accidents, falls, drowning, burns, poisoning, and acts of violence, including sexual and gender-based violence (SGBV) [ 1 , 2 ], SGBV remains a neglected cause of injuries that silently affects the lives of many, especially women [ 3 , 4 ]. Injuries due to SGBV refer to physical harm or trauma resulting from acts of violence perpetrated based on an individual’s sex or gender. These injuries can encompass a range of physical harm, including but not limited to bruises, cuts, fractures, internal injuries, and sexual trauma (psychological or emotional) [ 5 ].

Sexual and gender-based violence is a pervasive issue [ 6 , 7 , 8 , 9 , 10 ] with alarming rates globally, particularly in the WHO Africa and South-East Asia regions with 33% each compared to 20% in the Western Pacific, 22% in high-income countries and Europe, and 31% in the WHO Eastern Mediterranean region [ 8 ]. However, this statistic includes only physical and/or sexual violence by an intimate partner alone and does not include other forms of violence [ 8 ]. Sexual and gender-based violence encompasses various acts such as sexual assault, rape, intimate partner violence, and harmful traditional practices, all of which have severe physical and psychological consequences for women [ 9 , 11 , 12 ]. The sub-Saharan Africa region has witnessed numerous cases of SGBV perpetrated against vulnerable populations, such as women, children, refugees, and individuals with disabilities, with devastating impacts on their well-being and overall quality of life [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].

Understanding the extent and nature of injuries and trauma resulting from SGBV among survivors is crucial in formulating effective interventions, policies, and support systems. Research evidence plays a fundamental role in shaping responses to this pressing public health concern, guiding the development of targeted interventions and preventive measures. However, the available research on injuries and trauma related to SGBV in sub-Saharan Africa remains scattered and diverse, necessitating a comprehensive and systematic review to consolidate and analyse existing knowledge.

A scoping review study would support a valuable research approach to systematically map and describe the existing evidence on injuries and trauma related to SGBV against women in sub-Saharan Africa. In so doing, the scoping review would provide a broader overview of the literature to identify knowledge gaps, key concepts, and various study designs employed in the field, and inform more specific research questions that can be unpacked by way of a systematic review and /or meta-analysis quantitative studies or meta-synthesis of qualitative studies [ 33 , 34 ]. To our knowledge, current literature shows no evidence of any previous scoping review that has focused on injuries and trauma due SGBV. This study, therefore, conducted a systematic scoping review to explore the scope of research evidence regarding injuries and trauma stemming from SGBV among survivors in sub-Saharan Africa. This research sheds light on the prevalence, patterns, and factors associated with injuries and trauma resulting from SGBV in the region and their impact on survivors.

To achieve the objective of this scoping review, we utilised the Arksey and O’Malley methodological framework [ 35 ] as a guiding framework for mapping and examining the literature on injuries and trauma associated with SGBV in the context of sub-Saharan Africa. This framework comprises several key steps, including identifying the research question, identifying relevant studies, study selection, data charting and collation, and summarizing and reporting the results [ 33 , 34 ].

Identifying the research question

The primary research question guiding this scoping review is as follows: What is the scope of research evidence regarding injuries and trauma resulting from sexual and gender-based violence among survivors in sub-Saharan Africa in the last decade? To ensure the appropriateness and relevance of this question, we employed the Population, Concept, and Context (PCC) framework [ 36 ] as part of the study eligibility criteria, which is detailed in Table  1 . To comprehensively address the research objective, the scoping review explored the following sub-questions:

Literature searches

The purpose of our search was to identify relevant peer-reviewed papers that address the review questions. To accomplish this, a comprehensive search was conducted across several electronic databases, including PubMed, EBSCOhost (CINAHL, PsycInfo, and Health Source: Nursing/Academic Edition), SCOPUS, and Web of Science for original articles published within between 2012 and 2023. Additionally, a search using the Google Scholar search engine was performed to identify additional literature of relevance. For the database searches, we developed a search strategy in collaboration with an information scientist, ensuring the inclusion of relevant keywords such as “survivor,” “gender-based violence,” “sexual violence,” “injuries,” and “trauma.” We employed Boolean operators (AND/OR) and Medical Subject Heading (MeSH) terms to refine the search string (Please refer to Supplementary File 1 for the detailed search strategy). Adjustments were made to the syntax based on the specific requirements of each database. The information scientist also played a role in conducting website searches. In addition to electronic searches, we manually explored the reference lists of included sources to identify any additional relevant literature. At this stage, no search filters based on language or publication type were applied, however, the search results will be limited to publications from 2012 to 2023. This date limitation was to enable as captured recent and relevant studies to understand the current trend. All search results were imported into an EndNote Library X20 for efficient citation management.

Articles selection process

A study selection tool was developed using Google Forms based on the items outlined in the inclusion criteria (Table  1 ) and was subsequently pilot tested. The EndNote library was then examined for duplicates using the “Find Duplicate” function. Two authors (DK and ML) independently utilised the study screening tool to categorise titles and abstracts into two groups: “include” and “exclude.” Any discrepancies in their responses during this phase were resolved through discussion and consensus. The full-text articles of all titles and abstracts that met the inclusion criteria during the initial screening phase were obtained from using the Durban University of Technology Library Services, and independently screened by DK and ML following the eligibility criteria as a guide. In cases where there was a lack of consensus between DK and ML, a third author (PA) was consulted to resolve any discrepancies. The PRISMA flow diagram was utilised to document the article selection process, ensuring transparency and accountability.

Quality appraisal

The Mixed Method Quality Appraisal Tool (MMAT) Version 2018 [ 37 ] was utilised to assess the methodological quality and potential risk of bias in the included studies. This tool was employed to evaluate the appropriateness of the study’s objective, the suitability of the study design, participant recruitment methods, data collection procedures, data analysis techniques, and the presentation of results/findings. To determine the quality of the studies, a quality score based on established criteria was applied, where a score of 50% indicated low quality, 51–75% indicated average quality, and 76–100% indicated high quality. The total percentage score was calculated by adding all the items rated, divided by seven, and multiply by a hundred. This rigorous assessment is crucial for identifying any research gaps. Two authors (DK and ML) independently conducted the quality appraisal, and any disagreements were resolved by involving a third author (PA).

Data charting

Data extraction was conducted using a spreadsheet, which underwent a pilot test with 15% (3) of the included evidence sources to ensure its efficacy in capturing all relevant data for addressing the review question. Feedback from the pilot test was carefully considered, and necessary adjustments were made to the form. Upon a comprehensive examination of the full texts, two independent reviewers (DK and ML) extracted all pertinent data from the included studies. The data extraction process employed a hybrid approach, incorporating both inductive and deductive reasoning [ 38 ]. The process involved a thorough analysis of the extracted information to identify patterns, themes, and trends in the existing research evidence regarding injuries and trauma resulting from SGBV among survivors in sub-Saharan Africa. Key study characteristics, including author(s), publication year, study title, aim/objective, geographical location (country), study design and study population, were extracted. Additionally, the study findings pertaining to injuries and/or trauma resulting from SGBV were recorded.

Collating, summarising, and reporting the results

The results of the data extraction were collated and summarised in a narrative format. Descriptive analysis and narrative synthesis were utilised to present the findings in a comprehensive manner. The study outcomes included a comprehensive overview of the scope of research evidence on injuries and trauma due to SGBV among survivors in the region. This study was be reported in keeping with the Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) checklist [ 39 ].

Study selection

A total of 569 potentially eligible titles and abstracts across databases were screened and after excluding duplicates and those that did not meet this eligibility criteria, included 20 [ 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] studies for data extraction and analysis (Fig.  1 ).

PRISMA 2020 flow diagram

Characteristics and quality appraisal of the included studies

Of the 20 included studies, the majority ( n  = 4; 20%) were from South Africa, and mostly ( n  = 11; 55%) published between 2012 and 2022. The majority ( n  = 9, 45%) were cross-sectional studies, and mostly ( n  = 15; 75%) involved women. The mean quality score ± SD of the 20 included studies was 87% ± 13. All details on the characteristics and quality appraisal of the included studies are provided in Table  2 .

Study findings

Theme 1: physical injuries/trauma due to sgbv occurrence/prevalence, pattern, and associated factors.

Several studies have explored the prevalence and factors associated with injuries/trauma due to SGBV (Table  3 ). Ssewanyana et al. highlighted the occurrence of genital trauma among adolescent girls resulting from sexual assault [ 14 ]. Apatinga et al. demonstrated that sexual violence was accompanied by physical abuse, leading to physical injuries among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of injuries including genital injuries [ 16 ]. Amashnee et al. identified specific patterns in the occurrence of sexual assault injuries, with higher prevalence on Mondays (28%) and Fridays (27.3%), during specific months, and predominantly during working hours [ 17 ]. Abubeker et al. examined the impact of physical violence on female students, with findings indicating various injuries such as bruising, cuts, scratches, and fractures, leading to missed classes and fear of walking alone [ 19 ]. Biribawa et al. investigated the burden of GBV-related injuries and found a significant number of hospital visits in Uganda, with slightly declining injury rates (from 13.6 to 13.5 per 10,000 population) from 2012 to 2016 [ 18 ]. Umana et al. documented that 6.6% of undergraduate and postgraduate female students experienced sexual intimate partner violence, leading to injuries such as cuts, bruises, and sprains [ 20 ]. Mukanangana et al. reported the prevalence of virginal bleeding, genital irritation and urinary tract infection among women in reproductive age in Zimbabwe [ 21 ]. These findings collectively underscore the occurrence/prevalence physical injuries/trauma, pattern and specific associated factors associated resulting from SGBV.

Theme 2: consequences and impact on mental health

Several studies highlighted the significant consequences and impact of SGBV on mental health (Table  4 ). Ombok et al. found that sexually abused children had a high prevalence (49%) of post-traumatic stress disorder (PTSD), which was associated with the duration of abuse, severity of injuries sustained, parents’ marital status, and family dynamics [ 13 ]. Apatinga et al. demonstrated that sexual violence was accompanied by emotional abuse, leading to psychological problems, sexual and reproductive health issues, and suicidal ideations among women [ 15 ]. Azumah et al. reported that visually impaired women who experienced gender-based violence faced a higher risk of suicide attempts, and marital breakdown [ 16 ]. Liebling et al. found that women and girls who experienced SGBV frequently became pregnant and suffered from injuries, disability, and psychological trauma [ 22 ]. Morof et al. highlighted the high prevalence of violence and its association with PTSD symptoms and depression among women [ 23 ]. Nguyen et al. demonstrated that exposure to various forms of gender-based violence, including intimate partner violence and sexual harassment, was significantly associated with hypertension, mediated by depression, post-traumatic stress symptoms, and alcohol binge-drinking [ 24 ]. Abrahams et al. reported that women raped by intimate partners had higher levels of depressive symptoms compared to those raped by strangers [ 25 ]. Pitpitan et al. found a significant association between gender-based violence and increased alcohol use, as well as heightened levels of depressive symptoms and PTSD symptoms [ 26 ]. Okunola et al. revealed the complications experienced by survivors of sexual assault, including sexually transmitted infections, depression, and post-traumatic stress disorder [ 27 ]. Umana et al. identified the negative impact of violence on academic performance, with victims experiencing loss of concentration, self-confidence, and school absenteeism [ 20 ]. Roberts et al. highlighted the association between severe GBV and higher depressive symptoms, PTSD symptoms, disordered alcohol use, and more sex partners [ 29 ]. Tantu et al. emphasized the wide range of social, health-related, and psychological consequences resulting from gender-based violence [ 28 ]. Finally, Mukanangana et al. revealed that the majority of respondents who experienced rape suffered from psychological trauma, exposure to sexually transmitted infections, unwanted pregnancies, loss of libido, and illegal abortions [ 21 ]. These findings collectively demonstrate the significant impact of SGBV on mental health, including psychological trauma, depression, PTSD symptoms, and various adverse outcomes.

Theme 3: healthcare access and support services

The findings from the studies conducted in the Democratic Republic of the Congo and Togo highlight significant barriers and challenges faced by survivors of SGBV in accessing healthcare and receiving proper psychological care. In the Democratic Republic of the Congo, Scott et al. reported that SGBV survivors faced barriers to accessing healthcare, such as availability and affordability, in their study to evaluate community attitudes of SGBV and health facility capacity to address SGBV in the eastern part of the country [ 30 ]. Access to mental health care was difficult [ 30 ]. Witch doctors and other traditional healers provided mental health services to some survivors [ 30 ]. Burgos-Soto et al.‘s study in Togo, which sought to estimate the prevalence and contributing factors of intimate partner physical and sexual violence among HIV-infected and -uninfected women, found that lifetime prevalence rates of physical and sexual violence were significantly higher among HIV-infected women compared to uninfected women [ 31 ]. 42% of the women admitted to ever suffering physical harm as a result of intimate partner abuse [ 31 ]. Only one-third of the injured women had ever told the medical professionals the true nature of their injuries, and none had been directed to neighbourhood organizations for the proper psychological care [ 31 ].

Theme 4: rural vs. urban disparities

According to a study conducted in Nigeria by Na et al. to identify the trends in sexual assault against women in urban and rural areas of Osun State, completed rapes occurred 10.0% of the time in urban areas and 9.2% of the time in rural areas, while attempted rapes occurred 31.4% of the time in urban areas and 20.0% of the time in rural areas [ 32 ]. Rural women were more likely than urban women to endure repeated sexual assault and non-genital injuries [ 32 ]. This study findings suggest that sexual assault against women occurs in both urban and rural areas, with notable differences in the patterns and outcomes.

This scoping review study on injuries and trauma resulting from sexual and SGBV) in sub-Saharan Africa revealed key findings that shed light on this critical issue. The majority (15%) of the included studies were conducted in South Africa. Most (75%) of these studies adopted a cross-sectional design and focused on women as the population of interest. The overall mean quality score of the included studies was high, indicating robustness and reliability in the research.

The findings from the included studies collectively highlighted the prevalence of physical injuries and trauma resulting from SGBV in sub-Saharan Africa such as genital injuries, cuts, bites, scratches, abrasions, bruises, sprains, dislocations, fractures, vaginal bleeding, and genital trauma. The included studies provided insights into the consequences and specific factors associated with such violence, emphasising the urgent need for effective interventions and support services. Notably, the impact of SGBV on mental health was a recurring theme in the literature, with evidence pointing to psychological trauma, depression, PTSD symptoms, and other adverse outcomes experienced by survivors.

While the review identified limited research on healthcare access and support services for SGBV survivors, the available studies underscored significant barriers in accessing healthcare and receiving proper psychological care [ 30 , 31 ]. Challenges included limited availability and affordability of services, as well as survivors’ hesitancy to disclose abuse to medical professionals. These findings highlight importance healthcare gaps requiring interventions to ensure comprehensive support for survivors in sub-Saharan Africa.

Policymakers in sub-Saharan Africa should prioritise the implementation of comprehensive and evidence-based interventions to address injuries and trauma resulting from SGBV. The concentration of included studies from South Africa indicates the need to expand research efforts to include other countries in the region, ensuring that policies are tailored to meet the diverse needs and contexts of different nations. The limited research on healthcare access and support services for SGBV survivors underscores the urgency of improving healthcare systems and strengthening support services for survivors. Policymakers should consider investing in accessible and affordable healthcare services that provide specialised care for SGBV survivors, including mental health support. Additionally, addressing publication language bias by promoting research in multiple languages (e.g., French and Portuguese) can ensure that relevant findings reach policymakers across the sub-Saharan African region. Furthermore, this scoping review’s potentially can inform the development of targeted policies that address the specific risk factors, consequences, and contributing factors associated with injuries and trauma resulting from SGBV.

The scoping review findings highlight several avenues for future research on injuries and trauma as a result of SGBV in sub-Saharan Africa. Researchers should focus on conducting studies in countries with limited representation in the current literature to enhance the breadth and diversity of evidence available. Investigating the barriers and challenges faced by survivors in accessing healthcare and support services should be a priority to identify gaps and improve service delivery. Moreover, longitudinal studies could provide valuable insights into the long-term consequences of SGBV on survivors’ mental health and well-being. Researchers should also explore the effectiveness of various interventions, including those involving community-based support systems, to address SGBV-related injuries and trauma. Furthermore, incorporating qualitative research approaches could deepen the understanding of survivors’ experiences and help in tailoring interventions to their specific needs. Future research should also consider the perspectives of various stakeholders, including healthcare providers, community leaders, and policymakers, to develop comprehensive and context-specific strategies to prevent and respond to SGBV and its consequences. Overall, conducting rigorous research that spans diverse contexts and populations will contribute to a more comprehensive understanding of the multifaceted challenges posed by SGBV and inform evidence-based interventions that promote survivor support and well-being.

The scoping review’s strength lies in its comprehensive approach, encompassing a wide range of literature on injuries and trauma resulting from SGBV in sub-Saharan Africa. By considering various study designs and sources of evidence, the review offers a holistic view of the topic. Additionally, the study effectively identifies key themes and trends in the literature, leading to a deeper understanding of the prevalence, consequences, and specific factors associated with injuries and trauma resulting from SGBV in the region. The mapping of research evidence within the review proves to be a valuable resource for researchers, policymakers, and practitioners working in the field of SGBV. Furthermore, the review’s emphasis on studies with an overall high mean quality score (87% ± 13%) enhances the credibility and reliability of the findings, ensuring that the evidence presented is robust and trustworthy.

Despite these strengths, this scoping review has several limitations. The concentration of included studies from South Africa introduces a geographic bias, potentially limiting the generalizability of findings to other countries within sub-Saharan Africa. To enhance the review’s applicability, a more diverse representation of research from different regions in the area would be beneficial. Additionally, the paucity of studies investigating healthcare access and support services for SGBV survivors may restrict the review’s ability to provide comprehensive insights into this critical aspect of the topic. Despite these limitations, this scoping review provides a valuable overview of the available research evidence on injuries and trauma related to SGBV in sub-Saharan Africa, paving the way for further research and targeted interventions to address this critical issue. Researchers should acknowledge and consider these limitations when interpreting and applying the review’s findings.

In conclusion, this scoping review provides a comprehensive overview of the research evidence on injuries/trauma resulting from SGBV in the sub-Saharan African region. It underscores the urgent need for further research and targeted interventions to address this pervasive issue and support the well-being of survivors.

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Desmond Kuupiel, Monsurat A. Lateef, Gugu G. Mchunu & Julian D. Pillay

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Desmond Kuupiel

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D.K., G.M. and J.D conceptualised the study. D.K. wrote the manuscript and P.A., M.A., G.M., and J.D. did critical reviews. All authors approved the manuscript.

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Kuupiel, D., Lateef, M.A., Adzordor, P. et al. Injuries and /or trauma due to sexual gender-based violence among survivors in sub-Saharan Africa: a systematic scoping review of research evidence. Arch Public Health 82 , 78 (2024). https://doi.org/10.1186/s13690-024-01307-3

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DOI : https://doi.org/10.1186/s13690-024-01307-3

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Gender Based Violence against Women in Sub-Saharan Africa: A Systematic Review and Meta-Analysis of Cross-Sectional Studies

Muluken dessalegn muluneh.

1 School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Parramatta, NSW 2151, Australia

2 Amref Health Africa in Ethiopia, Addis Ababa 17022, Ethiopia

Virginia Stulz

3 School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia

Lyn Francis

Kingsley agho.

4 School of Health Sciences, Western Sydney University, Locked Bag1797, Penrith, NSW 2571, Australia

5 African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban 4041, South Africa

Associated Data

This study aimed to systematically review studies that examined the prevalence of gender based violence (GBV) that included intimate partner violence (IPV) and non-IPV among women in sub-Saharan Africa (SSA). This evidence is an important aspect to work towards achieving the Sustainable Development Goals (SDG’s) target of eliminating all forms of violence in SSA. The Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines were followed. Ovid Medline, CINAHL, Cochrane Central, Embase, Scopus and Web of Science were used to source articles with stringent eligibility criteria. Studies on GBV in SSA countries that were published in English from 2008 to 2019 were included. A random effect meta-analysis was used. Fifty-eight studies met the inclusion criteria. The pooled prevalence of IPV among women was 44%, the past year-pooled prevalence of IPV was 35.5% and non-IPV pooled prevalence was 14%. The highest prevalence rates of IPV that were reported included emotional (29.40%), physical (25.87%) and sexual (18.75%) violence. The sub-regional analysis found that women residing in Western (30%) and Eastern (25%) African regions experienced higher levels of emotional violence. Integrated mitigation measures to reduce GBV in SSA should focus mainly on IPV in order to achieve the SDG’s that will lead to sustainable changes in women’s health.

1. Introduction

According to the United Nations (UN), gender based violence (GBV) is defined as “any act of gender based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life [ 1 ].” GBV occurs and is classified in various ways. It can be defined depending on the relationship between the perpetrator and victim (intimate partner violence (IPV) and non-IPV), or by type of the act of GBV, such as sexual, physical or emotional violence [ 2 ]. This definition resonates throughout this manuscript.

GBV is a global public health problem that poses challenges in human health, with a higher prevalence in developing countries [ 3 , 4 ]. GBV not only plays a significant component in the morbidity and mortality of women, but this form of violence disproportionately affects the health status of women and their children [ 4 ]. GBV is an abuse of human rights that occurs internationally, in both developing and developed countries, regardless of culture, socio-economic class or religion [ 2 , 5 , 6 ] and varies in frequency, forms and extent from country to country [ 6 ].

It is often considered a ‘tip of the iceberg or silent epidemic’ as victims are hesitant to reveal their experiences of violence due to many barriers [ 7 , 8 , 9 , 10 ]. The barriers that women experience about reporting GBV include fear of stigma and shame, financial barriers, lack of awareness of available services, fear of revenge, lack of law enforcement action and attitudes surrounding violence as a normal component of life. Subsequently, this results in underreporting and challenges in accurately measuring the prevalence of GBV [ 7 , 10 ]. Overall, it is estimated that 30% of women have experienced at least one form of GBV in their lifetime since the age of 15 [ 4 ]. A World Health Organisation (WHO) multi-country study among women of reproductive age revealed that the overall prevalence of IPV ranged between 15% in urban areas (such as Japan) to 71% in provincial areas (such as Ethiopia) [ 3 ]. Evidence reveals that the problem is mostly prominent in developing countries where socioeconomic status is low and education is limited, especially in sub-Saharan Africa (SSA) countries [ 11 , 12 ].

The SDG’s are targeting eliminating all forms of violence against women and that all countries should be free from IPV by the year 2030, considering the deep rooted practices and effects of GBV against women [ 13 ]. In response to this, all stakeholders in all countries need to improve and work towards decreasing the prevalence of IPV [ 14 ]. Hence, better understanding of the prevalence of GBV is necessary for government and nongovernment organisations to inform an appropriate and effective policy response.

Despite the scope of this problem, most available studies are limited to developed countries with limited evidence focused on SSA countries [ 4 , 7 , 11 ]. Setting priority prevention and mitigation measures using the evidence from developed countries alone have substantial drawbacks [ 4 , 13 ]. In addition, studies conducted in SSA countries were focused on small-scale studies such as provinces and districts in particular countries that could overestimate the prevalence of GBV [ 3 , 4 ]. The small-scale studies conducted cannot be generalizable to the wider population. As a result, many SSA countries are yet to include the elimination of GBV on their policy agendas as a serious human rights violation with severe short and long-term implications [ 15 ]. There have been limited studies to date that have collectively and systematically examined the prevalence of GBV in varying forms among women aged 15-49 years of age in SSA countries, besides these small-scale studies.

Therefore, the aim of this research was to systematically determine the pooled prevalence rates of GBV including IPV and non-IPV in SSA countries. Additionally, the study analysed pooled prevalence rates of physical, sexual and emotional IPV in SSA countries. Findings reported in this study will provide vital evidence to inform policy and guide health investments to respond and prevent violence in alignment with the SDG’s target by 2030. In addition, the research findings will serve as a stimulus for further research on the dynamics of GBV in SSA countries to close existing gaps in the literature.

2. Materials and Methods

2.1. study setting.

According to the United Nation (UN) World Population Review 2019, SSA consists of 48 countries with a population of 1,066,283,427 and accounts for 14.2% of the world population, with a growth rate of 2.66% in 2019 [ 16 ]. According to the UN sub-classification, regions are subdivided in to four regions including Western, Central African, Eastern, and Southern SSA [ 16 ]. Western SSA included Benin, Burkina Faso, Cape Verde, Gambia, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone and Togo. Central African SSA included Cameroon, Central African Republic, Chad, Congo Republic-Brazzaville, Democratic Republic of Congo, Equatorial Guinea, Gabon, and Sao Tome and Principe. Southern SSA included Angola, Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe [ 16 ]. The fourth least developed sub-region of SSA is Eastern SSA that included Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Rwanda, Seychelles, Somalia, Somaliland, Tanzania and Uganda [ 16 ].

GBV is reported as a common practice in SSA and sexual violence prevalence is high in some countries such as Zambia (90%) and Ethiopia (711%) [ 3 , 17 ]. According to the Gender Equality Index Report, which includes data on reproductive health, employment, and empowerment, 27 of the 30 countries in the world that exhibit unequitable gender indices, are in Africa [ 13 ]. Most African cultural beliefs and traditions promote men’s hierarchical role in sexual relationships and especially in marriage [ 18 ]. Almost two-thirds (63%) of the African population live in remote rural settings that increases the difficulty to access basic amenities [ 16 ] and communities are disparate from the influence of central government or laws that prohibit GBV [ 13 ]. Only 22 African countries have adopted laws that prohibit GBV [ 14 ].

2.2. Information Source

A search of six electronic databases including Ovid Medline, CINAHL, Cochrane Central, EMBASE, Scopus, and Web of Science were undertaken. Relevant reference listings were checked, and grey literature was included, in addition to key research publications. Prior to starting this systematic review, the authors ensured the research question did not appear in any existing systematic reviews using Cochrane, Health Services Research Projects in Progress (HSRProj), and Prospero International Prospective Register of Systematic Reviews (PROSPERO) database registries.

2.3. Search Strategy

This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 19 ]. Pre-selected Medical Subject Headings (MeSH) terms and text words were used and searched in the above six databases for peer reviewed articles published between January 2008 and July 2019. The year 2008 was used as a baseline that provided increased global commitment of addressing GBV over the past decade [ 20 ]. There has been an increased uptake on the number of studies determining GBV prevalence internationally [ 20 ]. Moreover, the population dynamics have changed rapidly over the past ten years including improvements in health service access and education [ 21 ]. The search was limited to English language papers. Gender-based violence, intimate partner violence, domestic violence, spouse abuse, physical abuse, emotional violence, reproductive coercion, sexual assault, sub-Saharan countries, women aged 15-49 years, prevalence, magnitude and estimates were the key words used to conduct the search ( Table S1 ). The specified age of 15 years was used as a baseline as most studies used Demographic Health Surveys (DHS) that focused on women aged 15 to 49 years of age.

2.4. Eligibility Criteria

The following eligibility criteria were used to include studies in the systematic review:

• (i) Studies that reported the prevalence of GBV that focused on either or a combination of IPV, non-IPV, physical, sexual or emotional violence;
• (ii) Sample size greater than 300;
• (iii) Females within the age range of 15–49 years of age;
• (iv) Studies conducted in SSA countries [ 16 ] including countries in Western, Central, Eastern and Southern countries (see study setting for the list of countries);
• (v) Published in English from 2008 to 2019;
• (vi) Only quantitative studies.

2.5. Exclusion Criteria

• GBV studies with no prevalence reported for example, studies that focused on factors associated with GBV; GBV consequences;
• Sample size less than 300;
• Qualitative studies not included as the main objective was to generate a pooled prevalence of GBV using the meta-analysis;
• Studies conducted outside SSA;
• Studies published before 1st of January 2008;
• Studies published other than English;
• Study participants less than 15 years of age or greater than 49 years of age.

2.6. Quality of Study

The quality of the studies that met the inclusion criteria was appraised using a Critical Appraisal Skills Programme (CASP) checklist for cross-sectional studies [ 22 ]. The following criteria were the key questions derived from the CASP to appraise the quality of the studies:

• Did the study address a clearly focused issue?
• Were the participants of the study recruited in an acceptable way?
• Was the outcome accurately measured to minimise bias?
• Was the sampling appropriate for the study?
• What are the results of the study?
• How precise are the tools used to measure the results?
• Do you believe the results?
• Can the results be applied to the local population?
• Are the results of the study relevant and fit with other available evidence?
• What are the implications of this study for practice?

The two independent reviewers rated the quality of each study by screening and considering the findings in relation to current practice or policy or relevant research-based literature and whether the findings can be transferred to other populations. The quality of each paper was rated using a ten-point scale using the CASP measurement criteria, 0 (none of the quality measures met) to ten (all quality measures met). The quality of the paper was based on the sum of points awarded. Studies were rated as poor quality (score ≤ 6); medium quality (7–8); and high quality (≥9) (See Table S2 in the Supplementary Materials .

2.7. Data Extraction

Endnote was used to manage search results. The authors reviewed the titles, abstracts, and keywords of every article retrieved by the search according to the selection criteria developed that included author, country, population/study subjects, study design, sample size and key findings and quality of the paper. The full texts of the articles were retrieved for further assessment if the information suggested that the study met the selection criteria or if there was any doubt regarding eligibility of the article based on the information in the title and abstract. Outcome data were extracted from studies using a tailored data extraction form adopted from various literature.

2.8. Data Analysis and Synthesis

This study was based on secondary data analysis. The syntax “metaprop” in Stata version 16.0 [ 23 ] was used to generate forest plots for each of the Figures S1–S8 . Each forest plot showed the prevalence of an indicator in individual authors and countries and its corresponding weight, as well as the pooled prevalence in each sub-region and its associated 95% confidence intervals (CI’s). A test of heterogeneity of the DHS and other data sets were obtained for the different authors and countries that showed a high level of inconsistency (I 2 > 50%) thereby warranting the use of a random effect model in all the meta-analyses. Sensitivity analyses were conducted to examine the effect of outliers by using a method similar to that employed by Patsopoulos and colleagues [ 24 ] which involves comparing the pooled prevalence before and after elimination of one author or country at a time. Subgroup analysis was conducted by Eastern Africa, Western Africa and Southern Africa based on the UN classification [ 16 ]. The findings of the systematic review are synthesized and presented in summary form in Table 1 .

Characteristics of included studies (intimate partner violence (IPV) and non-IPV).

2.9. Ethical Statement

This review used secondary data available in the public domain including the six electronic databases for the systematic review and the DHS dataset that are publicly available. Therefore, ethical approval was not required for this study because the data included in this analysis contained no identifying information and is publicly available and ethical approval has already been obtained by the original author or by the DHS program.

A total of 4931 articles were found in the initial search from all databases. After removal of duplicates, 3275 remained for screening. Screening by title led to the exclusion of 3021 articles. Further reading of abstracts for 245 full-text articles led to the exclusion of another 187 articles. Twelve grey literature articles were included. Finally, 58 articles met the inclusion criteria ( Figure S1 ).

3.1. Description of Included Studies

Fifty-eight articles were reviewed for data analysis and interpretation. The majority (95%) [ 4 , 9 , 15 , 21 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 ] of research articles included in this review were cross-sectional and the remaining (5%) were cohort studies [ 86 , 87 , 88 ]. Only cross-sectional studies were used to estimate the pooled prevalence rates. Overall, the total sample sizes ranged from 300 to 86,024 women of reproductive age ( Table 1 ).

Overall, 58 cross-sectional studies investigated the prevalence of IPV either in the woman’s lifetime or over the previous year. Four studies reported non-IPV [ 4 , 27 , 60 , 80 ]. The studies that focused on IPV included 23 that reported physical violence, 18 that reported sexual violence and 20 studies that reported emotional violence. A relatively larger number of studies were found from Nigeria, South Africa, Kenya, Ethiopia and Uganda ( Table 1 ). The assessment of the studies’ quality found that 30 (52%) were very good, 22 (38%) were medium quality and six (10%) studies were deemed low quality. The details of this assessment are provided as a supporting document (Table S2) .

3.2. Prevalence of IPV among Women Aged 15–49 Years of Age

The prevalence of IPV in various SSA countries was sourced from 25 studies. The findings showed the prevalence ranged from as low as 13.9% (95% CI 10.8, 17.6%) [ 86 ] in a study conducted on perinatal women with depression symptoms in South Africa to as high as 97% (95% CI 94.6, 98%) [ 37 ] in a study conducted among rural women in Nigeria. The overall meta-analysis estimate for prevalence of IPV was 44.4% (95% 38.4, 49.8%) ( Figure S2 ).

3.3. Prevalence of Intimate Partner Physical or Sexual Violence among Women Aged 15–49 Years of Age Using DHS Data (2008–2019)

Additional information was sourced from the most recent DHS reports that were conducted in SSA countries from 2008 to 2019 [ 101 ]. Only 29 sub-Saharan countries from the DHS reported on GBV. The prevalence focused on physical or sexual violence committed by a husband or partner against women [ 101 ]. We found that prevalence ranged from as low as 6.4 % in Comoros to 51% in Cameroun [ 101 ]. The meta-analysis showed a pooled prevalence of 31.3% (95% CI 26.3, 36.3) with heterogeneity detected among various surveys and countries ( Figure S3 ).

3.4. Prevalence of Past Year IPV among Women Aged 15–49 Years of Age

A total of 18 studies investigated experiences of IPV over the past year among 24,941 women. The highest prevalence of IPV was found among women engaged in commercial sex work 78.7% (95% CI 75.2, 81.8%) in Kenya and in Nigeria (52.5%) (95% CI 46.7, 58.2%) [ 66 ]. Furthermore, a meta-analysis was estimated at 35.5 % (95% CI, 27.2, 44.12) ( Figure S4 ). The sub-region analysis showed the highest pooled estimates in Eastern Africa (38.93%), followed by Western Africa (32%). Limited studies were sourced in South and Central SSA countries on IPV over the past year. Another sub-group analysis over the past year’s prevalence of GBV among pregnant and non-pregnant women showed the prevalence of experiencing any form of GBV amongst pregnant women was 30.5% (95% CI 21.2, 39.6) compared to non-pregnant women 39.8% (95% CI 26.98, 52.69) ( Figure S4 ).

3.5. Prevalence of Physical IPV among Women Aged 15–49 Years of Age

Prevalence of physical violence was found in 23 studies ranging from 5.5% (95% CI 3.9, 7.9%) [ 47 ] among nurses in Ethiopia and 5.9% (95% CI 3.6–9.3%) [ 66 ] among HIV positive pregnant women in Nigeria to 59.9% (95% CI 55.5–63.8%) [ 29 ] among women in Uganda. A total of 66,361 women participants were included in the meta-analysis. Further, analysis of sub-regional estimates of physical violence was 29.3%, (95% CI 20.49, 38.09%) in Eastern Africa, 22.38% (95% CI 17.64, 27.12%) in Western Africa, 26.59% (95% CI 18.79, 34.38%) in Central Africa and 29.29% (95% CI 10.36, 48.18%) in Southern Africa. The overall pooled prevalence of physical violence was 26.14% (95% CI 21.69, 30.40%) with differences detected amongst the studies ( Figure S5 ). Eleven studies showed that over the past year, the prevalence of IPV ranged from 9.3% (95% CI 8.3, 10.6%) in a Tanzanian study [ 96 ] to 43.8% (95% CI 39.5, 47.8%) [ 29 ] in Uganda. The pooled past year prevalence of physical IPV was estimated at 21.59% (95% CI 15.84, 27.33%).

3.6. Prevalence of Sexual IPV among Women Aged 15–49 Years of Age

Seventeen studies showed an overall prevalence of violent experiences and seven studies found experiences of sexual violence over the past year. Overall, pooled prevalence of sexual violence was 18.61% (95% CI 15.21, 22.00) with a high disparity among studies detected ( Figure S6 ). The highest prevalence report was found in women in Northern Uganda (50%) (95% CI 46, 53%) [ 29 ], followed by a study conducted amongst women (39.7%) (95% CI 32.2, 47.2) in the Democratic Congo [ 31 ]. The lowest prevalence was found in Ghana (4%) (95% CI 3.1, 5.1) [ 37 ] and Nigeria (6.6%) (95% CI 6.3, 6.9) [ 45 ] amongst women of reproductive age. Similarly, a study conducted amongst nurses in Ethiopia showed one in 25 nurses (3.8%) had an experience of sexual violence (95% CI 2.5, 5.6) [ 47 ]. Eastern African women experienced relatively more sexual violence compared to other sub-regions. Among the seven studies with women experiencing sexual violence over the past year, violence ranged from the highest in Nigeria (42%) [ 66 ] and Ethiopia (31%) [ 39 ] to the lowest being 2% (95% CI 1.1–3.6 %) in a study conducted among HIV infected pregnant women in South Africa [ 93 ]. The results show there were no differences in lifetime and past year sexual IPV experiences ( Figure S6 ).

3.7. Prevalence of Emotional IPV among Women Aged 15–49 Years of Age

There were 57,434 study participants included in the analysis. The prevalence of emotional violence was the highest among health care workers in Ethiopia (53.1%) (95% CI 48.7%, 57.4) [ 100 ] to Rwanda 9.7% (95% CI 8.8, 10.7) [ 56 ]. In particular regions, one in three women in most parts of Western Africa were emotionally abused by their partner. For instance, two studies conducted amongst women aged 15–49 years of age in Nigeria indicated the prevalence rate of emotional violence experienced was 44.4% (95% CI 40.9, 47.9) [ 58 ] and 34.7% (95% CI 29.5, 40.2) [ 28 ]. The most common type of violence was purported to be emotional violence in these countries in comparison to other regions. Sub-group analysis was conducted based on timing of the violence and found a pooled overall prevalence of emotional violence of 29.36% (95% CI 24.77, 33.9) and past one-year prevalence rate of 21.42% (95% CI 17.58, 25.26) ( Figure S7 ). The test of heterogeneity and publication bias was detected (I 2 = 98.9% and 88.6%, Egger’s test = 0.205).

Six studies have demonstrated the magnitude of emotional violence over the past year. The highest prevalence was found among female sex workers (31.9%) (95% CI 26.7, 37.1) [ 71 ] in Nigeria, followed by a study in Ghana (24.6%) (95% CI 20.5, 29.2) [ 98 ]. Correspondingly, a study conducted in Ethiopia showed one in five pregnant women experienced IPV over the past year [ 52 ].

3.8. Prevalence of Non-IPV among Women Aged 15–49 Years of Age

Non-IPV studies were rarely found. Of the total studies screened (58), only four studies investigated non-IPV. The highest non-IPV was found in Uganda (18.5%) and Somalia (16.5%) [ 60 , 80 ]. One out of six women reported experiencing physical and/or sexual violence by a non-intimate partner during their lifetime [ 60 , 80 ]. Two international studies showed that the prevalence of non-IPV was 11% (95% CI 4.5, 37.5) and 11.1 % (95% CI 8.5, 15.3) [ 4 , 5 ]. The pooled prevalence of non-IPV was 14.18 % (95% CI 11.61, 16.97) ( Figure S8 ).

4. Discussion

This review incorporated all forms of GBV, including physical, sexual and emotional violence and IPV and non-IPV. The findings showed the pooled prevalence of GBV was high in SSA countries. This high pooled prevalence included almost half of the women experiencing IPV and a considerable number of females being abused by non-IPV. Emotional IPV violence was the most common type of violence in SSA. GBV was more prevalent in the sub-regions, in Western and Eastern Africa as compared to southern regions of SSA countries. Methodological quality of cross-sectional studies was appraised. We used only cross-sectional studies because we only found three cohort studies and/or randomized controlled trials.

Overall, a high pooled prevalence of IPV among women in SSA was found as compared to the global estimate which was conducted in 56 countries in 2013 [ 4 ] and SSA countries [ 5 , 21 , 102 , 103 ]. The findings of this review are comparable or slightly higher to studies conducted in 14 SSA countries [ 27 , 102 ]. The higher prevalence of IPV in our study could provide a better overview compared to previous studies where the number of countries involved were relatively small. Most importantly, this high prevalence might be due to the prevalence of gender inequality in regions for reasons including prerogative perceptions to males, tolerant attitudes in the community to IPV, poor education of women, female disempowerment and limited law enforcement in SSA [ 3 , 4 , 21 , 102 , 104 , 105 ].

Further analysis of the pooled prevalence rate over the past year revealed that more than two out of five women have reported experiencing IPV in SSA countries. This figure is consistent with a study conducted in other SSA countries [ 104 ] and more than five percent greater than the global lifetime prevalence of IPV (30%) [ 4 ]. This figure could be even higher, in reality, due to the underreporting associated with GBV [ 7 ] because of factors associated with fear of stigma, women preferring to keep quiet and fear of divorce, amongst many other reasons [ 6 , 7 , 14 , 17 ].

One of the interesting findings from this study is that the proportion (18%) of women affected during their lifetime and over the past year’s experiences of IPV were exactly the same as shown in Figures S2 and S4 . This finding reflects that women in SSA countries are being subjected to experiences of violence continuously compared to other areas [ 14 ]. Overall, IPV in SSA countries is the most prevalent and challenging public health issue. The social context of the region is very complex and strong ties, extended family size and large communities of relatives are quite common that might expose women to potential perpetrators [ 106 ]. The prevention and management of GBV makes it more difficult in SSA countries.

The finding of pooled prevalence of IPV of the DHS was very high. There were statistical differences compared to the pooled prevalence of IPV computed from the electronic sourced articles. Moreover, the pooled prevalence from non-DHS studies found in electronic databases and DHS reviews were statistically different ( p < 0.01). Our systematic review focused on IPV that included any of the combinations of physical, sexual or emotional violence or coexistence while DHS data focused on either physical or sexual violence among married women. In addition, DHS only explored married women, while in our study we used any population group in the age range of 15–49 years of age.

In this review, the pooled prevalence of all types of GBV, physical, sexual and emotional violence were consistently higher in SSA countries as compared to many other regions in the world [ 25 , 102 , 103 ]. Emotional violence was the most prevalent reported type of violence. Sexual experiences are reported not as frequently in many African countries for numerous reasons. The pattern of sexual violence is lower than emotional and physical violence, which might be related to victimized women being unlikely to report an attack due to fear of discrimination, feeling shame, and not being able to identify as well as physical violence [ 7 , 14 ].

One of the unexpected findings among health care providers was the highest prevalence rates (53%) of emotional violence and lowest prevalence rates (5%) of physical violence being reported in Ethiopia [ 100 ]. This high prevalence of emotional violence may be related to less satisfaction of service users due to long waiting times and less experienced health workers working in the health facilities. The majority of health care providers in the studies were females and this may be a reflection of gender inequality in the work areas. Most importantly, there is a lack of violence tracking or reporting mechanisms when it occurs among service providers, specifically focusing on emotional violence in the health care system [ 100 , 107 ]. Alternatively, the low prevalence of physical violence may be due to nurses having an understanding of the local context of GBV and being more likely to notify cases that would prevent perpetrators committing acts of violence [ 9 , 11 ]. Additionally, perpetrators may be unlikely to attack nurses at places such as a hospital or health centre where many other patients are receiving care from nurses.

The sub region analyses found that Eastern Africa (42%) including Ethiopia and Uganda were the most affected by all forms of IPV [ 29 , 47 ], followed by Western Africa (41.7%). In line with our findings, the two regions that experienced high prevalence rates of IPV in comparison to other African regions [ 7 , 25 ] was also consistent with other studies conducted in SSA countries [ 4 , 5 ]. In Eastern Africa, physical and sexual violence prevalence rates were worse and emotional violence prevalence rates were more common in Western Africa. This finding is consistent with findings of other studies [ 2 , 6 , 15 , 27 ]. This might be attributed to factors such as socioeconomic class, women’s disempowerment, community acceptance for wife beating and the type of community in which the study was conducted [ 4 , 6 , 27 , 29 , 108 , 109 ].

Alternatively, in Southern regions of Africa, the educational qualifications are relatively much better when compared to Eastern African countries [ 110 ]. A study conducted in South Africa found a combined intervention of economic intervention and education reduced IPV prevalence rates by 55% over a period of two years. Therefore, education differences could explain the differences of IPV prevalence in the two regions [ 110 ].

The pooled non-IPV prevalence (14%) experiences were very high. The pooled non-IPV prevalence experiences were slightly higher than the three studies that were conducted internationally, which was 11% [ 4 , 5 , 27 ]. The highest non-IPV prevalence may be related to political instability and war violence. For example, in Somalia the non-IPV prevalence was found to be 16.5% [ 80 ] which is mainly related to political instability and migration of the region. Moreover, some basic services are lacking, for example, health services, water and education. As a result, women are forced to travel long distances, which puts women more at risk to be subjected to violence as compared to those who have easy access and less travel time to those services.

4.1. Policy Implication

Findings reported in this study provide vital evidence to inform policy and guide health practitioners to respond and prevent violence in alignment with the SDG’s target by 2030. The aftermath of GBV has large ramifications for women’s health. It will be a challenge to achieve the SDG’s target to eradicate IPV by the year 2030, unless there is a timely intervention and policy designed for SSA regions. Governmental policies top priorities should focus on prevention of GBV, especially with the high prevalence of both IPV and non-IPV in all regions of SSA countries. This strategy needs to be supported by a legal framework to accommodate social support that includes educational and economic growth and provision of health information and services. All SSA countries need to develop an immediate action plan to support the challenges that women are facing with GBV. This review has added evidence to the current existing knowledge in the literature and has provided a stimulus for future research on the dynamics of GBV in SSA countries.

4.2. Strengths and Limitations of this Review

This is the first systematic review and meta-analysis to quantitatively summarize the prevalence of GBV that includes IPV and non-IPV that extends to SSA countries. A rigorous search was conducted from many electronic databases and selected nationally representative data sets (DHS) were used for most studies. A quality assessment was conducted with two independent reviewers conducting the quality screening. Only studies with adequate samples greater than 300 for representativeness were included in the review.

Despite the rigorous process of the systematic review, the searches only included articles published in English. The heterogeneity in our review could have been due to various factors such as different recall periods, underreporting, contextual differences including conflict, cultural differences and the quality of tools used to assess GBV. The generalizability of some small-scale studies is limited as studies may overestimate or underestimate GBV depending upon the context of the study. In addition, the number of studies on non-IPV were limited and it was difficult to identify the broader picture of GBV in the region. Furthermore, this review only included quantitative studies, most of which were cross-sectional. Therefore, qualitative studies were not included which may provide further information on the attitudes of women and communities about GBV that could indicate higher prevalence rates of GBV.

5. Conclusions and Recommendations

GBV against women is a pertinent health challenge in SSA countries. GBV that includes IPV and non-IPV are prevalent in SSA. More than two-fifths (44%) of women aged 15–49 years of age in SSA countries experienced some form of IPV and almost a fifth (14%) experienced non-IPV. All types of IPV (physical, sexual and emotional violence) are common experiences among women in SSA countries, with emotional violence being the most prevalent. Women living in Eastern and Western African regions experience the highest levels of GBV.

The need for an integrated mitigation measure to reduce GBV needs to be considered as a top priority in line with the SDG target in 2030 to reduce all forms of violence in SSA countries. Hence, government and private organisations should understand and address the problem of GBV. All organisations can allocate resources and design appropriate interventions that includes law enforcement to ensure social support is provided for women in the quest to eradicate GBV. In addition, more research is required to provide information on the dynamics of communities, the context, and associated factors of GBV and the subsequent effects of women’s reproductive health and beyond. Furthermore, more studies on IPV in SSA are required, especially in areas where political instability and war are on the increase.

Acknowledgments

This study is part of the first author’s work for Doctor of Philosophy at Western Sydney University, Australia. We are very grateful for the support of Maereg Wagnew during screening, data abstraction and quality assessment.

Supplementary Materials

The following are available online at https://www.mdpi.com/1660-4601/17/3/903/s1 , Figure S1: PRISMA flow chart for selection of studies on prevalence of GBV; Figure S2: overall pooled prevalence of IPV; Figure S3: pooled prevalence of physical or sexual violence committed by husband/partner among ever-married women age 15-49 years of old using latest DHS surveys; Figure S4: past one year pooled prevalence of IPV; Figure S5: pooled prevalence of physical IPV; Figure S6: pooled prevalence of sexual IPV by timing; Figure S7: overall pooled prevalence and recent past year prevalence of emotional IPV; and Figure S8: pooled prevalence of non-IPV. In addition, Table S1: search strategy, and Table S2: quality assessment of included studies.

Author Contributions

M.D.M., V.S., L.F. and K.A. were involved in the conceptualization of this study. M.D.M. carried out the analysis and drafted the manuscript. V.S., L.Y. and K.A. were involved in the revision and editing of the manuscript. All authors read and approved the final manuscript.

This research received no external funding.

Conflicts of Interest

The authors declare no conflicts of interest.

Males’ Experiences of Gender-Based Violence in Sub-Saharan Africa (SSA): A Review of Literature

• First Online: 21 January 2023

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• Dumsani Gumede 5 ,
• Manono Luthuli 5 ,
• Siphesihle Hlongwane 5 ,
• Kingsley Orievulu 5 ,
• Ntombizonke Gumede 5 &
• Oluwafemi Adeagbo   ORCID: orcid.org/0000-0003-1462-9275 6  

Part of the book series: Clinical Sociology: Research and Practice ((CSRP))

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Globally, gender-based violence (GBV) continues to be a serious global health, human rights, and development issue. There is no standard definition of GBV, but it can be enacted under different forms such as physical violence, sexual violence, economic violence, psychological and emotional aggression (including coercive tactics) directed at someone because of their biological sex or gender identity. Most literature focuses on violence against females (both heterosexual and homosexual) and children, with little focus on males’ perspectives. Most GBV narratives present males as perpetrators of violence. Recent statistics show that intimate partner violence (IPV) increased during the COVID-19 pandemic due to increased unemployment, substance abuse and reduced economic status. Recent country specific statistics are sparse but understanding the males’ perceptions and experiences of GBV can assist with identifying appropriate interventions to deal with GBV. This critical review highlights critical knowledge gaps in the existing literature and a need for future research within Sub-Saharan Africa (SSA).

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Gumede, D., Luthuli, M., Hlongwane, S., Orievulu, K., Gumede, N., Adeagbo, O. (2023). Males’ Experiences of Gender-Based Violence in Sub-Saharan Africa (SSA): A Review of Literature. In: Naidoo, K., Adeagbo, O., Li, X. (eds) Young People, Violence and Strategic Interventions in Sub-Saharan Africa. Clinical Sociology: Research and Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-20679-5_10

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Understanding Gender Policy and Gender- Based Violence in South Africa: A Literature Review

Similarly, gender and sexual based violence in South Africa is a widespread and common problem which is increasingly normalised and underreported.

In order to understand the drivers of gender inequality and the policy landscape, Soul City commissioned a literature review of gender and gender-based violence (GBV) policy in the country. The focus of the review is on the health rights of adolescents and young people in relation to gender and gender-based violence.

The review also identifies policy gaps and makes recommendations for policy including best practice from local, regional and international experience.

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This report provides details of a literature review that is intended to inform partners in the Population Council–coordinated regional network that aims to develop a multisectoral and comprehensive response to sexual and gender-based violence (SGBV) in Eastern, Central, and Southern Africa. The first section defines the terminology used throughout the review, and discusses the prevalence and consequences of SGBV, considers the implications of the disproportionate programmatic focus on adult women survivors, and explores approaches to managing child and male survivors of sexual violence. The second section presents regional policies and programming relating to the medical and psychosocial management of survivors. The third section discusses the forensic, referral, and judicial requirements of successful prosecutions. And the fourth section considers the role that community and institutional linkages play in the prevention of SGBV, and examines the extent to which violence is addressed through messages communicated during prevention strategies, and through routine screening.

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