Intimate Partner Violence (IPV) is a pervasive human rights and public health issue with far-reaching consequences for women’s health and well-being, particularly across Africa. The World Health Organization estimates that nearly one in three women globally has experienced physical and/or sexual violence by an intimate partner, with Sub-Saharan Africa reporting some of the highest prevalence rates. IPV encompasses not only physical and sexual abuse but also psychological coercion, emotional abuse, and controlling behaviors, each of which can undermine women’s autonomy and compromise their reproductive health. A growing body of evidence links IPV to adverse maternal and reproductive outcomes, such as unintended pregnancies, miscarriage, sexually transmitted infections, and complications during childbirth [1–3].

In Africa, the threat of IPV intersects with deep-rooted structural inequalities, patriarchal gender norms, and overstretched health systems. Despite progress in expanding access to antenatal care (ANC), skilled delivery, and contraceptive services, maternal health indicators remain poor in many contexts. Sub-Saharan Africa still accounts for nearly two-thirds of all global maternal deaths [1]. Modern contraceptive methods, as defined by the DHS, include short-acting methods such as oral pills, injectables, and male/female condoms; long-acting reversible methods such as intrauterine devices (IUDs) and implants; and permanent methods including male and female sterilization. The diversity of these methods shows not only women’s ability to exercise reproductive autonomy but also the structural and health system barriers that may limit their access to preferred options. IPV acts as a significant barrier to maternal healthcare by restricting women’s mobility, decision-making capacity, and access to financial and informational resources [4]. Studies show that women exposed to IPV are less likely to initiate ANC early, deliver in health facilities, or use postpartum and family planning services [5], underscoring the urgent need for gender-sensitive interventions across the health sector.

The influence of IPV on maternal and reproductive health service use has been documented in various country-level studies. Aboagye et al. [6] observed that women exposed to partner violence were significantly less likely to attend ANC or deliver in a facility. Similar patterns were reported in Ethiopia [7], Kenya [8,9], and Nigeria [9], where IPV served as a barrier to timely and adequate healthcare utilization. Silverman et al. [10]found that IPV was linked with unmet need for contraception across multiple countries. In northern India and parts of Africa, Muluneh et al. [11] identified fear of violent repercussions from partners as a key factor deterring women from using contraceptives. Studies by Capaldi et al. [12] and Garcia-Moreno et al. [13] further emphasize the long-term consequences of IPV, including reproductive coercion, psychological trauma, and poor maternal outcomes.

Moreover, Abramsky et al. [14], using data from the WHO Multi-country Study, demonstrated that IPV is a consistent predictor of reduced health-seeking behavior among women, particularly in resource-constrained settings. Stockl et al. [15]and Makayoto et al. [16]confirmed these findings, underscoring that IPV acts as both a health issue and a social determinant that shapes women’s ability to access and utilize services. Despite this growing body of evidence, most of these studies are geographically limited, focusing on one or a few countries, and often emphasize physical and sexual violence while neglecting the broader spectrum of IPV especially psychological and controlling behaviors that are equally damaging but less visible.

Although Demographic and Health Survey (DHS) data are available for over 25 African countries, few studies have fully utilized this resource to examine inter-country differences, policy contexts, or the cumulative effects of multiple forms of intimate partner violence (IPV) on contraceptive and maternal health service (MHS) use. Most research focuses on single country analyses or emphasizes physical and sexual violence, with limited attention to emotional and controlling forms of IPV [5,17,18]. For example, studies by Teshale et al. [19], Aboagye et al. [2], and Muluneh et al. [11] analyze the link between IPV and antenatal care or facility delivery, but often within limited national contexts. Similarly, while Nakie et al. [4]and Tekeba et al. [5] highlight IPV prevalence across sub-Saharan Africa, they do not explore how such violence affects maternal and reproductive service uptake. This points to the need for broader, cross-country analyses that integrate various IPV forms and contextual variables to inform more responsive policy and programming.

This study, therefore, seeks to fill this critical gap by conducting a large-scale, cross-country analysis of the relationship between IPV and maternal healthcare and contraceptive service use in 25 African countries. Specifically, it investigates how exposure to various forms of IPV, physical, sexual, emotional, and controlling behaviors shapes women’s utilization of ANC, facility-based delivery, postnatal care, and family planning. By leveraging nationally representative data, the study also seeks to identify individual and contextual predictors and uncover regional patterns. Ultimately, the analysis demonstrates that the aim was achieved: the study provides robust, multi-country evidence on how IPV constrains reproductive and maternal healthcare, while offering insights to guide the development of gender-responsive health systems across Africa.

This study investigated the association between various forms of intimate partners violence, such as sexual, physical and emotional violence, and contraceptive usage and MHS among women in 25 sub-Saharan African regions. We noted from our study that 29.2% of women used modern contraceptives, 39.2% received adequate MHS, and 34.3% of women had experienced at least one form of IPV. This new knowledge is important to help guide global efforts against gender-based violence and to further underscore how this influences health-seeking behaviour among victims.

Our study found a significant relationship between IPV and contraceptive use. This finding corroborates previous studies [11,31,32] showing that IVP-exposed women are more likely to adopt modern contraceptive methods. However, findings from a systematic literature review [33] reveals that women who had experienced IPV had about 53% lower odds of using contraception compared to those who did not experience IPV. This equivocal findings from the literature may be attributed to differences in regional focus, measurement approaches, or temporal and cultural contexts across the reviewed studies.

Our findings suggest that some women may resort to covert or self-initiated contraceptive use as a means of preventing further entrapment in violent relationships, particularly in settings where reproductive coercion is common.

Interestingly, we found that, despite increased contraceptive use among IPV-exposed women, these same women were significantly less likely to utilize adequate MHS. This paradox highlights a critical disconnect as women may take steps to avoid unintended pregnancies but still face structural and interpersonal barriers to care during pregnancy and childbirth. Previous studies have similarly documented this duality, noting that while IPV can drive covert contraceptive use as a form of self-protection [10,11], it often constrains access to antenatal, intrapartum, and postpartum care due to fear and lack of partner support [2,17]. These discrepancies highlight the need to view IPV not only as a public health issue but as a structural determinant that shapes women’s health-seeking behaviours across the reproductive lifecycle.

We also observed that education, wealth, health insurance, and rural–urban residence were consistently associated with higher contraceptive and MHS use, even after adjusting for IPV. Women with higher education and income were more likely to overcome barriers to care, even under IPV exposure, suggesting that socioeconomic empowerment may buffer its adverse effects. This finding is supported by previous studies [19,34], which demonstrates that higher educational attainment enhances health literacy, decision-making autonomy, and access to information, all of which contribute to improved reproductive health outcomes even under challenging circumstances. Wealth and insurance coverage reduce financial barriers, enabling women to access services independently of their partners’ control, which is critical in contexts where IPV survivors may face economic disempowerment. This association has been consistently documented in multi-country analyses across SSA, where higher household wealth is positively linked with increased uptake of antenatal care, facility-based delivery, and postnatal services because women from richer households are better positioned to afford both direct and indirect costs of care [35–38].

Similarly, in sub-Saharan Africa, where health systems are often under-resourced, health insurance plays a critical role in reducing financial barriers to antenatal care, facility-based delivery, and postnatal services. Evidence shows that coverage increases service utilization by alleviating out-of-pocket costs and promoting continuity of care [36,39]. For IPV survivors, insurance can be particularly empowering, enabling independent healthcare access without relying on partners’ financial support. This finding is particularly important in the context of sub-Saharan Africa, as it highlights the need to prioritise financial barrier–free care for women in the broader pursuit of achieving the Sustainable Development Goals (SDGs), particularly those related to health, gender equality, and poverty reduction.

Regular exposure to media such as radio, television and newspapers was associated with increased uptake of modern contraceptives and MHS in SSA. This finding supports previous studies that media exposure enhances awareness of reproductive health services, challenging harmful norms, and empowering women to seek care, particularly in resource-limited and rural settings [19,40]. This association calls for stronger alignment between national health communication strategies and media infrastructure emphasizing local languages, culturally sensitive content, and programming tailored to underserved groups. Strengthening health messaging through public and community media can bridge the awareness gap, improve service uptake and contribute to broader goals under the Sustainable Development Goals (SDGs), particularly SDG 3 (good health and well-being) and SDG 5 (gender equality).

This study highlights the complex relationship between intimate partner violence and women’s reproductive health behaviours in sub-Saharan Africa. Our cross-country, multi-dimensional analysis reveals that while IPV exposure is associated with increased use of modern contraceptives, it is also linked to reduced uptake of adequate MHS, pointing to a critical gap in the reproductive health continuum.

The findings advance existing literature by offering large-scale, cross-national evidence that IPV remain both a barrier and, paradoxically, a driver of certain reproductive choices.

Policy responses must integrate IPV prevention into reproductive health strategies, strengthen health communication through media, and ensure women’s access to comprehensive and affordable MHS. Doing so is essential for achieving Sustainable Development Goals 3 (health) and 5 (gender equality) and for safeguarding the health and autonomy of women experiencing violence.