Intimate partner violence(IPV) is a pervasive social and public health issue that endangers women's physical, emotional, sexual, and reproductive health irrespective of their age, education, economic status, race, religion, ethnicity, or sexual orientation(1, 2). It is a broad concept which can be explained in many forms, including physical violence, sexual violence, economical violence, control of behavior, and psychological violence between two intimate relationships(3).

Physical IPV is the condition which  an intimate partner are threatened with intentional use of force for the reason of causing hurt, death, and disability(3), and sexual IPV is an act of sexual attempt by an intimate partner like forced sex, practicing sex due to fear of the partner and doing something sexual without the interest of women(3). Psychological IPV is the act of   insulting, humiliating, belittling, and threat to take the child from his wife, and control of behavior is explained when women prevented from visiting her family of birth, friends and insisting to know where she go every time(4). Whereas economical violence is the condition by which the husband takes the women earning, and prevents money for household expenses(3).

The interval between the birth of a viable baby and twelve months after delivery is known as the extended postpartum period. Postpartum period can be divided into two categories: early postpartum period, which lasts from birth to six weeks, and late postpartum period, which lasts from six weeks to twelve months following delivery. During postpartum period there were significant physiological changes in the life of women. Furthermore, it was a period of significant psychosocial change as she adjusted to motherhood, reestablished relationships, and worked to meet the physical and emotional demands of her infant and family members. As a result, postpartum women's quality of life will be impacted, potentially leading to conflicts between intimate partners (5-6). Intimate partner violence can endanger women in the short and long term, resulting in temporary or permanent effects, as well as death in some situations(4). Intimate partner violence against women of reproductive age is a public health issue that has attracted scientific and political attention(7). Women of all ages can be victims of intimate partner violence, but it is especially common during pregnancy and the postpartum period(10). Postpartum intimate partner violence is very common i.e. delivery is not protective of intimate partner violence(9, 10).

Intimate partner violence (IPV) is one of the most common forms of violence against women (VAW), and includes physical, sexual, and emotional abuse as well as controlling behaviors by an intimate partner. It is a widespread, yet understudied social and health problem that occurs worldwide and worsen during times of crisis [25,26]. According to the World Health Organization’s report of 2021, nearly 307 million partnered women suffered from IPV in the year preceding the study. Concerning region specific estimates, IPV in 12 months is most prevalent in least developed countries (22%). Sub-Saharan Africa (20%) and Southern Asia (19%) have the next highest prevalence rates of past 12 months IPV, followed by Northern Africa (15%) and Western Asia (13%) [26]. Studies showed the continued existences of IPV among partnered women in Ethiopia, where nearly half of such women experienced the problem in a year [27]. The recent report from the Ethiopian Demographic and Health Survey EDHS) found the prevalence of lifetime IPV among partnered Ethiopian women to be 34%. The 12 month prevalence of IPV among these women was 27% [28].

Postpartum intimate partner violence is an act of violence that occurs between couples in a romantic relationship after child birth. Globally, in their lifetime 27% of ever married women aged from 15 to 49 years have experienced sexual and or physical violence by intimate partners or sexual violence by any agent(1), and the overall lifetime prevalence of IPV range from 16% to 23% in high-income countries; in Southern Asia 35% and in Sub-Saharan Africa it was 33%(1). Postpartum intimate partner violence was reported by 33.8% of women after childbirth in United States of America, from this 47.2% of them had never experienced it before delivery(11).

The severity of postpartum intimate partner violence (PPIPV) was highest in both high and low-income countries. Studies conducted in Australia(12) and Brazil(13) show that the magnitude of the problem ranges from 17.4% to 51.2%. In addition to this studies conducted in countries like India(14), Nepal(15), Bangladesh(16), and Iran(9) revealed that postpartum women were exposed to a wide range of PPIPV which range from 18% to 58%, and require specific attention. As evidenced from some studies conducted among postpartum mothers  in African countries such as, Zambia(17), Tanzania(18), and Ghana(19) magnitude of PPIPV ranges from 8.1% to 46%. In Ethiopia, the overall prevalence of IPV during prenatal period was 37%, with the highest rates of 50.7% in Oromia region and 12% in South Nation Nationalities peoples Ethiopia(20).

Intimate partner violence leads serious consequences on the maternal and infant health during postpartum period. The WHO report revealed that 38% of the women who were the victims of IPV were committing suicide(4), which was severe consequence. It has a significant maternal morbidity like anxiety(21), low self-esteem(13), and suicide ideation(22). Women who were exposed to IPV were at increased risk to sexually transmitted infection like Human Immune Virus(HIV) which was around five times higher than their counter parts(23), and at higher risk of cervical cancer(24).

Some studies have identified  factors that are linked to IPV during the postnatal period like the husband's age(14, 18) and educational level(30), living in extended family(30), the husband’s substance usage(31) and violent conduct(32). But there was no adequate data on PPIPV, and how it may be related to women's health issues(33,34). Different international organizations have planned to prevent, and how to overcome intimate partner violence across the world. Center for Disease Prevention and Control(CDC) have developed a technical package which have seven strategy to prevent IPV, and its consequence throughout the women’s life time(35). In addition to this WHO have recommended screening of postpartum women for any type of IPV(36). Prenatal care provides a golden opportunity for healthcare providers to identify cases of violence against women, provide appropriate counseling, and intervene(40). The Ethiopian government  have addressed  it in health sector transformation plan two since it is strong political agenda and women health problem worldwide(37).

Postpartum period is the most essential period in the life of the mother, and infant.  Postpartum care can be used by healthcare workers and community health extension workers to assess IPV against women. Furthermore, health care professional can plan for prevention through proper partner and community education about the problem, and its consequences. Even though there are several studies conducted on intimate partner violence during pregnancy, there was major gaps on postpartum intimate partner violence in Ethiopia. In addition to this majority of the studies conducted on IPV were not focused on control of behavior, and economic violence in both high- and low-income countries as a part of IPV and it will be included in this study. Therefore, the goal of this study is to assess prevalence of extended postpartum intimate partner violence and associated factors in the study area.

Methods and Materials

Study area and design  

The study was conducted in Mattu town Ilubabor zone Public facilities, Oromia Regional State of southwest Ethiopia. Which is located approximately 600 kilometers southwest of Addis Ababa, the capital city of Ethiopia. According to municipal administrative records, the town has an estimated 16,167 households and 14,164 women of reproductive age. Public healthcare services in the town are provided through three government health facilities; a referral hospital and primary health care units, which collectively serve the healthcare needs of the local population. An institution based Cross-sectional study design were employed from January 1, 2026 to February 1, 2026.      

Study Population

A randomly selected mothers who gave birth in the past 12 months and on postpartum follow up at health public facilities in Mattu town.

Inclusion and Exclusion Criteria

The study included all ever-partnered mothers attending postpartum follow-up services at the selected health facilities during the study period. Mothers who were critically ill and unable to participate in the interview during the data collection period, as well as those who declined to provide informed consent, were excluded from the study.

Sample Size Determination and Sampling Technique

The sample size was determined for both the primary objective (estimating the prevalence of intimate partner violence [IPV]) and the secondary objective (identifying factors associated with IPV). For the first objective, the sample size was calculated using the single population proportion formula, assuming a 95% confidence level (Z = 1.96), a margin of error of 5% (d = 0.05), and a prevalence of IPV of 50.5% obtained from a previous study. The calculated sample size was 384. After adding a 10% allowance for non-response, the final sample size was increased to 422 participants. For the second objective, the sample size was estimated using the double population proportion formula by considering key factors previously reported to be associated with IPV, including women’s educational status, supportive attitudes toward wife-beating, younger age, and alcohol consumption by male partners. However, since the sample size calculated for the first objective was larger than that obtained for the second objective, the larger sample size of 422 was used for the study.

Mattu Town is administratively divided into five kebeles, all of which were included in the study. A preliminary household enumeration was conducted in each kebele to identify households with eligible participants. Following the enumeration, the required sample size was proportionally allocated to each kebele based on the number of eligible households. Study participants were then selected using a systematic random sampling technique. The sampling interval (K) was determined by dividing the total number of eligible households by the required sample size and was found to be two. The first household was selected randomly using a lottery method, after which every second eligible household was included in the study until the allocated sample size was achieved.

Variables of the Study

The dependent variable of this study was intimate partner violence (IPV) among postpartum women. The independent variables included socio-demographic factors such as age, place of residence, educational status of the woman, educational status of the intimate partner, and women’s decision-making power within the household; socioeconomic factors including monthly household income and occupational status of the woman; and behavioral, cultural, and reproductive health-related factors such as alcohol consumption, smoking status, pregnancy intention (planned or unplanned pregnancy), and family history of violence.

Data collection instruments and techniques

Data were collected using a structured interviewer-administered questionnaire adapted from the World Health Organization (WHO) Violence Against Women (VAW) instrument (WHO, 2005), the Ethiopian Demographic and Health Survey (EDHS) (EPHI and ICF, 2021), and relevant published literature. The questionnaire comprised sections on socio-demographic characteristics, socioeconomic factors, reproductive and behavioral characteristics, and experiences of intimate partner violence. The tool was initially prepared in English, translated into Afan Oromo, and then back-translated into English to ensure consistency and accuracy of the content. Data were collected through private face-to-face interviews conducted in a confidential setting to safeguard participants' privacy and safety, following the WHO ethical and safety recommendations for research on violence against women (WHO, 2001; WHO, 2005)

Operational Definitions

Intimate Partner Violence (IPV): In this study, a woman was considered to have experienced intimate partner violence if she reported experiencing at least one act of physical, sexual, or psychological (emotional) violence, or any combination of these forms of violence, perpetrated by a current or former intimate partner during the specified reference period (14).

Intimate Partner: Refers to a current husband, cohabiting partner (a man living with a woman in an intimate relationship without formal marriage), or boyfriend.

Sexual Violence: Refers to any act in which a woman is forced to engage in sexual intercourse against her will, has sexual relations due to coercion or intimidation, or is compelled to perform degrading or unwanted sexual acts by an intimate partner (26).

Physical Violence: Refers to the intentional use of physical force by an intimate partner that may result in injury, harm, disability, or death. Examples include slapping, pushing, punching, kicking, beating with an object, twisting the arm, choking or strangulation, and threatening or attacking with a weapon such as a knife or gun (7).

Psychological (Emotional) Violence: Refers to acts that undermine a woman’s emotional well-being, self-worth, or mental health, including intimidation, threats of abandonment or harm, verbal insults, humiliation, controlling behaviors, restriction of movement, social isolation, confinement to the home, and withholding financial resources or support.

Data quality assurance

Data quality was ensured through a series of standardized procedures consistent with established research guidelines for survey data collection. The questionnaire was translated from English into Afan Oromo by language experts and then back-translated into English to ensure semantic consistency and conceptual equivalence. A pretest was conducted on 5% of the total sample size in health facilities outside Mettu Town to assess clarity, sequence, and comprehensibility of the questions, and necessary modifications were made based on the findings prior to the actual data collection. Data collectors and supervisors were trained intensively on the study objectives, interview techniques, ethical considerations, and standard data collection procedures to ensure uniformity in data collection. During fieldwork, close supervision, daily review of completed questionnaires, and cross-checking for completeness and consistency were performed to minimize errors and missing information. These procedures were implemented in line with standard epidemiological and survey research quality assurance guidelines (Creswell and Creswell, 2018; Kothari, 2004)

Data Analysis procedures

Data were checked for completeness, consistency, and accuracy before entry into EpiData version 4.6 and subsequently exported to SPSS version 26 for analysis. Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participants’ socio-demographic, socioeconomic, behavioral, and reproductive health characteristics. The prevalence of intimate partner violence was presented using frequencies and percentages with corresponding 95% confidence intervals.

Bivariable logistic regression analysis was performed to assess the association between each independent variable and intimate partner violence. Variables with a p-value of less than 0.25 in the bivariable analysis were considered candidates for multivariable logistic regression analysis. Multivariable logistic regression was then conducted to identify factors independently associated with intimate partner violence while controlling for potential confounding variables. The strength of associations was measured using adjusted odds ratios (AORs) with 95% confidence intervals. Model fitness was assessed using the Hosmer–Lemeshow goodness-of-fit test, and multicollinearity among independent variables was examined using variance inflation factors (VIFs). Statistical significance was declared at a p-value of less than 0.05.

 Result

Socio-Demographic Characteristics of Respondents

A total of 422 mothers attending maternal and child health services in Mettu Town participated in the study with a 100% response rate. Nearly half, 210 (49.8%), were aged 20–29 years, and the majority were housewives, 254 (60.1%). Regarding education, respondents were distributed across primary education 145 (34.3%), secondary 114 (27%), no formal education 67 (15.8%), and college or above 96 (22.8%). Most participants were urban residents, 281 (66.5%), and 160 (37.9%) reported a monthly income below 2000 ETB. Overall, the study population was mainly young, urban, and economically low to middle status with a predominance of housewives Table 1.

Table 1: Socio-demographic characteristics of participants at Ilubabor zone public facilities 2026 (N: 422)

Regarding partners’ socio-demographic characteristics, the largest proportion, 150 (35.5%), had primary education, followed by 120 (28.4%) with secondary education, while 72 (17.1%) had no formal education. In terms of occupation, 134 (31.7%) were farmers, 120 (28.4%) were merchants, and 98 (23.3%) were government employees. Concerning behavioral characteristics, nearly half of the partners, 197 (46.7%), reported alcohol consumption, whereas 225 (53.3%) did not. In addition, 127 (30.1%) were smokers and 295 (69.9%) were non-smokers. Substance use was reported by 117 (27.7%) of partners, while the majority, 305 (72.3%), did not use any substances Table 2.

Table 2: Partners characteristics at Ilubabor public health facilities 2026 (N:422)

 Reproductive and Obstetric history Characteristics

Among the respondents, 213 (50.5%) had 1–2 children, 141 (33.4%) had 3–4 children, and 68 (16.1%) had five or more children. Regarding duration of marriage, 177 (41.9%) had been married for less than five years, 159 (37.7%) for 5–10 years, and 86 (20.4%) for more than 10 years. Overall, the majority of women reported high utilization of maternal health services, with 350 (82.9%) attending ANC and 370 (87.7%) delivering in health facilities Table 3.

Table 3: Reproductive and obstetric history of mothers at public facilities in Ilubabor zone, southwest Ethiopia

Decision-Making Power in the Household and relationship factor

Regarding household decision-making, 197 (46.7%) of respondents reported that decisions were made by their husbands, 141 (33.3%) indicated joint decision-making, and 85 (20%) stated that women made decisions independently. In addition, 150 (35.5%) of women reported fear of their partner. Overall, the findings suggest the presence of limited women’s autonomy and unequal power dynamics within households Table 4.

Table 4: Decision-making power and relationship factor among mothers of Ilubabor public Health facilities Southwest Ethiopia.

More than half of the postpartum women (52.6%) experienced at least one form of intimate partner violence (IPV), indicating a high overall burden of violence among the participants Figure 1.

Figure 1: Overall intimate partner violence among mothers at maternal and child health at Ilubabor public health facilities, Southwest Ethiopia.

Among the different types, emotional violence was the most prevalent, affecting 45.0% of respondents, showing that nearly half of the mothers experienced psychological abuse such as insults, humiliation, or controlling behaviors. Physical violence was reported by 34.8% of the women, indicating that more than one-third experienced acts such as slapping, hitting, or other forms of physical harm. Sexual violence was the least reported form at 21.5%, yet it still represents a substantial proportion of mothers who experienced forced or coerced sexual acts Table 5.

Table 5: Intimate partner violence among mothers at Ilubabor public health facilities Southwest Ethiopia.

The health consequences of intimate partner violence (IPV) among abused women attending public health facilities. It shows that physical injury was reported by 28.0% of the respondents, indicating that more than one-quarter of the women experienced direct physical harm. Mental health impact was more prominent, with 41.9% of women reporting depression, highlighting a substantial psychological burden associated with IPV Table 6.

Table 6: Health outcomes among abused women at Ilubabor Public health facilities Southwest Ethiopia

The multivariate logistic regression analysis identified several significant factors associated with intimate partner violence (IPV). Women who were unable to read and write were about four times more likely to experience IPV compared to those with college or higher education (AOR = 4.3, 95% CI: 2.631–10.192). Women engaged in merchant activities were 62% less likely to experience IPV compared to housewives (AOR = 0.571, 95% CI: 0.336–0.971). Similarly, women whose partners could not read and write had significantly higher odds of experiencing IPV, being about five times more likely than those whose partners had college or higher education (AOR = 5.20, 95% CI: 2.672–10.124). Women who were single were 54% less likely to experience IPV compared to married women (AOR = 0.543, 95% CI: 0.385–0.8274). Alcohol use was also a strong predictor, with women who consumed alcohol being about four times more likely to experience IPV than their counterparts (AOR = 4.402, 95% CI: 3.266–7.607).

In addition, women with a monthly income of less than 2000 ETB were four times more likely to experience IPV compared to those earning more than 4000 ETB (AOR = 4.500, 95% CI: 1.458–13.887). Conversely, women who did not use substances were 63% less likely to experience IPV compared to those who used substances (AOR = 0.376, 95% CI: 0.243–0.573) Table 7.

Table 7: Multivariate Logistic Regression Analysis of Factors Associated with Intimate Partner Violence