Beyond poverty reduction: heterogeneous effects of intimate partner violence on reproductive decision-making in communities with social protection in Northern Ghana

Abstract

Intimate partner violence (IPV) remains a major public health concern and can constrain women’s reproductive autonomy and reproductive health. Rural women who experience IPV face increased risks of trauma, sexually transmitted infections, and adverse pregnancy outcomes, and may have limited ability to make independent family planning and fertility decisions. Although previous studies have linked IPV to contraceptive use and fertility preferences, evidence remains mixed, partly because most studies treat IPV as a single construct and overlook potential differences across forms of violence. Focusing on rural women in communities of a government cash transfer programme, this study examines the effects of how different dimensions of IPV shapes family planning behaviour and fertility preferences among poor women in northern Ghana. This study uses quantitative methods to analyse a two-wave panel data on 2,202 women in northern Ghana using an instrumental-variable approach (control-function estimations) to address the potential endogeneity of IPV. Models estimated the effects of composite IPV, emotional, physical and sexual violence, together with partner controlling behaviour, on modern contraceptive use, use of implants or injectables, willingness to have another child, and desired number of children. Baseline outcomes were included using an ANCOVA specification, and robustness was assessed through attrition, baseline-only and endline-only analyses. The results show that approximately three out of five women experienced at least one form of IPV. Overall IPV was associated with significantly lower use of modern contraceptive methods, including implants and injectables, lower likelihood of wanting another child, and fewer desired children. However, important heterogeneity emerged across IPV dimensions. Sexual and physical violence were associated with greater use of modern contraception, whereas emotional violence reduced contraceptive use, fertility intentions, and desired family size. Partner controlling behaviour consistently reduced contraceptive use while increasing women’s desire for additional children and larger families. Robustness analyses produced qualitatively similar findings. Different forms of IPV influence women’s reproductive decision-making through distinct behavioural pathways. These findings suggest that poverty reduction alone is insufficient to strengthen women’s reproductive autonomy. Integrating IPV prevention, reproductive health services, and gender-transformative interventions into social protection programmes may improve family planning uptake and support informed fertility decisions among vulnerable women.