Association between concurrence of risk factors and intimate partner violence against women: evidence from Demographic and Health Surveys in 53 low- and middle-income countries

BACKGROUND: Intimate partner violence (IPV) is a major public health challenge in low- and middle-income countries (LMICs). Women are commonly exposed to multiple IPV risk factors concurrently, but the association between the concurrence of risk factors and IPV remains poorly understood. This study assessed the association between the concurrence of risk factors and IPV among women in 53 LMICs. METHODS: We analysed cross-sectional Demographic and Health Survey (DHS) data from 364 404 women aged 15-49 years in 53 LMICs between 2003 and 2023. Multivariable logistic regression was used to identify leading risk factors for past-year physical, emotional, sexual and co-occurring IPV. We counted the top five risk factors present for each woman and examined the association between the number of concurrent risk factors and the odds of IPV. RESULTS: Among 364 404 women, 27.2% reported physical IPV, 22.7% emotional IPV and 8.3% sexual IPV in the previous year. Spousal controlling behaviours and spousal alcohol use were the risk factors most strongly associated with IPV. Among women exposed to IPV, the prevalence of concurrence varied across contexts, being higher in low-income than in higher-income settings, highest in East Asia and the Pacific, and lowest in the Middle East and North Africa. A clear graded association was observed: compared with women with no leading risk factors, those with one had higher odds of each IPV outcome, and the odds increased further among those with two or more concurrent leading risk factors, with the highest odds observed among women with all five. CONCLUSIONS: The concurrence of risk factors was common but contextually heterogeneous across the studied 53 LMICs and was associated with substantially increased odds of IPV. These findings suggest that approaches focused solely on single risk factors may be insufficient and highlight the importance of integrated, multisectoral strategies to prevent violence against women.