Association between severity of physical intimate partner violence and neonatal mortality in Afghanistan: Survival analysis using Cox proportional hazard model

Soc Sci Med. 2025 May 8;378:118160. doi: 10.1016/j.socscimed.2025.118160. Online ahead of print.

ABSTRACT

BACKGROUND: Child survival and the prevalence of intimate partner violence (IPV) are critical global health concerns. The Sustainable Development Goals (SDGs) emphasize reducing IPV prevalence and child mortality rates as essential objectives in global health and development. The study investigates the relationship between the severity of physical IPV experienced by women and neonatal mortality in Afghanistan, focusing on the moderating role of antenatal care (ANC) visits and skilled birth attendants (SBA) in this association.

METHODS: Our study utilized data from Afghanistan’s most recent 2015 demographic and health survey (AfDHS). We employed Cox proportional hazard analysis to measure the potential association between the severity of physical IPV experienced by women and neonatal mortality. The severity of physical IPV was categorized as no IPV, less severe physical IPV, or severe physical IPV. Moreover, to assess the moderating effects of ANC and SBA in the relationship between the severity of physical IPV and neonatal mortality, we conducted a moderation analysis. Additionally, a sensitivity analysis using Weibull proportional hazards and accelerated failure time analyses was conducted to assess the robustness of the findings.

RESULTS: In total, 17.26 % of women experienced severe physical IPV, while 48.07 % experienced less severe physical IPV. The Cox model indicated that, after adjusting for control variables, the hazard of neonatal mortality was significantly higher among women who experienced severe physical IPV (aHR = 1.67; 95 % CI; p < 0.001) compared to those who experienced no or less severe physical IPV.

CONCLUSION: This study highlights the significant association between the severity of physical intimate partner violence experienced by women and increased neonatal mortality in Afghanistan, highlighting the urgent need for targeted interventions and policies to address the issue of IPV in order to improve mother (maternal) and child health outcomes.

PMID:40359624 | DOI:10.1016/j.socscimed.2025.118160