Physical Intimate Partner Violence during Pregnancy in India: A Multilevel Analysis of Socioeconomic Disparities and Modifiable Risk Factors Using NFHS-5 Data

Abstract

Physical intimate partner violence (IPV) during pregnancy remains an under-examined public health concern in India, where existing evidence documents wide sociodemographic and geographic variation but has not disentangled the independent contribution of individual, household, partner-related, empowerment, and community-level factors operating simultaneously. Guided by Heise's integrated ecological framework, this study examined the prevalence, trends, and multilevel determinants of physical IPV during pregnancy in India. Using data from the National Family Health Survey (NFHS-5, 2019-21) and NFHS-4 (2015-16), the analysis included 58,993 ever-married, ever-pregnant women aged 18-49 who completed the domestic violence module. A stepwise multilevel binary logistic regression, incorporating sampling weights and clustering by primary sampling unit, was fitted across four nested models to assess individual, household, empowerment, partner, and regional determinants. The national prevalence of physical IPV during pregnancy declined from 3.42% (NFHS-4) to 2.65% (NFHS-5) (95% CI: 2.41–2.92), though this masked pronounced geographic heterogeneity, with southern states such as Karnataka (5.24%) recording persistently high rates despite strong gender-development indicators. The null model showed substantial community-level clustering (ICC=47.89%), which individual and household factors barely reduced, while partner-related characteristics and regional factors together explained most of the between-cluster variance (PCV=87.14%). Partner controlling behaviour emerged as the strongest determinant, followed by partner alcohol use, childhood exposure to interparental violence, and women earning more than their partners, while women's participation in household decision-making was protective independent of employment status. These findings suggest that coercive control, rather than economic disadvantage alone, underlies much of the risk of violence during pregnancy in India, and that community-level mechanisms warrant further investigation.