The role of healthcare access in the association between intimate partner violence and pregnancy loss in Nigeria

Background: Intimate partner violence (IPV) remains a critical public health issue with adverse consequences for women’s reproductive health, including pregnancy loss. In Nigeria, high rates of both IPV and maternal health challenges underscore the need to examine how structural factors, such as healthcare access, may influence these outcomes. This study investigates whether access to healthcare moderates the relationship between IPV and pregnancy loss among Nigerian women. Methods: This study analyzed data from the 2018 Nigeria Demographic and Health Survey (NDHS), a nationally representative cross-sectional survey using a stratified two-stage cluster sampling design. The analytic sample included 8,217 ever-pregnant women who completed the domestic violence module and provided valid responses on IPV, pregnancy loss, and healthcare access. Moderated binary logistic regression was used to assess the independent and interactive effects of physical and sexual IPV on pregnancy loss, with healthcare access examined as a potential moderator. Results: The respondents’ ages ranged from 15 to 49 years (M = 32.48, SD = 8.23). Sexual IPV significantly increased the odds of pregnancy loss (B = 0.29, AOR = 1.34, 95% CI [1.05, 1.73], p = .002), while also physical IPV showed a significant positive association ((B = 0.19, AOR = 1.03, 95% CI [0.82, 1.19], p = .003)). Access to healthcare was also significantly positively associated with pregnancy loss (B = 0.17, AOR = 1.15, 95% CI [1.03, 1.17], p = .001), possibly reflecting reverse causality. Importantly, healthcare access moderated the relationship between sexual IPV and pregnancy loss (B = -0.31, AOR = 0.84, 95% CI [0.66, 0.94], p < .001), suggesting a buffering effect. Slope analysis confirmed that sexual IPV remained a risk factor across access levels but was less pronounced when access was high. No moderating effect was observed for physical IPV (p = .216). Conclusions: The findings highlight that both physical and sexual IPV significantly increase the risk of pregnancy loss among Nigerian women. Notably, access to healthcare moderated these associations, suggesting that improving healthcare access may mitigate the harmful reproductive health consequences of IPV. These results underscore the importance of integrated interventions addressing both violence prevention and structural healthcare barriers.