The prevalence and impacts of adverse childhood experiences in women in Sub-Saharan Africa: A scoping review.

Abstract

Background: Adverse Childhood Experiences (ACEs) are a worldwide problem. Child maltreatment includes sexual, physical, and emotional abuse and neglect. Growing up in a home with substance use, parental mental illness, or divorce affects physical, mental, and social health. ACEs are common in high-income countries (HICs) and low and middle-income countries (LMICs) but are mostly studied in HICs. Little evidence exists on ACEs in Sub- Saharan Africa (SSA). This review aimed to explore ACEs' prevalence and impact on women in SSA, as women often experience more adversity.

Methods: A scoping review was conducted to synthesise the existing knowledge on the prevalence and impact of ACEs on women in SSA. The scoping review methodology (PRISMA) was implemented following a five-step framework. Three databases were searched in abstracts and titles – ERIC, Medline, and Criminal Justice Abstracts. The analysis involved both numerical and thematic syntheses in line with the framework.

Results: Twelve articles were reviewed. Prevalence for emotional abuse ranged from (2.04%- 72.5%), sexual abuse from (2.4%-33%), witnessing intimate partner violence from (0.56%- 35.9%), physical abuse from (1.1%-39.4%), collective violence (50.49%), lifetime interpersonal violence at (60.3%), child marriage from (16.5%-81.7%), and death/divorce of a parent at (0.57%). The review found an association between ACEs and interpersonal violence, and that women exposed to interpersonal violence as children were at risk of intimate partner violence (IPV). Women with ACEs were more likely to be victims and perpetrators of violence in adulthood, continuing the cycle of violence. ACEs also increased the risk of HIV infection and were linked to mental health issues like stress and postpartum depression. Child marriage was associated with fertility and reproductive outcomes: women married as children had lower odds of early childbirth than those not married as children. ACEs were linked to higher rates of perinatal substance use, likely due to psychological distress caused by ACEs.

Conclusion: This dissertation sheds light on ACEs’ prevalence and multifaceted impact on women in SSA. The results highlight the urgent need for a holistic approach to address ACEs, integrating mental health services, IPV prevention, HIV prevention and treatment, reproductive healthcare, intergenerational support, and substance abuse interventions. Effective policies and programmes in these areas can improve women's well-being and quality of life in SSA, breaking the cycle of ACEs and promoting healthier futures for individuals and communities alike.