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Abstract Background Community acceptance of Traditional birth attendants (TBAs) as professional birth attendant was reported as one of the bottlenecks that has been hindering facility childbirth care service use. Hence, the World Health Organization (WHO) recommended that all childbirths needed to be attended by professional skilled attendants who at least possessed midwifery skill through the safe motherhood initiative. However, many births in developing countries have been being attended by Traditional birth attendants (TBAs) mainly due to pregnant women and community acceptance for TBAs as sole birth attendants. Therefore, measuring pregnant women’s perceived community acceptance towards TBAs assisted childbirth care and identifying factors could be imperative. This provides evidence for policy makers, health program managers and health care practitioners in their effort to escalate skilled and facility childbirth care there by improving maternal and newborn health outcome. Methods This study had used the cross-sectional baseline data from Performance and monitoring for action Ethiopia (PMA_Et) cohort one survey which enrolled and collected data from currently pregnant women and recently postpartum women. The baseline survey collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. The final sample size was 2,186 women who were pregnant by the time of the survey and who provided response for the perceived community acceptance for TBAs assisted childbirth care question item. Frequencies were computed to describe the study participant’s characteristics. Multinomial logistics regression statistical model building process was employed to identify associated factors of perceived community acceptance for childbirths to be attended by TBAs. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results The overall proportion of perceived community acceptance for TBAs assisted childbirth care was found to be 58.63% (95%CI: 56.47%, 60.76%). Attending primary education was found to increase the likelihood of pregnant women perceived community acceptance by most people in their community for TBAs assisted childbirth care. Women having intentions to have another child were found to have higher likelihood perceived community acceptance by few people in their community for TBAs assisted childbirth care. On the contrary, religion, residing in the well to do households, residing in the Southern nations, nationalities and Peoples Region (SNNPR) and Addis Ababa had lowered pregnant women’s perceived community acceptance by most, few and some pleople in their community for TBAs assisted childbirth care. Conclusions The overall substantially greater proportion of pregnant perceived community acceptance for TBAs assisted childbirth care calls up on tremendous work to be done to avert such high level pregnant women perceived community acceptance for childbirths to be assisted by TBAs. Activities targeting in improving women economic status and empowerment; increasing women enrollment to secondary and higher education; using religious leaders and institutions to promote skilled delivery and childbirth care service use could likely aid in mitigating such huge surge of misconceptions towards childbirth care attendants. This significant perceived community acceptance substantially impact maternal and newborn health outcomes negatively which calls for awareness creation through community campaign to reverse this skewed perception. The activities and interventions need to be region specific. The finding also underscores the relevance of birth preparedness and complication readiness. The implication of the study is that the Health Minister and relevant actors need to design and implement region specific programs and strategies on women reproductive health empowerment and skilled childbirth care service use improvement. The other key implication of the finding was serving as one source of evidence to follow the WHO’s recommendation aimed at reducing maternal mortality through skilled delivery and childbirth care service provision. It also served to track the status of the new role of TBAs to serve as a liaison between the pregnant women and the modern health care system to escalate skilled childbirth care services.

Abstract Introduction Current intimate partner violence (IPV) in Ethiopia is considerably high. This study aimed at determining the prevalence of IPV among a panel of pregnant women during their index pregnancy and identify its correlates using Performance Monitoring for action (PMA) cohort 2 baseline data. Documenting the magnitude of IPV thus far during the index pregnancy and identifying factors affecting it contributes its share for the ministry and relevant developmental partners in tracking progress towards eliminating all forms of violence against women and girls by 2030. Methods We conducted a further analysis of national level follow up secondary data sets from Performance Monitoring for action Ethiopian (E_PMA). This study used PMA cohort two baseline data which enrolled pregnant and recently postpartum women and collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. This study was restricted to 1,796 pregnant women at the enrollment. Frequency was computed to describe the study participant’s characteristics, and chi-square statistics was used to assess cell sample size adequacy. Multilevel binary logistics regression model building process was employed to identify correlates of IPV. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results One in six; 16.7% (14.81%, 18.76%) pregnant women have reported experiencing at least one form of physical and/or sexual IPV thus far in their index pregnancy. The prevalence of encountering at least one form of sexual violence was 12.53% (10.91%, 14.35%) while 7% (5.5%, 8.3%) of them experienced at least one form physical intimate partner violence thus far during their index pregnancy. Women perceived risk about contraceptive use ((AOR: 95% CI: 1.66 (1.10, 2.47)), higher birth order ((AOR: 95% CI: 1.88 (1.05, 3.34)), unhappy emotional fertility intention when learned their index pregnancy ((AOR: 95% CI: 1.7 (1.02, 2.84)) and a family size of 4 to 5 ((AOR: 95% CI: 1.87 (1.11. 3.14)) were the fixed effects factors found to increase the odds of IPV significantly and positively. On the contrary, being in the third trimester of gestation at enrollment was another fixed effect variable which contributed for the 44% lower odds ((AOR: 95% CI: 0.56 (0.34, 0.92)) of experiencing IPV thus far in their index pregnancy. Conclusions The overall burden of IPV reported was high; with nearly double the percentage of women experiencing sexual violence during the index pregnancy compared to physical IPV. More work needs to be done to achieve zero tolerance against any form of violence among women and girls in general and among pregnant women in particular. Efforts targeted in improving women perception on issue related with their contraceptive use, counseling women on how to prevent IPV during their antenatal care (ANC) visit along with advising the use of inter pregnancy contraception and empowering them to control on their fertility are hoped to mitigate such considerably higher odds of IPV among pregnant women. Further programs and intervention on awareness creation towards the misconception that women held about contraceptive use would contribute much. These activities and efforts need to target younger women. The implication of the findings calls key actors and the Federal Democratic Republic of Ethiopia Health Minster to design and implement programs on women emotional fertility readiness and empowering them to control over their fertility through diversified contraceptive provision which is critical in combating the reported substantial IPV experience during pregnancy. Creating institutional capacity in the health system through strengthening and expanding one stop centers to provide medical treatment, care, and psychosocial support for victims and survivors could play a pivotal role. In addition, installing rapid referral system and linkage to the legal system could play a vital role. Moreover, working on early marriage and counseling on childbirth; and spaced pregnancy for those young couples is imperative. Further implication of this study was installing contraceptive and violence related preconception care packages in the health system is very critical in the combat against IPV and any form of gender based violence.

Abstract Background Emotional fertility intention and couples communication are key during pregnancy and childbirth with simultaneous minimization of reproductive coercion. Intention to conceive is an integral part of the reproductive health (RH) right and can be considered as decision making on fertility, family wellbeing and the country’s population demographic dividend and composition. However, in low and middle income countries including Ethiopia where males dominance is culturally constructed and socially accepted, males took the lead in every decision making process. In the aforementioned context, women are less likely for their voices to be heard, hence, this study aimed at determining the level of womens´ emotional fertility readiness and its correlates. The finding provided actionable evidence for the ministry and developmental partners working on reproductive and womens´ health so as to be used as an action point to empower women in terms of their reproductive health right to have control over their fertility. Methods Linked community and facility data with nationally representation from Performance Monitoring for Action (PMA Ethiopia) 2020 Survey Ethiopia except Tigray Region were used for this study. A total of 2,069 current and/or recent contraceptive user women of child bearing age who are currently married/living together as a partner were included in this analysis. Frequency was computed to describe the study participant’s characteristics. Generalized Ordered logistics regression modeling was employed to identify correlates of the hierarchical variation in women fertility intention if they became pregnant. Results were presented in the form of percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results The proportion of womens´ emotional fertility intention of feeling unhappiness was 48.73% (95%CI: 46.21%, 51.23%). On the contrary, 22.88%, 11.36% and 17.03% of them reported that they felt sort of happy, very happy and mixed feeling. An increase in age,10 and above years marriage duration, the type of decision maker for contraceptive use were found to increase the odds of women emotional fertility intention across the higher level categories by (AOR: 95% CI: 6.75 (3.11, 14.62) times higher among elder women aged 35 to 49 years, (AOR: 95% CI: 3.79 (1.72, 8.31) times higher for women with a 10 or more years of marriage duration; and 1.83 (1.03,3.24) times higher for women whose contraceptive use was decided by the health care provide alone. A higher birth order lowered the cumulative odds of womens´ emotional fertility intention symmetrically across the higher level categories by 86% (AOR: 95% CI: 0.14 (0.07, 0.29). Women who wanted to have additional child and whose nearest facility provided 5 or more methods had an increased odds of being in the higher level categories of women emotional fertility intention with disproportional association across the cumulative logit. Accordingly, women whose nearest health facility provided 5 or more methods had an 49% (AOR: 95%CI:1.49 (1.01, 2.19) increased likelihood of being in the mixed or happy category than being very/sort of unhappy category of the emotional fertility intention while the number of methods had no significant association with emotional fertility intention at higher cumulative logit: 1.34 (0.87,2.10). Those who wanted to have an additional child had a 3.16 (2.28, 4.36) higher odds to be in the mixed or happy category than being in unhappy category. Further, this tendency was even stronger at higher categories of emotional fertility intention: 4.83 (3.23, 7.23). Conclusion Nearly one in two women reported being unhappy while 17.03% felt mixed emotion calling up on intended and spaced pregnancies by ensuring women reproductive and economic empowerment to empower women to have control over their fertility. Activities and efforts that promote intended and spaced pregnancies; and diversifying access to contraceptive methods in the nearest health facilities are likely to improve women emotional fertility intention; and activities that enable women to decide their contraceptive as well. The finding that health care provider decides on women current/recent contraceptive use calls for activities to improve quality of contraceptive use counseling to enable women to decide their contraceptive use by the themselves while the access of diversified methods in the nearby health facility create an opportunity for women to obtain the method they preferred to use and make them emotionally well. These activities are hoped to enable women to plan their fertility thereby increasing their emotional well-being. These activities and interventions need to be tailored across regions and need to be age sensitive.

Abstract Background Women alone contraceptive decisions making has become one of the top burring public health agenda. Despite Contraceptive method options are available and accessible, contraceptive prevalence rate (CPR) in Ethiopia is not far beyond 41%. Evidences showed that the freedom of women to choose the contraceptive method they desired to use is one of the potential determinants for the sluggish pace of increase in contraceptive usage. In this era of sustainable development, determining the level of women own contraceptive use decision making and identifying its correlates is very critical for the ministries and relevant partners’ effort in tracking the achievement of Sustainable Development Goal (SDG) 5.2 by providing actionable evidence through informed decision-making with the aim of improving contraceptive uptake; reducing maternal mortality and improve newborn health. Methods Nationally representative cross-sectional data from Performance Monitoring for Action (PMA) 2021 was used in this study. The sample was restricted among2446 married women who have been using or most recently used modern contraceptive method. Cell sample size adequacy was checked using a chi-square test. Frequency was computed to characterize the study participants. Multilevel binary logistics regression was used to identify factors associated with women own contraceptive use decision making. The findings were presented in a form of frequencies, percentage and as an odds ratio using 95% confidence interval. A p-value of 0.05 was used to declare significance. Results This study revealed that higher than one in two women (59.49%; 95% CI: 57.7-61.38%) decide their contraceptive use by themselves. What is more interesting is that 1 in 16 women (6.06%) reported that they did not participated in their contraceptive use decision-making.-. Women aged 20 to 24 years; (AOR: 2.51 (1.04, 4.45)), women who stayed10 and above years in marriage; (AOR: 1.73 (1.08, 2.77)), whose husband and/or partner age is 41 and above years; (AOR: 2.14 (1.06, 4.31)) and those who obtained contraceptive method they desired; (AOR: 2.49 (1.36, 4.57)) had higher odds of deciding their current and/or recent contraceptive use by their own. On the other hand, women mixed feeling if they became pregnant at the time of the survey; (AOR: 0.6 (0.44, 0.91)), women who started using contraceptive at younger age, 19 to 24; (AOR: 0.6 (0.44, 0.81)), those who use long acting and/or permanent method; (AOR: 0.54 (0.41, 0.71)) and those married at younger age, 10 to 19 years; (AOR: 0.28 (0.09, 0.86)) had lower odds of independently deciding their current and/or most recent contraceptive use. Conclusion 59% of women independently decide their contraceptive use which calls up on further improvement to enable each woman to decide by their own, with directing special focus for the 6.06% of women who reported no say in their contraceptive use decision. Activities targeting on enabling women to use the method they preferred, spacing their pregnancy, encouraging women to discuss with their husband on the time and type of contraceptive method they used, advocating and promoting marriage at least to be at the minimum age as indicate by the law and maintain the marriage duration as much as longer are hoped to improve women alone contraceptive use decision making to the fullest.

BackgroundFamily planning decision making is defined as women´s ability to determine the family planning methods that she wanted to use through the process of informed decision making. Despite the availability and accessibility of family planning methods, the utilization rate is not more than 41% in Ethiopia. Evidence and experts have consistently show that women decisions making ability on family planning method they desired to use is one of the possible reasons for this slow rate of family planning use increment. In consideration of this and further motives family planning use decision making has become one of the top sexual and reproductive health related sustainable development agendas. Hence, this study aimed at determining the level, trend and spatial distribution of family planning use decision making among married women and identify factors affecting it.MethodsThis study was based on Performance Monitoring for Action (PMA) 2020 cross sectional national survey data. Married women who are currently using or recently used family planning method were included in this study. Frequency was computed to describe the study participants while chi-square statistics was computed to examine the overall association of independent variable with family planning use decision making. To identify predictors of family planning use decision making multinomial logistics regression was employed. Results were presented in the form of percentage and relative risk ratio with 95% CI. Candidate variables were selected using p value of 0.25. Significance was declared at p value 0.05.ResultsThis study revealed that one in two women (51.2%; 95% CI: 48.8%-53.6%) decide their family planning use by themselves while 37% (36.8%; 95% CI: 34.5%-39.2%) decide jointly with their husband and/or partner. Women alone family planning use decision making increased significantly 32.8% (95% CI: 29.4%, 36.4%) in 2014 to 51.2% (95% CI: 48.8%, 53.6%) in 2020. It also shows variation across regions from scanty in Afar and Somali to 63.6% in Amhara region and 61.5 Addis Ababa. Obtaining desired family planning method was found significantly to improve women alone and joint family planning use decision making. Women who have perceive control and feeling if they get pregnant now were found to be positively associated with women alone family planning use decision making. Discussion with husband, his feeling towards family planning were found positively to influence family planning use joint decision making. Moreover, women religion, was found reducing the likelihood of both women alone and joint family planning use decision making while experiencing side effect reduces the likelihood of joint family planning use decision making.ConclusionHalf of the women independently decide their family planning use which calls up on further improvement. Family planning use decision making ability is expected to be improved by efforts targeted on husbands' approval on wife's family planning use, discussion on family planning use with husband/partner, improving women psychosociological readiness and trust on her own to decide her desired family planning method; informing the possible side effects and what to do when they encountered during their family planning use visit. In addition, influencing women on the use of family planning via religious leader will help much in this regard. Monitoring and evaluating reproductive health policy 2021 to2025 and addressing bottlenecks which hinder women decision making health service use is hoped to improve women family planning use decision making. Further qualitative study to identify and address factors that contribute for the variation across regions also help much.

Overheating in BIPV/T applications is a concern due to its negative impacts on the electrical conversion efficiency of the solar cells. Forced air cooling can be an effective thermal management strategy. However, its effectiveness is limited by the thermal resistance associated with the boundary layer formation on the walls of the air channel. The heat transfer effectiveness can be improved by appending transverse ribs to the BIPV/T air channel. This study numerically investigates the energy improvements associated with appending transverse ribs to a BIPV/T air channel using CFD. The impact of the varying the transverse rib roughness shape, pitch and height on the thermo-hydraulic performance parameter, electrical efficiency of the BIPV and building heating/cooling load is quantified. With the optimized transverse rib geometry, the heat removal rate is 2.73 times greater than with the smooth channel. This translated to a 30.5% reduction in the PV surface temperature and an increase in the electrical efficiency by 11.3% compared with the smooth channel under peak summer conditions for a mild oceanic climate. The wall heat gain during summer is also reduced by 45.2%.

The process of urbanization resulting from population growth is causing a transformation of natural landscapes into built environments, and contributing to a significant rise in air and surface temperatures in urban areas, resulting in what is known as the urban heat island (UHI). Ignoring the UHI effect and use of weather data from open fields and airport locations for energy and thermal comfort analysis can lead to over- and underestimation of heating and cooling loads, improper sizing of equipment, inefficiencies in the mechanical systems operation, and occupants’ thermal discomfort. There is a need for computationally efficient urban canopy temperature prediction models that account for the urban morphology and characteristics of the study area. This paper presents the development and application of an artificial neural network (ANN)-based method for generating hourly urban canopy temperature and local wind speed for energy simulation. It was used to predict the urban canopy temperature of a neighborhood in downtown Vancouver and the resulting building energy consumption and indoor temperature in a typical building in the area. The results showed that the UHI effect increased the total cooling energy demand by 23% and decreased the total heating energy consumption by 29%, resulting in an overall negative effect on the total energy demand of the building, which was 18% higher in the urban area. The UHI effect also increased the number of hours of indoor temperature above the cooling set point by 7.6%. The methodology can be applied to determine the urban canopy temperature of neighborhoods in different climate zones and determine the varying urban heat island effects associated with the locations.

Background: Community acceptance of Traditional birth attendants (TBAs) as professional birth attendant was reported as one of the bottlenecks that has been hindering facility childbirth care service use. Hence, the World Health Organization (WHO) recommended that all childbirths needed to be attended by professional skilled attendants who at least possessed midwifery skill through the safe motherhood initiative. However, many births in developing countries have been being attended by Traditional birth attendants (TBAs) mainly due to pregnant women and community acceptance for TBAs as sole birth attendants. Therefore, measuring pregnant women's perceived community acceptance towards TBAs assisted childbirth care and identifying factors could be imperative. This provides evidence for policy makers, health program managers and health care practitioners in their effort to escalate skilled and facility childbirth care there by improving maternal and newborn health outcome. Methods: This study had used the cross-sectional baseline data from Performance and monitoring for action Ethiopia (PMA_Et) cohort one survey which enrolled and collected data from currently pregnant women and recently postpartum women. The baseline survey collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. The final sample size was 2,186 women who were pregnant by the time of the survey and who provided response for the perceived community acceptance for TBAs assisted childbirth care question item. Frequencies were computed to describe the study participant's characteristics. Multinomial logistics regression statistical model building process was employed to identify associated factors of perceived community acceptance for childbirths to be attended by TBAs. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results: The overall proportion of perceived community acceptance for TBAs assisted childbirth care was found to be 58.63% (95%CI: 56.47%, 60.76%). Attending primary education was found to increase the likelihood of pregnant women perceived community acceptance by most people in their community for TBAs assisted childbirth care. Women having intentions to have another child were found to have higher likelihood perceived community acceptance by few people in their community for TBAs assisted childbirth care. On the contrary, religion, residing in the well to do households, residing in the Southern nations, nationalities and Peoples Region (SNNPR) and Addis Ababa had lowered pregnant women's perceived community acceptance by most, few and some pleople in their community for TBAs assisted childbirth care. Conclusions: The overall substantially greater proportion of pregnant perceived community acceptance for TBAs assisted childbirth care calls up on tremendous work to be done to avert such high level pregnant women perceived community acceptance for childbirths to be assisted by TBAs. Activities targeting in improving women economic status and empowerment; increasing women enrollment to secondary and higher education; using religious leaders and institutions to promote skilled delivery and childbirth care service use could likely aid in mitigating such huge surge of misconceptions towards childbirth care attendants. This significant perceived community acceptance substantially impact maternal and newborn health outcomes negatively which calls for awareness creation through community campaign to reverse this skewed perception. The activities and interventions need to be region specific. The finding also underscores the relevance of birth preparedness and complication readiness. The implication of the study is that the Health Minister and relevant actors need to design and implement region specific programs and strategies on women reproductive health empowerment and skilled childbirth care service use improvement. The other key implication of the finding was serving as one source of evidence to follow the WHO's recommendation aimed at reducing maternal mortality through skilled delivery and childbirth care service provision. It also served to track the status of the new role of TBAs to serve as a liaison between the pregnant women and the modern health care system to escalate skilled childbirth care services. [ABSTRACT FROM AUTHOR]

Introduction: Current intimate partner violence (IPV) in Ethiopia is considerably high. This study aimed at determining the prevalence of IPV among a panel of pregnant women during their index pregnancy and identify its correlates using Performance Monitoring for action (PMA) cohort 2 baseline data. Documenting the magnitude of IPV thus far during the index pregnancy and identifying factors affecting it contributes its share for the ministry and relevant developmental partners in tracking progress towards eliminating all forms of violence against women and girls by 2030. Methods: We conducted a further analysis of national level follow up secondary data sets from Performance Monitoring for action Ethiopian (E_PMA). This study used PMA cohort two baseline data which enrolled pregnant and recently postpartum women and collected real time data on various sexual, reproductive, maternal and new born nationwide priority indicators using customized Open Data Kit Mobile application. These data were collected using standard pretested questionnaire prepared in three local languages (Amharic, Afan Oromo and Tigrigna) by well experienced resident enumerators. This study was restricted to 1,796 pregnant women at the enrollment. Frequency was computed to describe the study participant's characteristics, and chi-square statistics was used to assess cell sample size adequacy. Multilevel binary logistics regression model building process was employed to identify correlates of IPV. Results were presented in the form percentages and odds ratio with 95% Confidence Intervals. Candidate variables were selected using p-value of 0.25. Statistical significance was declared at p-value of 0.05. Results: One in six; 16.7% (14.81%, 18.76%) pregnant women have reported experiencing at least one form of physical and/or sexual IPV thus far in their index pregnancy. The prevalence of encountering at least one form of sexual violence was 12.53% (10.91%, 14.35%) while 7% (5.5%, 8.3%) of them experienced at least one form physical intimate partner violence thus far during their index pregnancy. Women perceived risk about contraceptive use ((AOR: 95% CI: 1.66 (1.10, 2.47)), higher birth order ((AOR: 95% CI: 1.88 (1.05, 3.34)), unhappy emotional fertility intention when learned their index pregnancy ((AOR: 95% CI: 1.7 (1.02, 2.84)) and a family size of 4 to 5 ((AOR: 95% CI: 1.87 (1.11. 3.14)) were the fixed effects factors found to increase the odds of IPV significantly and positively. On the contrary, being in the third trimester of gestation at enrollment was another fixed effect variable which contributed for the 44% lower odds ((AOR: 95% CI: 0.56 (0.34, 0.92)) of experiencing IPV thus far in their index pregnancy. Conclusions: The overall burden of IPV reported was high; with nearly double the percentage of women experiencing sexual violence during the index pregnancy compared to physical IPV. More work needs to be done to achieve zero tolerance against any form of violence among women and girls in general and among pregnant women in particular. Efforts targeted in improving women perception on issue related with their contraceptive use, counseling women on how to prevent IPV during their antenatal care (ANC) visit along with advising the use of inter pregnancy contraception and empowering them to control on their fertility are hoped to mitigate such considerably higher odds of IPV among pregnant women. Further programs and intervention on awareness creation towards the misconception that women held about contraceptive use would contribute much. These activities and efforts need to target younger women. The implication of the findings calls key actors and the Federal Democratic Republic of Ethiopia Health Minster to design and implement programs on women emotional fertility readiness and empowering them to control over their fertility through diversified contraceptive provision which is critical in combating the reported substantial IPV experience during pregnancy. Creating institutional capacity in the health system through strengthening and expanding one stop centers to provide medical treatment, care, and psychosocial support for victims and survivors could play a pivotal role. In addition, installing rapid referral system and linkage to the legal system could play a vital role. Moreover, working on early marriage and counseling on childbirth; and spaced pregnancy for those young couples is imperative. Further implication of this study was installing contraceptive and violence related preconception care packages in the health system is very critical in the combat against IPV and any form of gender based violence. [ABSTRACT FROM AUTHOR]