Title: Intimate Partner Violence Among Pregnant Women in Kenya: Forms, Perpetrators and
Associations
Version: 1 Date: 27 Nov 2021
Reviewer:  Tamora Callands
Reviewer's report:
Title: Intimate Partner Violence Among Pregnant Women in Kenya: Forms, Perpetrators and
Associations
Manuscript Number:
Reviewer’s comments to the Authors:
Summary: This study aims to examine intimate partner violence (IPV) and factors associated
with IPV among pregnant women and in Kenya. The study also aims to provide data
necessary to lay the foundation for IPV prevention during pregnancy. This study is much
needed because lower-middle-income countries (LMICs) in Sub-Saharan Africa lack literature
explicitly focused on IPV pregnant women, a vulnerable population of women. The paper would
be an excellent addition to the current scientific literature in this area; however, not as is. The
paper would benefit from clarification in several areas, including improved organization, clarity
regarding the procedures and methodology, and extensive editing related to proofreading and
grammatical revisions. Please see the detailed comments below.
Introduction:
• In the 2nd sentence in the background, when it says, “on this dimension,” it would be helpful
to be more specific. This is not clear.
• In the background, it says, “violence during pregnancy has also been lined with...”  the word
“aligned” would be more fitting instead of lined.
• The language of “tackled and solved” is overly optimistic.
• On page 2, line 6, author(s) write “decreased coping mechanisms” did they mean “…which
may lead to decreased healthy coping mechanisms”? That sentence could be broken down into
two sentences for a better flow of reading.
• On page 2, line 14, the word “even” can be omitted
• Provide clarity on the rates of perpetrators who are intimate partners instead of using the word
“Most.”
• Provide more relevant information regarding the adverse outcomes associated with IPV. Be
sure to include those appropriate for the mother and child’s physical and mental health.  Also,
are these outcomes more or less several or different than comes in non- LMICs?
• Throughout the introduction, there is a lack of transitions between concepts and new ideas. For
example, the definition of IPV is provided the author(s) leap directly to why pregnant women
are especially vulnerable. Perhaps, here is where adverse outcomes can be provided that include
more details, and then end with this the impact it can have on pregnant women and why that
is particularly problematic.
• The relevance of Kenya needs to be a separate paragraph; what makes Kenya unique? The
authors need to clarify the forms of violence against women in Kenya and each forms’ percentage
(rates). Perhaps, then provide reasons why it is hard to estimate in Kenya.  The authors begin
to do this, but as pointed out above, the concepts are disjointed. There need to be more clarity
and better transitions regarding the underestimations.
• The paragraph beginning with, on the other hand, lacks clarity. It is hard to determine the
purpose of the last two paragraphs in the introduction because the transitions between topics
are not provided.
• The literature has gone beyond referring to women as victims. Women are now referenced as
women who experienced IPV. Change this throughout.
Methods:
• Be more specific about inclusion and exclusion criteria for the sample. For example, the study's
aim is about IPV among pregnant women; yet it is unclear how these women were selected. As
written, one whole was elected to participate in the DV module. Further,  the paragraph goes
on to say, “in the latter,” which does not make sense, nor does the age range for the selection
of women.
• How was the sample selected? Specifically, given the violence during pregnancy question, was
it the case that women who answered yes to this question were selected out for future analyses.
The results section mentioned the 9.2% prevalence rate of violence among women (n=397), how
this number was derived.
• Regarding the question on perpetration, please clarify what happened with the sample and
sample size if the women reported that an intimate partner was the perpetrator. Also, what
possible answered were considered “intimate” be clear.
• Something is missing regarding how the items a-m are described. Remove the “)” in the
description--it makes it hard to read. Also, what happened if more than one item was endorsed.
How was that dealt with in the analyses? Was this a count variable?
•  What do “moment at which a woman first became afraid of her partner” and “moment at which
the woman’s father beat her mother” mean. How were these operationalized and coded?
• Remove the “ an”  between cohabitation and age.
• What were the outcomes for the logistic regression models?  The author mentioned the
distribution of perpetration and three different formed of violence.  It is not clear what the binary
outcomes were for the logistic regression.
• The authors use the following terms exposure, dependent, independent, and outcomes
variables. Be consistent throughout.
Results:
• The age distribution in the results section is unclear. Suppose authors believe age at debut and
cohabitation are essential; in that case, breaking down by age may be more appropriate than
saying that most pregnant victims were aged 18 years or above at the first cohabitation (58.2%)
and the sexual debut (47.0%).
• “Women aged 15-17 years at first cohabitation (aOR = 1.27; CI = 1.01-1.58) were more likely
to experience violence during pregnancy, whereas women aged 18 years and above at first
cohabitation (aOR = 0.75; CI = 0.60-0.94) and sexual debut (aOR = 0.65; CI = 0.53-0.80) were
less likely to be victims of violence when they were pregnant.” This is unclear. The author uses
different descriptions in the beginning compared to the end of the sentence.  Consider changing
to this, if accurate, “ Women aged 15-17 years at first cohabitation (aOR = 1.27; CI = 1.01-1.58)
were more likely to experience violence during pregnancy,  compared women aged 18 years
and above at first cohabitation (aOR = 0.75; CI = 0.60-0.94) who were less likely to experience
violence during pregnancy.  Remove the sexual debut and make it a new paragraph.
• Review all results for clarity, making sure not to combine results that are not linked.
Discussion:
• COVID-19 was briefly mentioned as a possible factor of conflict; however, the data were
collected and reported on from 2014. This whole section is irrelevant.
• Beginning with the most critical findings is how discussion sections typically start. The rates
and range of IPV among pregnant women in other African countries and whether Kenya’s rates
fit or do not fit within the range are irrelevant for the discussion.
• “In the broader Kenyan community, intimate partner violence is accepted and socialised as a
normal and timeless tradition; perhaps the paper would benefit from introducing this above in
the introduction when the context of Kenya is described.
• “This might be explained by Mutisya’s findings that “the belief in the social superiority of a
man, man’s right to assert over a woman and the belief that women should tolerate violence
to save a relationship/marriage were predictors of increased violence” during pregnancy [3]”.
This explanation appears to come out of nowhere and does not help explain this finding unless
the authors say this is unique to the Kenyan context.  However, violence during pregnancy is
perpetrated by intimate partners across all contexts and countries.  IPV is the most commonly
perpetrated form of VAW.
• “In line with the latter, we revealed that young age (15-17 years) at cohabitation was positively
associated with all forms of IPV among pregnant women, which is consistent with the existing
literature [43], and an age of 18 years and above at first cohabitation and at sexual debut was
a protective factor”. This needs further explanation and clarity.  Perhaps break the different
findings for each factor up to make more clear.
• “In line with the latter” is used too much throughout the entire paper.
• The discussion lacks explanations when it comes to the findings. The authors merely provide
studies that support or do not support the findings, but little explanation and context are given.
• At the outset of the introduction, interventions' implications are heavily emphasized, but not
much is mentioned about how the results impact intervention.