Health Challenges Encountered by Spouses of the Selected Defense and Security Wing Personnel Experiencing Intimate Partner Violence (IPV) in Lusaka, Zambia: An Interpretive Phenomenological Study

Background : Intimate Partner Violence refers to violent behaviour perpetrated by a partner within the context of marriage or cohabitation such as; physical harm, sexual coercion, and controlling behaviour. Studies have shown that IPV is more prevalent among military than civilian populations. Effects of IPV include Physical injuries, Sexually Transmitted Infections, Pelvic Inflammatory Disease, Urinary Tract Infections, unwanted pregnancies, pregnancy complications and mental health problems. Nevertheless, there is very little understanding about the health challenges encountered by spouses of Defense and Security personnel in Lusaka. Objective: The aim of the study was to explore the health challenges encountered by spouses of the selected Defense and Security Wing personnel experiencing intimate partner violence in Lusaka. Setting(s): The study settings were two (02) of the seven (07) Garrisons in Lusaka, which is Garrison 1 and Garrison 2. Participants: The study population comprised spouses of the selected Defense and Security Wing personnel in the study setting. Fifteen participants were interviewed for this study. Methodology : The interpretive phenomenological design was used to answer the research question because it was exploratory in nature. Purposive

(Nabaggal, Reddy, and Manda, 2021). In Sub-Saharan Africa, an intimate male partner has physically assaulted 13 to 49% of women (Centre for Disease Control, 2015). Zambia is among the countries with a high incidence of lifelong physical and sexual IPV in the world ranging from 39 to 50% annually (Hampandeui and Rael, 2018;McCloskey et al., 2016;United Nations Women, 2016). In addition, the Zambian Demographic and Health Survey -ZDHS (2018) reported that 49.5% of women between the ages of 15-49 years experienced IPV. Congruently, the Zambia Police Victim Support Unit -ZPVSU (2021) fourth-quarter disaggregated data indicated that 60.5% of women compared to 16.6% of men reported IPV countrywide. The highest reports filed were under physical violence (61.7%), sexual offences (17.8%), and 5.5% emotional violence.

Causes / Risk Factors for IPV
Intimate partner violence has roots in both evolutionary and sociocultural forces. In the context of evolutionary processes, IPV may have evolved to facilitate survival goals like self-defense and reproduction, hence, preventing mates from defecting to other potential partners or helping reacquire former mates (Hamel, 2020;Chester and DeWall, 2018). Similarly, there is also strong evidence between all the socioeconomic and demographic, antisocial and borderline personality disorders as well as sociocultural factors that are associated with increased risk of IPV (Qi,  . Alike, in the Sub-Saharan region and Zambia, there is strong evidence that the risk of IPV is heightened by its acceptance as a normal practice. In the Zambian culture, the institution of marriage justifies sexual violence toward women (Alanen and Kasongo, 2021; Moono, 2019). The payment of lobola (bride price) means the woman automatically becomes the man's "property". Consequently, the husband's sexual satisfaction is mostly emphasized and denying him this conjugal right results in violence (

The Health Challenges Associated with Intimate Partner Violence
Globally, 38% of all murders of women are committed by male intimate partners compared to 7.6% of men murdered (WHO, 2021; Kim, 2020). According to the American Psychiatric Association, (2021) IPV has numerous effects on the victim's lives and quality of life. The health effects include physical injuries like lacerations, fractures, and other internal organ injuries. One important sex difference in IPV dynamics is the greater physical impact on female victims in comparison to men. This is noticeable from the number of women who seek medical attention for their injuries or killed in an intimate homicide (Hamel,

Methodology
The research design was interpretive phenomenology. The study setting were two (02) Garrisons in Lusaka that is Garrison 1 and Garrison 2. The Garrisons were selected purposively. The purposive selection was also used to select potential participants from the health facility's Outpatient Department Register (Gender Based Violence Register) and other registers with data related to the study. The inclusion criteria was that; the participant should be married to a Defense and Security Wing personnel of any rank and belonged to any of the two (2) selected Garrisons. Alike, participants who were not cognitively and physically fit at the time of data collection were excluded from the study. The collection of data took about 3 weeks and 15 participants were interviewed. Data were collected using a semi-structured interview guide. The researcher adapted "A six-step process for thematic analysis" presented by Braun and Clarke, (2021;2006) to analyze the data.

Ethical Considerations
The researcher sought clearance from the University of Zambia's biomedical research ethics committee (UNZABREC) and the National Health Research Authority (NHRA) before carrying out this study (Appendix I and II). In addition, due to the nature of the study setting, the researcher also sought clearance from the Defense and Security Command at headquarters through the Training Branch. Permission was also granted by NHRA to have the study findings disseminated. To ensure the confidentiality and anonymity of the study site and participants 'safety, the names the study setting have been withheld.

Findings 4.1. Participants' Demographics
Fifteen participants took part in the study with majority being women aged between 30 to 39 years. The majority of the participants had completed their secondary school education (12 th grade) and in informal employment. More than two thirds of the participants had 5 or more years of marriage as presented in the Table 1 below. Table 1. Participant's demographic characteristics.

Generated Themes
Two major themes namely: Types of violence experienced and Impact of violence emerged from the data as theme 1 and 2 respectively.

Theme 1: Types of violence
This theme described participants' narratives of the types of IPV they were subjected to by their military spouses of the selected Defense and Security wing. The study findings reviewed that some participants experienced patterns matching physical, sexual, psychological and stalking violence. Participants reported experiencing one or multiple violent acts from their spouses at the same time. These acts of violence constituted the subthemes that made theme 1 -Use of physical force, Abusive sexual activity, Mental torture and Snooping/Trailing. The revelation of the subthemes that informed this theme were:

Use of physical force.
The study findings revealed that physical violence was a common phenomenon among the female study participants. Some female participants' spouses were using a military belt or a piece of hosepipe to beat them as stated by the following participants:  In some instances, female participants experienced IPV from their spouses because of not doing the house chores in the expected manner and it was not only restricted to the use of hosepipe, belts, slapping and pushing the victims. One participant had this to say: "…..My husband usually gets annoyed when his uniforms are not properly done. …One time, he even burnt me with the pressing iron here on the thigh and this scar here is a testimony of his reaction to what he calls poor laundry services. …It's not that I don't know how to prepare his uniforms but some uniforms are difficult to just prepare the way he wants them" P12. Furthermore, it was also noted that some female participants' spouses seemingly cherished corporal punishment when handling family differences. This is depicted in the example below: "…My husband is such a kind of person who really treasures corporal punishment. …..Even his children knows this. Yet, each time you criticize him about this approach, it turns out that am the victim even when am pregnant. …..He would either slap me, push me hard or even kick me. P14.

Abusive sexual activity
The study findings revealed that abusive sexual activity (sexual violence) was a common concern among the female participants. It was noted from the findings that some female participants' spouses were sexually hyperactive as adduced from the following responses of the participants: "…..He demands too much sex and at times he just wants to be having sex almost the whole night. …..I get tired and need some rest as well…." P. 1. Similarly, another participant also stated, "…Sex should not be for many hours -it's not normal…." P4. Likewise, it was echoed that some of the female participants' spouses used to force them to have sex while they were menstruating. Correspondingly, one of the participants stated that: "….Forcing your partner to have sex especially in the manner she is not comfortable with and even during periods is sexual violence. "…If I refuse to have sex with him during my periods then he would often lock me out of the bedroom. …..And I would sleep in the other bedroom with the kids" P12. In addition, one participant went further to state that her spouse would rape her while asleep. She stated that "….Sometimes, he would force himself even in my sleep, you just feel or realize that he is inside (he has penetrated you). …..You see its painful most of the times…I honestly thought that in marriage one has to consent to sex as well…" P3. The findings also indicated that some female participants experienced regular inspection of their private parts by spouses on suspicion of 'sexually cheating' and had this to say: It was noted that some participants' spouses were sexually hyperactive because of using concoction of traditional sexual boosters (Aphrodisiacs). Comparably, one participants stated that: "….My husband has also this habit of taking "Congo dust or Mutoto/Mwana apeluke" just to punish me or prove a point. ….I hate having sex because of that and I feel reduced to a prostitute…" P4.
On the contrary, male participants were denied conjugal rights by their spouses. One of the male participants revealed having sex at his wife's will, which was very tormenting and infuriating to him. He only enjoys the conjugal rights when his wife wants to be 'touched'. In his narrative, he indicated that: "…You know, us men are always ready and charged to have sex, but when your wife only gives you when she wants or feels so, it's very tormenting. …..How do you deal with pressure of just watching her and only have access when she wants to be touched? ….I have even lost concentration…" P15.

Mental torture
The study revealed that mental torture (psychological violence) was the commonest element amongst all the participants. The recorded acts that lead to mental torture included; use of inappropriate language or disrespectful comments in the presences of others which includes children and dependents, controlling behaviour, and refusing to eat food prepared by a wife. In view of the above findings, the following statement from the female participants have been quoted: "...My husband told that one of these days he would organize alangizi (traditional marriage counsellors) for me, so that they can help me sharpen my sexual skills. He claims I am an 'old kalewa' meaning oldtimer and finished woman…..I have even lost weight because of such disturbing remarks from him….I do not feel that worthiness for myself….." P1. Additionally, the male participants were also negatively affected by acts of their military spouses. In support to the finding, one of the male participants stated that his spouse used to shout at him and poured dirty water on his body: "...She does not respects me even in the presence of others… she would shout at me. One day, I wanted to go and check on my friend but my wife did not approve that. We differed just on that, and she even poured dirty water on me during the same misunderstanding…" P5. In line with the findings, some female participants were experiencing negative emotions because their spouses were denying them the conjugal rights. This can be noted in the following statements: "…..I developed some emotional problems because I expected to be having sex frequently with him, but I used to have sex once in two weeks or more…sometimes I would even experience sleepless nights. …..I would wander all night figuring out what has gone wrong with me…." P7. Another participant echoed: "…..There was no way I could stay a month plus without my husband touching me as if I was sick because even a heavily pregnant woman is touched. …..This is mental torture for me…" P6.

Psychological problems
The study findings revealed that all the participantsboth males and females experienced some sort of psychological health problems. The following experiences were reported by participants; feeling of shame or embarrassment, living in fear, persistent headaches, lowered self-confidence or esteem, hatred towards their spouses, felt betrayed and trapped in the relationship, sleeplessness, fatigue, and nightmares.

Reproductive health problems
The study findings revealed that nearly every female participant had reported experiencing IPV effects related to the reproductive health. The experiences included bruises on the private parts, cases of STIs, unplanned pregnancies, abortions, contraceptives sabotage and refusal to use them. Furthermore, the following experiences were also reported; loss of libido, (UTIs), prolonged monthly period and painful sexual intercourse despite enough arousal. This was evident from some of the following participants' narratives:

Chronic health problems
From the study findings, it was also noted that some participants were experiencing chronic health challenges that are associable with IPV. The findings revealed the following: traumatic deafness, loss of libido, pain or some discomfort during sex, raised blood pressure (hypertension), painful monthly periods, insomnia, stigma and low self-esteem, persistent headaches, nightmares, and loss of tooth. In addition, it included physical disability, STIs and HIV infection. Like noted earlier, loss of libido was common among the majority of the participants. Some participants experienced on and off abdominal pains, backaches as well as stress incontinence. One of them stated "…I have now noticed that when am annoyed my bladder easily get full and I would be passing urine most often …In the night I have to wake up many times otherwise, I will end up messing up myself. ….I was never like this before …" lamented P11. Another participant said: "….I usually experience this backache ….and this makes it hard for me to perform sexually. I hold back to avoid worsening the pain…" P7. The study also revealed that participants admitted experiencing abusive sexual activities (sexual violence) from their military spouses that aroused feelings of rage and betrayal which others found hard to overcome. Some female participants' partners forced themselves on them (marital rape) or repeatedly demanded for sex. A minority of participants described experiencing this while asleep or during their menses. Others cited experiencing sexual acts that they did not find comfortable.

Study limitations While findings from this study provide important data on "The health challenges encountered by spouses of the selected Defense and Security Wing personnel experiencing intimate partner violence (IPV) in
Lusaka-district" there are limitation to the study: 1. It is likely that sensitive topics such as IPV may be affected by nondisclosure due to many underlying factors (for example cultural, religious, and societal). Thus, it is possible that some participants did not disclose much of the IPV data in spite of participants being assured of confidentiality and anonymity. 2. The second limitation is that, although the qualitative method was considered a strength to this study, it was also a limitation. This is because qualitative methods are often less likely to be generalized to the entire community. 3.

Conclusion
Two major themes of focus emerged from the data. Theme 1 -Types of IPV, which was characterised by the different types of violence experienced by spouses. Mental torture was the most pronounced type of violence among study participants. Similarly, theme 2 -Impact of violence established that spouses suffered the following ailments: burns, ear injuries, broken teeth, eye injuries, persistent headaches, panic attacks, rage and hatred. Likewise, some participants continued to experience some IPV upshots, which were referred to as chronic health problems. These problems included physical disabilities, sexual dysfunctional problems, emotional complications, social stigma, and HIV infection. The findings of the study reveals that spouses of the selected Defense and Security Wing personnel experience various health problems that stemmed from each type of IPV. Therefore, midwives and other healthcare providers should actively screen every man or woman accessing healthcare services for IPV and treat or refer them appropriately.

Acknowledgements
• I would like to acknowledge the selected Defense and Security Wing Command for the opportunity and support accorded to me to undertake this study in the military cantonments. • Many thanks to the men and women who spared their precious time to share their stories that helped me gather valuable information on the phenomenon of IPV among spouses of the selected Defense and Security Wing personnel.

Conflict of interest
The authors declare no conflict of interest in the study.

Funding sources
No external funding was provided for this study.