Women's empowerment and intimate partner violence among pregnant women in Northern Ghana: evidence from coarsened exact matching and double-selection LASSO analyses

Background Intimate partner violence (IPV) is a major public health problem in sub-Saharan Africa. Its relationship with women's empowerment is theoretically contested, and most studies collapse empowerment into a single composite score, which may mask dimension-specific associations. We examined three empowerment dimensions including reproductive autonomy, household decision-making, and economic empowerment against physical, sexual, and emotional IPV among pregnant women in Northern Ghana. Methods We surveyed 260 pregnant women attending antenatal care (April–May 2023). Coarsened Exact Matching (CEM) balanced high- and low-empowerment women on age, education, and number of children, retaining n = 246 for the pre-specified primary analysis. Double-Selection LASSO (DSL) logistic regression, applied to the full analytical sample ( n = 260), served as a complementary sensitivity analysis. Balance after matching was assessed by standardised mean differences (SMDs) and variance ratios. Results Any-IPV prevalence was 59.6%. Two associations showed convergent evidence across both Methods: (1) reproductive autonomy was protective against sexual IPV (CEM OR = 0.34, 95% CI 0.19–0.61; DSL OR = 0.36, 95% CI 0.20–0.63) and emotional IPV (CEM OR = 0.29, 95% CI 0.16–0.54; DSL OR = 0.36, 95% CI 0.20–0.64); and (2) household decision-making was positively associated with physical IPV in a backlash-direction pattern (CEM OR = 1.34, 95% CI 1.07–1.66, p = 0.009; DSL OR = 1.26, 95% CI 1.03–1.55, p = 0.028). Economic empowerment and the composite empowerment index were not significantly associated with any IPV outcome in either analysis. Conclusions Reproductive autonomy showed a protective association with sexual and emotional IPV in the two different analytic approaches. Household decision-making showed a convergent positive association with physical IPV consistent with the backlash hypothesis. Composite empowerment scores obscured all dimension-specific patterns. Interventions strengthening reproductive autonomy, particularly contraceptive access and sexual-consent education, may reduce IPV vulnerability more directly than broad aggregated empowerment measures.