From Bottles to Bruises: Partner Substance Use, Relationship Dynamics, and the Risk of Intimate Partner Violence in South Africa

Abstract

Highlights: Public health relevance—How does this work relate to a public health issue? Intimate partner violence (IPV) and substance use are interlinked public health challenges that significantly increase women’s risk of physical, sexual, and emotional harm. This study examines the association between partner alcohol consumption and women’s experiences of IPV in South Africa, a setting with high levels of both harmful drinking and gender-based violence. Public health significance—Why is this work of significance to public health? Findings demonstrate that women whose partners consume alcohol have substantially higher odds of experiencing all forms of IPV, reinforcing alcohol use as a critical but underaddressed driver of violence. The study provides population-level evidence that substance use operates as a structural risk factor for IPV, rather than merely an individual behavioural issue. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? IPV prevention and response strategies should integrate alcohol harm-reduction and substance-use interventions, particularly within primary healthcare and community-based programmes. Policymakers and researchers should strengthen cross-sectoral approaches linking public health, social services, and alcohol regulation to reduce IPV risk and improve women’s health outcomes. Intimate partner violence (IPV) remains a persistent public health and human rights challenge globally, with South Africa experiencing some of the highest rates. This study investigates the intersection between partner substance use, controlling behaviours, and women’s risk of experiencing emotional, physical, and sexual IPV. Using nationally representative data from the South African Demographic and Health Survey (SADHS), a weighted sample of 2354 women was analysed. Findings show that 41.8% of women reported that their partners used alcohol and/or drugs, and IPV prevalence among this group was 36.38%. Multivariate logistic regression revealed that partner substance use more than doubled the risk of emotional violence and nearly tripled the risk of physical and sexual violence. Controlling behaviours also emerged as significant predictor, with affected women facing up to nine times higher odds of IPV. These findings highlight the urgent need for integrated intervention strategies that address substance abuse and coercive control within intimate relationships. Prevention efforts must be context-specific, targeting underlying behavioural and gendered power dynamics to reduce IPV and improve women’s safety.