A comparative analysis of inequalities in sexual violence before age 18 among women in Ghana using the WHO health equity assessment toolkit, 2008 and 2022

Abstract

Background: Sexual violence before age 18 is a severe public health concern with long-lasting consequences. Despite Ghana's legal and policy reforms including the Domestic Violence Act of 2007, differences in the burden of childhood sexual violence across population subgroups remain inadequately characterised. This study examined differences in the estimated prevalence of childhood sexual violence among young Ghanaian women between 2008 and 2022, with a specific focus on age cohort and marital-status subgroups. Methods: A secondary comparative analysis of the 2008 and 2022 Ghana Demographic and Health Surveys was conducted using the WHO Health Equity Assessment Toolkit. The primary outcome was the self-reported proportion of women who experienced sexual violence before age 18. Summary inequality measures included absolute difference, ratio, population-attributable fraction (PAF), and population-attributable risk (PAR), with 95% confidence intervals. Results: The estimated national prevalence of childhood sexual violence was lower in 2022 (6.4%) than in 2008 (8.3%). Never-married women had the highest estimated prevalence in both years (11.3% in 2008; 8.4% in 2022). Among age cohorts, women aged 20-24 years had the highest estimate in 2008 (10.5%), declining to 7.0% in 2022. However, estimates increased among women aged 35-39 (5.1% to 6.6%) and 40-44 years (3.4% to 5.1%), suggesting a cohort-specific burden pattern. The age-related PAF shifted from -9.3% (95% CI: -9.8 to -8.9) in 2008 to -44.2% (95% CI: -44.4 to -43.9) in 2022, reflecting a more protective age distribution. The age PAR became statistically significant, moving from -0.7% (95% CI: -3.8 to 2.5) to -2.5% (95% CI: -4.0 to -1.0). Marital-status differences showed modest differences: PAF from -18.0% to -16.4%, and PAR from -1.5% to -1.1% (CI crossing zero in 2022). Conclusions: The estimated prevalence of childhood sexual violence was lower in 2022 than in 2008 across most subgroups; however, differences in burden by age cohort and marital status persisted, with never-married women and some older cohorts carrying a disproportionate burden. These patterns highlight the need for equity-targeted prevention strategies and intensified support for never-married young women.