The Impact of Emotional,Physical, and Sexual Abuse on Contraceptive Method Selection and Discontinuation

Objectives. We evaluated the impact of exposure to emotional, physical, or sexual abuse on contraceptive method selection and discontinuation.Methods. We performed a secondary analysis of 7170 women enrolled in the Contraceptive CHOICE Project in St. Louis, Missouri, a prospective cohort study in which 9256 women were provided their preferred method of contraception at no cost from 2007 to 2011. We defined contraceptive discontinuation as device removal or nonuse for at least 4 weeks within the first 12 months after initiation.Results. One third of women experienced some abuse in their lifetimes. Women with an abuse history were as likely as those without to select a long-acting reversible contraceptive method and more likely to choose a contraceptive injection, the patch, or the ring. When we compared women who were abused to those who were not, rates of discontinuation at 12 months were higher among women who selected long-acting reversible contraception (17% vs 14%; P = .04) and significantly higher among women who selected non–long-acting methods (56% vs 47%; P < .001). Type of abuse did not alter the association between abuse and contraceptive continuation.Conclusions. Previous experiences of abuse are associated with both contraceptive method selection and continuation.Research has shown that violence against women is disturbingly common.1,2 A 2000 Centers for Disease Control and Prevention nationally representative survey of 8000 women aged 18 years and older found that the lifetime prevalence of physical intimate partner violence was 25%, and 56% of women reported at least 1 incident of physical or sexual assault.1 A 2010 survey conducted by the National Center for Injury Prevention and Control found that 36% of women reported intimate partner violence during their lifetime, 18% of women had been raped, and 45% of women reported some other form of sexual violence.2A developing body of evidence suggests that childhood and adulthood violence has far-reaching effects on women’s lives.1,3,4 Women with a history of violence report more high-risk health behaviors, such as early age at first intercourse or more lifetime sexual partners,5,6 more psychological effects including posttraumatic stress disorder and depression, higher rates of physical injury, and decreased access to social networks than women with no history of violence.1,7 In addition, women with current or past histories of violence may face unwanted or mistimed pregnancies, are at an increased risk of acquiring sexually transmitted infections (STIs), and are more likely to undergo repeat abortions.1,8–14Exposure to all forms of violence may influence the choices that women make regarding contraceptive use.10,12,15,16 Women’s perceptions and experience of loss of reproductive control may affect their decisions to use contraception, lead to decreased conviction to use condoms, or result in partner control over administration and type of contraception used.11,16 Gee et al. demonstrated that, because of difficulties imposed by their partners, women with exposure to intimate partner violence were less likely than nonexposed women to use birth control.9 Compared with women without violence exposure, women with a history of intimate partner violence reported that their male partners were more likely to refuse to use condoms (21% vs 7%; P < .001) and to refuse to allow contraception (5% vs 1%; P < .001).15 Women exposed to violence were also less likely than their nonexposed peers to ask their partners to wear condoms (35% vs 56%; P < .001).15 Finally, previous experiences of abuse, particularly those occurring in childhood, might have an impact on contraceptive choices via alternate pathways including depression, substance abuse, and alcohol use.17–19In light of these findings, women who experience histories of abuse may benefit from contraceptive methods that are independent of their partners. In this analysis, we sought to estimate the association of childhood, adult, and lifetime exposure to physical, emotional, or sexual abuse with contraceptive method selection and duration of use for both long-acting reversible contraception (LARC; intrauterine devices and hormonal implant) and non–long-acting methods of contraception (non-LARC; birth-control pill, injection, ring, or patch) in the Contraceptive CHOICE Project (CHOICE).