Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia |
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| Institution: | 1. Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA 92093, USA;2. Center on Gender Equity and Health, University of California, San Diego, CA 92093, USA;3. Clinical Addiction Research and Education, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, USA;1. John Snow, Inc, Lusaka, Zambia;2. Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA;3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA;4. Research Department of Infection and Population Health, University College London, UK;5. Africa Health Research Institute, Mtubatuba, South Africa;6. Institute of Public Health, Faculty of Medicine, University of Heidelberg, Heidelberg, Germany;7. Francis I. Proctor Foundation, University of California, San Francisco, CA, USA |
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| Abstract: | ObjectiveTo assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.Study designCross-sectional analyses were conducted using the most recent Demographic and Health Surveys from Bangladesh, India and Nepal for married, pregnant women aged 15–49 years who responded to IPV assessments specific to current marriage (N= 4738). Adjusted logistic and multinomial regression analyses were conducted with pooled data to assess associations of IPV ever (sexual only, physical only, sexual plus physical or none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional or modern) for the current pregnancy.ResultsIPV was not associated with a mistimed or unwanted pregnancy. Sexual IPV was associated with pre-pregnancy modern contraceptive use (aOR=2.32, 95% CI=1.24, 4.36); sexual plus physical IPV was associated with pre-pregnancy traditional contraceptive use (aOR=1.85, 95% CI=1.12, 3.07). Post hoc analysis of reasons for pre-pregnancy contraceptive discontinuation revealed that women with a history of IPV, particularly sexual IPV, had higher prevalence of contraceptive failure (sexual only, 37.3%; sexual plus physical, 30.9%; physical only, 22.6%; no IPV, 13.6%).ConclusionPregnant women who experienced sexual IPV from husbands were more likely to use contraceptives pre-pregnancy but had no reduced risk unintended pregnancy, possibly due to higher rates of pre-pregnancy contraceptive failure among those with this history. These findings suggest that victims of sexual IPV are able to acquire and use family planning services but require more support to sustain effective contraceptive use.ImplicationsFamily planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy. |
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