Citation

Raj A, McDougal L. Contraception 2015; 91(6): 456-463.

Affiliation

Division of Global Public Health, Department of Medicine; University of California, San Diego School of Medicine, San Diego, CA, USA; Center on Gender Equity and Health; University of California, San Diego, CA, USA. Electronic address: lmcdouga@ucsd.edu.

Copyright

(Copyright © 2015, Elsevier Publishing)

DOI

10.1016/j.contraception.2015.03.008

PMID

25769441

Abstract

OBJECTIVE: To assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia. STUDY DESIGN: Cross-sectional analyses were conducted using most recent Demographic and Health Surveys (DHS) 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, none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional, or modern), for the current pregnancy.

RESULTS: IPV 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%).

CONCLUSION: Pregnant 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. IMPLICATIONS: Family 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.

Language: en