Intimate partner violence and women's contraceptive use

Partner violence and abortion characteristics

We conducted a retrospective cohort study using randomly selected medical charts of women reporting a history of partner violence and women with no history of partner violence at the time of a family planning or abortion appointment (n = 6,564 per group). We analyzed lifetime history of partner violence for odds of lifetime history of abortion and miscarriage number, and birth control problems. To more closely match timing, we analyzed a subsample of 2,186 women reporting current violence versus not at the time of an abortion appointment for differences in gestational age, medical versus surgical method choice, and return for follow-up visit. After adjusting for years at risk and demographic characteristics, women with a past history of partner violence were not more likely to have ever had one abortion, but they were more likely to have had problems with birth control, repeat abortions, and miscarriages than women with no history of violence. Women with current partner violence were also more likely to be receiving an abortion at a later gestational age. We found no differences between the groups in return for abortion follow-up visit or choice of surgical versus medication abortion. Findings support screening for the influence of partner violence on reproductive health and related safety planning.

Adolescent relationship abuse and reproductive and sexual coercion among teens

PURPOSE OF REVIEW

Adolescent relationship abuse (ARA) involves a range of coercive and violent behaviours in romantic or consensual relationships. ARA is prevalent and is associated with multiple poor reproductive and sexual health outcomes, especially for adolescent girls.

RECENT FINDINGS

Recent studies and reviews of ARA research point to the prevalence of ARA, health consequences of ARA and the contribution of social and cultural norms to ARA perpetration, all of which can inform how to address ARA more effectively with adolescents. Emerging research on reproductive and sexual coercion among adolescents and technology-based abuse is directly relevant to the reproductive and sexual healthcare of adolescents.

SUMMARY

Current findings underscore the extent to which young, reproductive-aged women may particularly benefit from more effective methods to address ARA. In line with recent American Congress of Obstetricians and Gynecologists recommendations, clinicians should assess for and counsel their adolescent female patients about how ARA and reproductive and sexual coercion may influence adolescent girls' reproductive health. Recent evidence also highlights that ARA manifests in ways that may be less recognizable to clinicians, such as cyber dating abuse. Finally, ARA prevention and intervention efforts should continue to promote gender equity and address the social and cultural norms that shape adolescent girls' experiences of abuse.

Reproductive coercion and partner violence: implications for clinical assessment of unintended pregnancy

Unintended pregnancy is common, disproportionately affects younger women and is associated with intimate partner violence. Forced sex, fear of negotiating condom and contraceptive use, inconsistent condom use and partner interference with access to healthcare all contribute to this association between unintended pregnancy and intimate partner violence. A growing body of literature on male partner influences on contraception and pregnancy decision-making has identified a range of male partner pregnancy-controlling behaviors which we have termed reproductive coercion, defined as male partners' attempts to promote pregnancy in their female partners through verbal pressure and threats to become pregnant (pregnancy coercion), direct interference with contraception (birth-control sabotage), and threats and coercion related to pregnancy continuation or termination (control of pregnancy outcomes). This article examines recent studies on male partner reproductive coercion, underscores the link between unintended pregnancy and intimate partner violence and highlights future directions for research as well as implications for clinical practice.

Recent reproductive coercion and unintended pregnancy among female family planning clients

OBJECTIVE

Reproductive coercion (RC)--birth control sabotage and coercion by male partners to become pregnant and to control the outcome of a pregnancy--has been associated with a history of both intimate partner physical and sexual violence (IPV) and unintended pregnancy among females utilizing reproductive health services. The temporal nature of associations of RC and unintended pregnancy (distinct from the impact of IPV), however, has remained less clear.

STUDY DESIGN

A survey was administered to females aged 16-29 years seeking care in 24 rural and urban family planning clinics in Pennsylvania (n=3539).

RESULTS

Five percent of respondents reported RC in the past 3 months, and 12% reported an unintended pregnancy in the past year. Among those who reported recent RC, 21% reported past-year unintended pregnancy. Compared to women exposed to neither condition, exposure to recent RC increased the odds of past-year unintended pregnancy, both in the absence of a history of IPV [adjusted odds ratio (AOR) 1.79, 1.06-2.03] and in combination with a history of IPV (AOR 2.00, 1.15-3.48); history of IPV without recent RC was also associated with unintended pregnancy (AOR 1.80, 1.42-2.26).

CONCLUSIONS

Findings indicate the temporal proximity of the association of RC and unintended pregnancy, with recent RC related to past-year unintended pregnancy, both independently and in combination with a history of IPV. Recent RC is relatively prevalent among young women using family planning clinics and is associated with increased risk for past-year unintended pregnancy even in the absence of IPV.

IMPLICATIONS

Recent RC and a history of IPV are prevalent among female family planning clients, particularly younger women, and these experiences are each associated with unintended pregnancy. Pregnancy prevention counseling should include not only assessment for physical and sexual partner violence but also specific inquiry about RC.

Intimate partner violence and unintended pregnancy: prevalence and associated factors

This study investigated the association between unintended pregnancy and intimate partner violence before pregnancy. A cross-sectional study was carried out with 1,054 women, aged 18 to 49, in Recife, Northeastern Brazil, from July 2005 to March 2006. Non-conditional logistic regression analysis was performed with a hierarchical strategy for entering variables into the model, according to the conceptual framework defined. Unintended pregnancy was reported by 60.3% (636) women. Intimate partner violence prior to the pregnancy was associated with unintended pregnancy (ORadj = 1.57; 95%CI: 1.17-2.11), even when adjusted for the women's sociodemographic characteristics, the partner's behaviour, and the relationship dynamic. When the association was adjusted for the use of contraception and the partner's refusal to use contraception, the association was no longer significant, suggesting that the effect of partner violence on unintended pregnancy may be mediated by these variables. The findings point to the need of screening for intimate partner violence in reproductive health services.

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.

Physical domestic violence and subsequent contraceptive adoption among women in rural India

This study examines the relationship between male to female physical domestic violence and contraceptive adoption among women in four economically and culturally distinct areas of India. Data from India's 1998-1999 National Family Health Survey-2 and a follow-up survey in 2002-2003 for which the same women in four states were reinterviewed are analyzed. The focus of the analysis is on how baseline exposure to physical domestic violence is associated with the intersurvey adoption of contraception. Women who experience physical violence from their husbands are significantly less likely to adopt contraception in the intersurvey period, although this relationship varies by State. This study builds upon previous work by using an indicator of physical domestic violence exposure that is measured before contraceptive adoption, thus allowing the identification of how exposure to violence shapes the adoption of contraception. The results demonstrate that for women living in Bihar and Jharkhand there is a clear negative relationship between physical domestic violence and a woman's adoption of contraception; this relationship was not found for women in Maharashtra and Tamil Nadu. The results point to the need to include domestic violence screening and referral services into family planning services.

Prospective association of intimate partner violence with receipt of clinical preventive services in women of reproductive age

BACKGROUND

Women who experience intimate partner violence (IPV) have a greater risk for adverse health outcomes, suggesting the importance of preventive services in this group. Little prior research has explored how IPV exposure impacts receipt of relevant preventive services. We assess the prospective association of IPV exposure with receiving specific preventive services.

METHODS

Women in the Central Pennsylvania Women's Health Study's longitudinal cohort study (conducted 2004-2007; n = 1,420) identified past-year exposure to IPV at baseline and receipt of IPV-relevant preventive services (counseling for safety and violence concerns, tests for sexually transmitted infections [STIs], counseling for STIs, Pap testing, counseling for smoking/tobacco use, alcohol/drug use, and birth control) at 2-year follow-up. Multiple logistic regression analysis assessed the impact of IPV on service receipt, controlling for relevant covariates.

FINDINGS

Women exposed to IPV had greater odds of receiving safety and violence counseling (adjusted odds ratio [AOR], 2.40; 95% confidence interval [CI], 1.25-4.61), and tests for STIs (AOR, 2.46; 95% CI, 1.41-4.28) compared with women who had not been exposed to IPV. Independent of other predictors, including IPV, women who saw an obstetrician-gynecologist were more likely to receive Pap tests, STI/HIV testing and counseling, and birth control counseling, compared with women who had not seen an obstetrician-gynecologist.

CONCLUSION

Overall rates of preventive service receipt for all women in the sample were low. Women exposed to IPV were more likely to receive safety and violence counseling and STI testing, and seeing an obstetrician-gynecologist increased the odds of receiving several preventive services.

The relationship between perinatal psychiatric disorders and contraception use among postpartum women

BACKGROUND

The relationship between perinatal psychiatric disorders and the use of effective contraceptive methods among postpartum women served by primary care clinics has not been established.

STUDY DESIGN

This was a prospective cohort study with 831 pregnant women recruited from 10 primary care clinics of the public sector in São Paulo followed up to 18 months after delivery.

RESULTS

Among 701 postpartum women, 644 women (91.8%) had resumed sexual activity. Two hundred fifty-three women (39.2%) were classified as using a less effective contraception method (LECM). The presence of perinatal psychiatric disorder (in pregnancy and/or postpartum) was not associated with LECM. Resumption of sexual life 3 months or beyond after delivery was associated with LECM (odds ratio=1.28, 95% confidence interval: 1.02-1.56).

DISCUSSION

Although the use of an LECM after delivery is common, contraception choice is not associated with perinatal depressive/anxiety symptoms. However, women who delay the resumption of sexual activity after delivery should be counseled on the use of available contraceptive methods.

Transforming the healthcare response to intimate partner violence and taking best practices to scale

BACKGROUND

Intimate partner violence (IPV) is prevalent among adolescent and adult women, with significant physical, sexual, and mental health consequences. In 2011, the Institute of Medicine's Clinical Preventive Services for Women consensus report recommended universal screening for violence as a component of women's preventive services; this policy has been adopted by the Health Resources and Services Administration (HRSA). These policy developments require that effective clinic-based interventions be identified, easily implemented, and taken to scale.

METHODS

To foster dialogue about implementing effective interventions, we convened a symposium entitled "Responding to Violence Against Women: Emerging Evidence, Implementation Science, and Innovative Interventions," on May 21, 2012. Drawing on multidisciplinary expertise, the agenda integrated data on the prevalence and health impact of IPV violence, with an overview of the implementation science framework, and a panel of innovative IPV screening interventions. Recommendations were generated for developing, testing, and implementing clinic-based interventions to reduce violence and mitigate its health impact.

RESULTS

The strength of evidence supporting specific IPV screening interventions has improved, but the optimal implementation and dissemination strategies are not clear. Implementation science, which seeks to close the evidence to program gap, is a useful framework for improving screening and intervention uptake and ensuring the translation of research findings into routine practice.

CONCLUSIONS

Findings have substantial relevance to the broader research, clinical, and practitioner community. Our conference proceedings fill a timely gap in knowledge by informing practitioners as they strive to implement universal IPV screening and guiding researchers as they evaluate the success of implementing IPV interventions to improve women's health and well-being.

A review of factors associated with unprotected sex among adult women in the United States

OBJECTIVE

To provide an updated review of research since 2005 on factors associated with unprotected sex among women in the United States.

DATA SOURCES

PubMed, CINAHL, and PsychINFO were searched from January 2006 through April 2011 using the terms unsafe sex, sexual risk taking, contraception, contraception behavior, birth control, condoms, and condom utilization.

STUDY SELECTION

Inclusion criteria included studies written in English on adult women in the United States age ≥ 18. Forty-five publications met inclusion criteria.

DATA EXTRACTION

All factors associated with engagement in unprotected sex are presented.

DATA SYNTHESIS

Unprotected sex has been associated with increasing age, being married, establishment of trust, recent experience of intimate partner violence, contraceptive side effects, infrequent sexual intercourse, and decreased arousal and pleasure due to contraceptive use. Religion, depression, history of abortion, number of children, having children, and number of pregnancies have not been associated with unprotected sex in recent studies. Several other variables have been studied with mixed results, possibly due to differences in research methods and sample characteristics.

CONCLUSIONS

More research is needed to elucidate the impact of cultural factors, relationship factors, attitude to pregnancy and motherhood, and reproductive coercion on prevention of pregnancy and sexually transmitted infections. Nurses can lead research on these topics and implement evidence-based practice based on study findings.

Intimate Partner Violence and Adverse Health Consequences

Nearly 1 in 4 women and 1 in 13 men experience intimate partner violence (IPV) at some time in their life. Victims of IPV suffer significant negative health consequences because of the physical, sexual, and emotional abuse they have experienced. Elevated risks have been observed for a wide range of adverse health outcomes. Research has substantially improved our understanding of the physiology that underlies the association between violence victimization and an array of adverse health outcomes. Given the high prevalence of IPV and the associated medical consequences and costs of IPV, it is critical to address this public health problem. IPV prevention and intervention can substantially decrease the public health burden of IPV and greatly improve the health of patients being seen in the medical system. Primary care and family physicians are in an ideal position to diagnose victims of IPV and provide the victims and their families the appropriate care that is needed. However, to accomplish this goal, there remains an urgent need to integrate information on IPV into medical and health care curricula, and to train future physicians and other health care providers about the pervasiveness of IPV and the far-reaching implications for patient health.

Contraception use and associations with intimate partner violence among women in Bangladesh

This study examines the association between contraception use and intimate partner violence (IPV) among women of reproductive age in Bangladesh. The observational study of 10,996 women used the chi-squared test and logistic regressions to assess the associations. Almost 80% of all respondents had used contraceptives at some point in their lives. About half of the respondents (48%) were victims of physical violence, while 11% experienced sexual abuse from their husbands. Urban residents, higher educated women and women aged 20-44 were more likely to use contraceptives than their peers in rural areas, those with lower education and those in their late forties (45-49 years). Women exposed to physical violence were almost two times (OR 1.93, CI 1.55-2.41) more likely to use contraceptives compared with their non-abused peers. Sexual abuse had no significant association with contraceptive use. Physical violence is a predictor for higher levels of contraceptive use among women in Bangladesh. The findings emphasize the importance of screening for IPV at health care centres. The differences in urban and rural contraceptive use and IPV exposure identified by the study have policy implications for service delivery and planning.

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

BACKGROUND

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

STUDY DESIGN

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16-29 years (N = 906) completed audio computer-assisted surveys prior to a clinic visit and 12-24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

RESULTS

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio = 1.63; 95% confidence interval=1.01-2.63).

CONCLUSIONS

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.

"There is such a thing as too many daughters, but not too many sons": A qualitative study of son preference and fetal sex selection among Indian immigrants in the United States

In response to concerns from feminists, demographers, bioethicists, journalists, and health care professionals, the Indian government passed legislation in 1994 and 2003 prohibiting the use of sex selection technology and sex-selective abortion. In contrast, South Asian families immigrating to the United States find themselves in an environment where reproductive choice is protected by law and technologies enabling sex selection are readily available. Yet there has been little research exploring immigrant Indian women's narratives about the pressure they face to have sons, the process of deciding to utilize sex selection technologies, and the physical and emotional health implications of both son preference and sex selection. We undertook semi-structured, in-depth interviews with 65 immigrant Indian women in the United States who had pursued fetal sex selection on the East and West coasts of the United States between September 2004 and December 2009. Women spoke of son preference and sex selection as separate though intimately related phenomena, and the major themes that arose during interviews included the sociocultural roots of son preference; women's early socialization around the importance of sons; the different forms of pressure to have sons that women experienced from female in-laws and husbands; the spectrum of verbal and physical abuse that women faced when they did not have male children and/or when they found out they were carrying a female fetus; and the ambivalence with which women regarded their own experience of reproductive "choice." We found that 40% of the women interviewed had terminated prior pregnancies with female fetuses and that 89% of women carrying female fetuses in their current pregnancy pursued an abortion. These narratives highlight the interaction between medical technology and the perpetuation of this specific form of violence against women in an immigrant context where women are both the assumed beneficiaries of reproductive choice while remaining highly vulnerable to family violence and reproductive coercion.

Male reproductive control of women who have experienced intimate partner violence in the United States

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18-49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.

Intimate partner violence and contraception use among women in Sub-Saharan Africa

OBJECTIVE

To determine the association between contraceptive use and intimate partner violence (IPV) in Sub-Saharan African women.

METHOD

The data analyzed were from national Demographic Health Surveys conducted between 2003 and 2006 in 6 Sub-Saharan African countries: Cameroon, Kenya, Malawi, Rwanda, Uganda, and Zimbabwe. Women of childbearing age completed surveys regarding the use of contraception and about their experience of physical, emotional, and sexual violence inflicted by their partners. Analyses were conducted using logistic regression.

RESULTS

Of the 24311 women who responded to the violence modules, 39.8% reported that they had experienced IPV. Women who had experienced IPV were significantly more likely to report that they had used contraception compared with women who had not experienced IPV (odds ratio 1.30; 95% confidence interval, 1.22-1.38).

CONCLUSION

Intimate partner violence appears to be associated with increased contraception use in the African setting. Among women who have experienced IPV, modern contraception is used more commonly than traditional and folkloric contraceptive methods.