1
|
Chatterji S, Johns NE, Ghule M, Begum S, Averbach S, Battala M, Raj A. Assessing the impact of CHARM2, a family planning program on gender attitudes, intimate partner violence, reproductive coercion, and marital quality in India. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003220. [PMID: 38771823 PMCID: PMC11108161 DOI: 10.1371/journal.pgph.0003220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/17/2024] [Indexed: 05/23/2024]
Abstract
Using a two-armed cluster randomised controlled trial, CHARM2 (Counselling Husbands to Achieve Reproductive health and Marital equity), a 5-session gender equity and family planning intervention for couples in rural India, showed an impact on family planning outcomes in primary trial analyses. This study examines its effects on gender-equitable attitudes, intimate partner violence, reproductive coercion, and marital quality. We used multilevel mixed-effects models to assess the intervention impact on each outcome. Both male (aIRR at 9 months: 0.64, C.I.: 0.45,0.90; aIRR at 18 months: 0.25, C.I.: 0.18,0.39) and female (aIRR at 9 months: 0.57, C.I.: 0.46,0.71; aIRR at 18 months: 0.38, C.I.: 0.23,0.61) intervention participants were less likely than corresponding control participants to endorse attitudes accepting physical IPV at 9- and 18-month follow-ups. Men in the intervention, compared to those in the control condition, reported more gender-equitable attitudes at 9- and 18 months (ß at 9 months: 0.13, C.I.: 0.06,0.20; ß at 18 months: 0.26, C.I.: 0.19,0.34) and higher marital quality at the 18-month follow-up (ß: 0.03, C.I.: 0.01,0.05). However, we found no effects on women's experiences of IPV, reproductive coercion, or marital quality. CHARM2 shows promise in improving men's and women's attitudes towards gender equality and male perceptions of marital quality. Still, IPV and reproductive coercion reductions may require more intensive programming than that provided within this 5-session model focused on family planning.
Collapse
Affiliation(s)
- Sangeeta Chatterji
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Nicole E. Johns
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Mohan Ghule
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Shahina Begum
- ICMR-National Institute for Research in Reproductive and Child Health, Mumbai, India
| | - Sarah Averbach
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, California, United States of America
| | | | - Anita Raj
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, San Diego, California, United States of America
- Newcomb Institute, Tulane University, New Orleans, Louisiana, United States of America
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America
| |
Collapse
|
2
|
Ibrahimi S, Youssouf B, Potts C, Dumouza A, Duff R, Malaba LS, Brunner B. United States Government-Supported Family Planning and Reproductive Health Outreach in the Democratic Republic of the Congo: Lessons Learned and Recommendations. Open Access J Contracept 2024; 15:13-21. [PMID: 38476860 PMCID: PMC10929168 DOI: 10.2147/oajc.s446263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Background In response to limited contraception availability and a lack of knowledge about family planning (FP) in the Democratic Republic of the Congo (DRC), the United States Agency for International Development (USAID) Integrated Health Program (IHP) in the DRC has been providing FP services, including outreach programs in the DRC. Our study aims to assess the FP outreach program by understanding the participants' perception of the campaign, its impact on their behavior, and their feedback regarding the campaign. Additionally, we draw insights from lessons learned and provide recommendations. Methods Between July and August 2022, we conducted 47 in-person participant interviews with women of reproductive age who used the outreach services provided by USAID IHP. Participants were randomly selected from Sud-Kivu, Kasai-Oriental, Haut-Katanga, and Tanganyika provinces. Consent and confidentiality were assured, and responses were recorded and transcribed in a Word document. We used Excel for data coding and analysis. Results The campaign reached 95.7% of women interviewed; however, some participants could not recall specific message details. Most respondents (89.3%) reported that the campaign motivated them to make FP decisions and change their behaviors. While 14.8% of women reported making FP decisions independently, 85.1% reported making the decision jointly with their partners. Our analysis resulted in three emerging themes: 1) Increased FP outreach and improved perception of FP, 2) Improved perceived behavioral changes due to FP outreach, and 3) The need for program improvement by including men and providing additional information about possible FP side effects. Implications Our study provides insights into how women receive information and whether they find it useful and share it with other women in their community. In particular, women's feedback about the FP outreach program and our recommendations can inform future policies and interventions.
Collapse
Affiliation(s)
- Sahra Ibrahimi
- International Development Division, Abt Associates, Rockville, MD, USA
- Department of Global Health, Denison University, Granville, OH, USA
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Bamba Youssouf
- Matchboxology, Johannesburg, Gauteng, province, South Africa
| | - Christine Potts
- International Development Division, Abt Associates, Rockville, MD, USA
| | - Alexandre Dumouza
- International Development Division, Abt Associates, Rockville, MD, USA
| | - Rani Duff
- International Development Division, Abt Associates, Rockville, MD, USA
| | | | - Bettina Brunner
- International Development Division, Abt Associates, Rockville, MD, USA
| |
Collapse
|
3
|
Caira-Chuquineyra B, Fernandez-Guzman D, Cortez-Soto AG, Urrunaga-Pastor D, Bendezu-Quispe G, Toro-Huamanchumo CJ. Association between intimate partner violence and pregnancy intention: evidence from the Peruvian demographic and health survey. BMC Womens Health 2024; 24:140. [PMID: 38402397 PMCID: PMC10893598 DOI: 10.1186/s12905-024-02958-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Intimate partner violence (IPV) in Peru represents a significant public health challenge. IPV can influence women's reproductive and social behaviors, undermining fertility control, and exacerbating unintended pregnancies. Our objective was to assess the association between IPV and pregnancy intention among Peruvian women of reproductive age. METHODS We conducted a secondary analysis of Peru's 2020 Demographic and Family Health Survey data. The independent variable in this study was IPV against women, which includes psychological IPV, sexual IPV, and physical IPV. If a respondent experienced any of these three forms of IPV, the IPV variable was labeled as "yes"; if none were present, it was labeled as "no". The dependent variable was pregnancy intention (no vs. yes). We utilized a generalized linear model (GLM) from the Poisson family with a log link function to assess the relationship between IPV occurrences (total and each IPV type) and pregnancy intention. We report crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI). RESULTS We analyzed data from 8466 women aged 15 to 49. The prevalence of any IPV was 49.6% (psychological IPV: 45.8%; physical IPV: 22.2%; and sexual IPV: 4.3%). Exposure to physical IPV (aPR: 1.05; 95% CI: 1.03-1.07), psychological IPV (aPR: 1.04; 95% CI: 1.02-1.06), and sexual IPV (aPR: 1.09; 95% CI: 1.04-1.13), as well as a history of any IPV (aPR: 1.05; 95% CI: 1.02-1.07), were associated with a higher probability of not intending to become pregnant. This association persisted after adjusting for confounders like age, marital status, educational attainment, education level of the child's father, place of residence, wealth, ethnicity, and parity. CONCLUSION One in two Peruvian women reported experiencing IPV. An association was observed between IPV exposure and a higher probability of not holding an intention to become pregnant.
Collapse
Affiliation(s)
| | - Daniel Fernandez-Guzman
- Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Andrea G Cortez-Soto
- Sociedad Científica de Estudiantes de Medicina de Ica (SOCEMI), Universidad Nacional San Luis Gonzaga, Ica, Peru
| | - Diego Urrunaga-Pastor
- Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru.
| | - Guido Bendezu-Quispe
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - Carlos J Toro-Huamanchumo
- Escuela de Medicina, Facultad de Ciencias Médicas, Universidad César Vallejo, Trujillo, Peru
- OBEMET Center for Obesity and Metabolic Health, Lima, Peru
| |
Collapse
|
4
|
Wollum A, Bornstein M, Mopiwa G, Norris A, Gipson JD. Assessing the relationship between reproductive autonomy and contraceptive use in rural Malawi. Reprod Health 2023; 20:142. [PMID: 37736687 PMCID: PMC10515069 DOI: 10.1186/s12978-023-01688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/12/2023] [Indexed: 09/23/2023] Open
Abstract
Reproductive autonomy, or the extent to which people control matters related to their own sexual and reproductive decisions, may help explain why some people who do not intend to become pregnant nevertheless do not use contraception. Using cross-sectional survey data from 695 women aged 16 to 47 enrolled in the Umoyo Wa Thanzi (UTHA) study in Malawi in 2019, we conducted confirmatory factor analysis, descriptive analyses, and multivariable logistic regression to assess the freedom from coercion and communication subscales of the Reproductive Autonomy Scale and to examine relationships between these components of reproductive autonomy and current contraceptive use. The freedom from coercion and communication subscales were valid within this population of partnered women; results from a correlated two-factor confirmatory factor analysis model resulted in good model fit. Women with higher scores on the freedom from coercion subscale had greater odds of current contraceptive use (aOR 1.13, 95% CI: 1.03-1.23) after adjustment for pregnancy intentions, relationship type, parity, education, employment for wages, and household wealth. Scores on the communication subscale were predictive of contraceptive use in some, but not all, models. These findings demonstrate the utility of the Reproductive Autonomy Scale in more holistically understanding contractive use and non-use in a lower-income setting, yet also highlight the need to further explore the multidimensionality of women's reproductive autonomy and its effects on achieving desired fertility.
Collapse
Affiliation(s)
- Alexandra Wollum
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA.
| | - Marta Bornstein
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Gladson Mopiwa
- Adolescent Girls and Young Women Program-The Global Fund Grant ActionAid Malawi, Lilongwe City, Malawi
| | - Alison Norris
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California Los Angeles (UCLA), UCLA Bixby Center on Population and Reproductive Health, Los Angeles, USA
| |
Collapse
|
5
|
Boyce SC, Minnis AM, Deardorff J, McCoy SI, Challa S, Johns N, Aliou S, Brooks M, Nouhou AM, Gochyyev P, Wilson M, Baker H, Silverman JG. Measuring social norms of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy: an item response modelling of the IPV-ASRA scale. Reprod Health 2023; 20:90. [PMID: 37316890 DOI: 10.1186/s12978-023-01632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 06/02/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The field of violence prevention research is unequivocal that interventions must target contextual factors, like social norms, to reduce gender-based violence. Limited research, however, on the social norms contributing to intimate partner violence or reproductive coercion exists. One of the driving factors is lack of measurement tools to accurately assess social norms. METHODS Using an item response modelling approach, this study psychometrically assesses the reliability and validity of a social norms measure of the acceptability of intimate partner violence to exert control over wife agency, sexuality, and reproductive autonomy with data from a population-based sample of married adolescent girls (ages 13-18) and their husbands in rural Niger (n = 559 husband-wife dyads) collected in 2019. RESULTS A two-dimensional Partial Credit Model for polytomous items was fit, showing evidence of reliability and validity. Higher scores on the "challenging husband authority" dimension were statistically associated with husband perpetration of intimate partner violence. CONCLUSIONS This brief scale is a short (5 items), practical measure with strong reliability and validity evidence. This scale can help identify populations with high-need for social norms-focused IPV prevention and to help measure the impact of such efforts.
Collapse
Affiliation(s)
- Sabrina C Boyce
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Alexandra M Minnis
- Women's Global Health Imperative, RTI International, 2150 Shattuck Ave. Ste 800, Berkeley, CA, 94704, USA
| | - Julianna Deardorff
- Community Health Sciences, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sandra I McCoy
- Division of Epidemiology, School of Public Health, University of California Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Sneha Challa
- School of Nursing, University of San Francisco, 3333 California Street, San Francisco, CA, 94118, USA
| | - Nicole Johns
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Sani Aliou
- Niger Country Office, Pathfinder International, Niamey, Niger
| | - Mohamad Brooks
- Pathfinder International, 9 Galen Street, Suite 217, Watertown, MA, 02472, USA
| | | | - Perman Gochyyev
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Mark Wilson
- Graduate School of Education, University of California, 2121 Berkeley Way, Berkeley, CA, 94720-1670, USA
| | - Holly Baker
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Jay G Silverman
- Center on Gender Equity and Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| |
Collapse
|
6
|
The role of male partners in modern contraceptive use by women in South Africa: Does space also matter? JOURNAL OF POPULATION RESEARCH 2023. [DOI: 10.1007/s12546-023-09297-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
AbstractThis paper examined the role of male partners in modern contraceptive use by women across clusters in South Africa. Its main objective was threefold. First, the present paper sought to test whether South African married women’s modern contraceptive use is related to the influence of their husbands or male partners. Second, it examined whether modern contraceptive use is similar within clusters. Third, it tested whether group effects are spatially dependent among neighbouring clusters. It used the recent Demographic and Health Survey for South Africa as the data source to carry out the empirical analysis. On the one hand, the results confirm a positive and significant relationship between South African married women’s modern contraceptive use with their partners’ secondary education level, irrespective of the cluster in which they reside. On the other hand, the hypothesis that spatial dependence of random effects is not confirmed, leading to the conclusion that space only matters when it comes to spatial heterogeneity or group effects.
Collapse
|
7
|
Muluneh MD, Francis L, Agho K, Stulz V. The association of intimate partner violence and contraceptive use: a multi-country analysis of demographic and health surveys. Int J Equity Health 2023; 22:75. [PMID: 37101283 PMCID: PMC10134549 DOI: 10.1186/s12939-023-01884-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 04/04/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause of poor health, disability, and death among women of reproductive age. However, the existing studies about the association between IPV and contraceptive use have been found to be conflicting and relatively less studied, particularly in low and middle income countries, including Eastern Sub Saharan Africa (SSA). This study examines the relationship between IPV and contraceptive use in Eastern SSA countries. METHODS The Demographic and Health Surveys (DHS) from 2014 to 2017 were a multi-stage cluster sample survey of 30,715 ever married (or cohabitating) women of reproductive age from six countries. The six Eastern SSA datasets were pooled and multivariable logistic regression using a hierarchical approach was performed to examine the association between IPV and contraceptive use after adjusting for women, partners, and household and health facility factors. RESULT Two thirds of women 67% [66.55, 67.88] were not using any modern contraceptive methods and almost half (48%) of the women had experienced at least one form of IPV from their partners. Our analysis showed a strong association with decreased odds of physical violence [adjusted odds ratios (aOR) = 0.72, 95%CI: 0.67, 0 0.78] among women not using any contraceptive methods. Other factors associated with women not using any contraceptive methods were older women (35-49 years), illiterate couples and women from poorest households. Women who had no access to any form of communication [aOR = 1.12, 95%CI: 1.08, 1.36], unemployed partner [aOR = 1.55, 95%CI: 1.23, 1.95] and women who travelled long distances to access health services [aOR = 1.16, 95%CI: 1.06, 1.26] significantly reported increased odds of not using any contraceptive methods. CONCLUSION Our study indicated that physical violence was negatively associated with not using any contraceptive method among married women in Eastern SSA countries. Tailored intervention messages to reduce IPV including physical violence among women not using contraceptive methods in East Africa should target those from low-socioeconomic groups especially, older women with no access to any form of communication, unemployed partners, and illiterate couples.
Collapse
Affiliation(s)
- Muluken Dessalegn Muluneh
- Amref Health Africa in Ethiopia, Addis Ababa 17022, Bole Sub, Ethiopia.
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia.
| | - Lyn Francis
- School of Nursing and Midwifery, Western Sydney University, Parramatta South Campus, Penrith, NSW, 2751, Australia
| | - Kingsley Agho
- School of Health Sciences, Western Sydney University, Locked Bag1797, Penrith, NSW, 2571, Australia
- African Vision Research Institute (AVRI), University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Virginia Stulz
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| |
Collapse
|
8
|
Dixit A, Johns NE, Ghule M, Battala M, Begum S, Saggurti N, Silverman J, Reed E, Kiene SM, Benmarhnia T, Averbach S, Raj A. Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India. CULTURE, HEALTH & SEXUALITY 2023; 25:521-536. [PMID: 35465833 PMCID: PMC9588848 DOI: 10.1080/13691058.2022.2062052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry and purdah, compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours, including women's control over contraceptive decision-making, couples' communication about contraception, and ever use of contraceptives, among married women aged 18-29 years (N = 1,200) and their husbands in rural Maharashtra, India. Multivariable logistic regression was used to examine the association between these marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (AOR 1.76, 95% CI 1.16-2.68), and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.
Collapse
Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, CA, USA
| | - Nicole E. Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Division of Health Promotion and Behavior, San Diego State University, San Diego, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
- Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA. USA
| |
Collapse
|
9
|
Negotiating Autonomy: The Linkages between Intimate Partner Violence, Women’s Paid Work Status and Birth Outcomes. ADMINISTRATIVE SCIENCES 2023. [DOI: 10.3390/admsci13030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Maternal and child health is severely impacted by adverse birth outcomes leading to a public health concern. A whole host of socioeconomic factors are instrumental in determining birth outcomes. Importantly, there is an intricate relationship between women’s autonomy, the perpetration of intimate partner violence in households, women’s paid work status and their consequent impact on birth outcomes. Noting this, we ask how intimate partner violence and women’s work status interact and how women’s ‘autonomy’ is negotiated to mitigate adverse birth outcomes such as miscarriage, abortion, stillbirth, low birth weight and preterm birth. We use the nationally representative NFHS-5 data for India and use multiple correspondence analyses to create an index of women’s autonomy, and multinomial logistic regression has been used to determine the relation. Women’s working status in association with the perpetration of intimate partner violence contributes significantly to adverse birth outcomes. The study found that mitigation of adverse birth outcomes, which is necessary for bringing about improvements in maternal and child health, is contingent on a multiplicity of social factors, which requires redressal in association to ensure a reduction in adverse birth outcomes.
Collapse
|
10
|
Wood SN, Thomas HL, Guiella G, Bazié F, Mosso R, Fassassi R, Akilimali PZ, Thiongo M, Gichangi P, Oumarou S, OlaOlorun FM, Omoluabi E, Khanna A, Kibira SPS, Makumbi F, Decker MR. Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence. Reprod Health 2023; 20:22. [PMID: 36707833 PMCID: PMC9881347 DOI: 10.1186/s12978-023-01568-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/13/2023] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Reproductive coercion (RC) is a type of abuse where a partner asserts control over a woman's reproductive health trajectories. Recent research emphasizes that RC experiences may differ within and across low- and middle-income countries (LMICs), as compared to higher income contexts, given social pressures surrounding childbearing. To date, nationally representative surveys have lacked comprehensive measures for RC, leading to gaps in understanding its prevalence and risk factors. Across eight LMICs (10 sites), we aimed to (1) validate the RC Scale; (2) calculate prevalence of RC and specific behaviors; and (3) assess correlates of RC. METHODS This analysis leverages cross-sectional Performance Monitoring for Action (PMA) data collected from November 2020 to May 2022. Analyses were limited to women in need of contraception (Burkina Faso n = 2767; Côte d'Ivoire n = 1561; Kongo Central, Democratic Republic of Congo (DRC) n = 830; Kinshasa, DRC n = 846; Kenya n = 4588; Kano, Nigeria n = 535; Lagos, Nigeria n = 612; Niger n = 1525; Rajasthan, India n = 3017; Uganda n = 2020). Past-year RC was assessed via five items adapted from the original RC Scale and previously tested in LMICs. Confirmatory factor analysis examined fit statistics by site. Per-item and overall prevalence were calculated. Site-specific bivariate and multivariable logistic regression examined RC correlates across the socioecological framework. RESULTS Confirmatory factor analysis confirmed goodness of fit across all sites, with moderate internal consistency (alpha range: 0.66 Cote d'Ivoire-0.89 Kinshasa, DRC/Lagos, Nigeria). Past-year reported prevalence of RC was highest in Kongo Central, DRC (20.3%) and lowest in Niger (3.1%). Prevalence of individual items varied substantially by geography. Polygyny was the most common RC risk factor across six sites (adjusted odds ratio (aOR) range: 1.59-10.76). Increased partner education levels were protective in Kenya and Kano, Nigeria (aOR range: 0.23-0.67). Other assessed correlates differed by site. CONCLUSIONS Understanding RC prevalence and behaviors is central to providing woman-centered reproductive care. RC was most strongly correlated with factors at the partner dyad level; future research is needed to unpack the relative contributions of relationship power dynamics versus cultural norms surrounding childbearing. Family planning services must recognize and respond to women's immediate needs to ensure RC does not alter reproductive trajectories, including vulnerability to unintended pregnancy.
Collapse
Affiliation(s)
- Shannon N. Wood
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Haley L. Thomas
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA
| | - Georges Guiella
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Fiacre Bazié
- grid.463389.30000 0000 9980 0286Institut Supérieur des Sciences de la Population (ISSP/University of Ouagadougou), Ouagadougou, Burkina Faso
| | - Rosine Mosso
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Raimi Fassassi
- grid.508476.80000 0001 2107 3477Ecole Nationale Superieure de Statistique et Appliquee d’Abidjan (ENSEA), Abidjan, Côte d’Ivoire
| | - Pierre Z. Akilimali
- grid.9783.50000 0000 9927 0991Kinshasa School of Public Health, Kinshasa, Democratic Republic of Congo
| | - Mary Thiongo
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health-Kenya, Nairobi, Kenya ,grid.449703.d0000 0004 1762 6835Technical University of Mombasa, Mombasa, Kenya ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Sani Oumarou
- Institut National de la Statistique du Niger, Niamey, Niger
| | - Funmilola M. OlaOlorun
- grid.9582.60000 0004 1794 5983College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Omoluabi
- grid.8974.20000 0001 2156 8226University of the Western Cape, Cape Town, South Africa
| | - Anoop Khanna
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Simon Peter Sebina Kibira
- grid.464858.30000 0001 0495 1821Indian Institute of Health Management Research, Sanganer, Jaipur, India
| | - Fredrick Makumbi
- grid.11194.3c0000 0004 0620 0548Makerere University School of Public Health, Kampala, Uganda
| | - Michele R. Decker
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E4009, Baltimore, MD 21205 USA ,grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA ,grid.21107.350000 0001 2171 9311Johns Hopkins School of Nursing, Baltimore, USA
| |
Collapse
|
11
|
Wood SN, Dozier JL, Karp C, Desta S, Decker MR, Shiferaw S, Seme A, Yirgu R, Zimmerman LA. Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women. Sex Reprod Health Matters 2022; 30:2139891. [PMID: 36469634 PMCID: PMC9728127 DOI: 10.1080/26410397.2022.2139891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Partner-perpetrated pregnancy coercion inhibits women's reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women's health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15-49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53-0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41-0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.
Collapse
Affiliation(s)
- Shannon N Wood
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Correspondence:
| | - Jessica L Dozier
- PhD Student, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Celia Karp
- Assistant Scientist, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Selamawit Desta
- Director of Survey Operations, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Bloomberg Professor of American Health, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Women’s Health and Rights Program Director, Center for Public Health & Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Joint Professor, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Solomon Shiferaw
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Assefa Seme
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Robel Yirgu
- Associate Professor, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Linnea A Zimmerman
- Assistant Professor, Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
12
|
Dixit A, Ghule M, Rao N, Battala M, Begum S, Johns NE, Averbach S, Raj A. Qualitative Examination of the Role and Influence of Mothers-in-Law on Young Married Couples' Family Planning in Rural Maharashtra, India. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2200050. [PMID: 36316150 PMCID: PMC9622279 DOI: 10.9745/ghsp-d-22-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
Unmet need for family planning (FP) continues to be high in India, especially among young and newly married women. Mothers-in-law (MILs) often exert pressure on couples for fertility and control decision making and behaviors around fertility and FP, yet there is a paucity of literature to understand their perspectives. Ten focus group discussions (FGDs) were carried out with MILs of young married women (aged 18-29 years) participating in a couple-focused FP intervention as a part of a cluster-randomized intervention evaluation trial (the CHARM2 study) in rural Maharashtra, India. FGDs included questions on their roles, attitudes, and decision making around fertility and FP. Audio-recorded data were translated/transcribed into English and analyzed for key themes using a deductive coding method. MILs reported having social norms of early fertility and son preference. They understood that family size norms are lower among daughters-in-law and that spacing can be beneficial but were not supportive of short-term contraceptives, especially before the first child. They preferred female sterilization, opposed abortion, had apprehensions around side effects from contraceptive use, and had misconceptions about the intrauterine device, with particular concerns around its coercive insertion. MILs mostly believed that decision making should be done jointly by a husband and wife, but that as elders, they should be consulted and involved in the decision-making process. These findings highlight the need for engagement of MILs for FP promotion in rural India and the potential utility of social norms interventions.
Collapse
Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Namratha Rao
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | - Nicole E Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
13
|
Rowlands S, Holdsworth R, Sowemimo A. How to recognise and respond to reproductive coercion. BMJ 2022; 378:e069043. [PMID: 36126969 DOI: 10.1136/bmj-2021-069043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
14
|
Garg P, Verma M, Sharma P, Coll CVN, Das M. Sexual violence as a predictor of unintended pregnancy among married women of India: evidence from the fourth round of the National Family Health Survey (2015-16). BMC Pregnancy Childbirth 2022; 22:347. [PMID: 35449041 PMCID: PMC9027838 DOI: 10.1186/s12884-022-04673-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual Intimate Partner Violence (IPV) is a public health problem globally, with about one in three women experiencing sexual IPV ever in their lifetime. Unintended pregnancy is one of the consequences of sexual IPV and has its repercussions that can span generations. The present study was conducted to estimate the prevalence of sexual intimate partner violence (IPV) and assess the association between sexual IPV and unintended childbirth in India among married women aged 15-49 years. METHODS The National Family Health Survey-India (NFHS-4) fourth-round dataset was used for the present study. Pregnancies intention was the primary outcome variable, and the main predictor variable was self-reported sexual IPV in the past 12 months. Women's current age, age at marriage, education and occupation, place of residence, wealth quintile, parity, religion, caste, region, mass media exposure, and husband's education were other control variables. Weighted analysis depicted the prevalence of unintended pregnancies and their association with different socio-demographic variables. Binary logistic regression was done in two steps respecting a hierarchical approach for potential confounders. RESULTS Approximately 6.4% of study participants had ever experienced sexual IPV in India. Prevalence of sexual IPV was significantly higher when the age of marriage was < 19 years, among uneducated, in the lowest wealth index quintile, belonging to scheduled caste, having multiparity, and not having mass media exposure. About 12.1% of pregnancies were considered unintended by the respondents, and 22.9% of women who ever had a history of sexual IPV considered the last pregnancy to be unintentional. Women who experienced sexual IPV were in younger age groups, having parity ≥1, and bigger families had significantly higher odds of having an unintended pregnancy compared to their reference groups. CONCLUSIONS We observed that sexual IPV has a significant role in unintended pregnancies. Effective counseling means should be rolled out for victims of sexual IPV as it is a taboo subject. The significant factors that can predict unintended pregnancies highlighted in our study should be acknowledged while counseling.
Collapse
Affiliation(s)
- Priyanka Garg
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Madhur Verma
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, 151001, India
| | - Priyanka Sharma
- Department of Community Medicine, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, 110007, India
| | - Carolina V N Coll
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Milan Das
- Department of Population & Development , International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, 400088, India.
| |
Collapse
|
15
|
Upadhyay AK, Kumar K, James KS, Mcdougal L, Raj A, Singh A. Association between Intimate Partner Violence and Contraceptive Use Discontinuation in India. Stud Fam Plann 2022; 53:5-21. [PMID: 35032028 PMCID: PMC8957512 DOI: 10.1111/sifp.12184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Research on the association between experiences of intimate partner violence (IPV) and contraceptive use discontinuation in low- and middle-income countries (LMICs) is limited. This study aims to fill this important gap using microdata collected from women aged 15-49 in the 2015-2016 National Family Health Survey (NFHS). Analyses used multivariable multinomial logistic regressions stratified by long-acting reversible contraceptive methods (LARC)/non-LARC and condom/pill to examine the association between experience of IPV and contraceptive use discontinuation while still in need (DWSIN). Experience of physical violence was associated with DWSIN among LARC/IUD users (RRR: 3.73, 95 percent CI [1.55-8.95]) Among condom users, DWSIN was higher among women who experienced emotional violence compared with women who did not experience any violence (RRR: 4.16, 95 percent CI [1.59-10.90]). Although we did not find an association between IPV and overall contraceptive use discontinuation, we did find compelling evidence of an association between IPV and IUD and condom use discontinuation in India. There is a need to understand women's experience of IPV as a part of a broader strategy to provide high-quality family planning services to all women while considering individual circumstances and reproductive aspirations to support the uninterrupted use of contraception in India.
Collapse
Affiliation(s)
- Ashish Kumar Upadhyay
- Research Coordinator, GENDER ProjectInternational Institute for Population SciencesMumbai400 088India
| | - Kaushalendra Kumar
- Assistant Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
| | - K. S. James
- Director and Senior ProfessorInternational Institute for Population SciencesMumbai400 088India
| | - Lotus Mcdougal
- Associate Project Scientist, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Anita Raj
- Tata Chancellor Professor of Medicine and Director, Center on Gender Equity and HealthUniversity of California San DiegoLa JollaCA92093USA
| | - Abhishek Singh
- Professor, Department of Public Health & Mortality StudiesInternational Institute for Population SciencesMumbai400 088India
| |
Collapse
|
16
|
Performance Management and the Police Response to Women in India. SOCIAL SCIENCES-BASEL 2022. [DOI: 10.3390/socsci11020058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Crimes against women have critical implications, not only for victims but also for overall community health and safety. Communities entrust law enforcement agencies with the responsibility to safeguard vulnerable people through effective and efficient policing approaches that provide a safe environment. Enhancing and improving the efficiency and performance of the police is an important part of preventing and reducing crimes against women. One approach to addressing specific performance targets is to adopt a performance management strategy. This paper examines survey data from 310 police officials in northern India about one such strategy: the balanced scorecard (BSC). Our analysis illuminates police perspectives about the perceived benefits of a generalized performance management strategy such as the BSC for improving police performance in addressing crimes against women and the needs of female citizens. Our findings reveal that respondents’ assessments of all four dimensions of the balanced scorecard are associated with their degree of optimism that performance measurement can improve the police response to crimes against women.
Collapse
|
17
|
Crouthamel B, Dixit A, Pearson E, Menzel J, Paul D, Shakhider MAH, Silverman J, Averbach S. The association between intimate partner violence and self-managed abortion: a cross-sectional study among women in urban Bangladesh. Sex Reprod Health Matters 2022; 29:2107078. [PMID: 36001008 PMCID: PMC9415493 DOI: 10.1080/26410397.2022.2107078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In Bangladesh, abortion is illegal, except to save a woman's life. However, menstrual regulation (MR) to induce menstruation up to 12 weeks from the last menstrual period is permitted. Although safe and legal MR services are available, many women choose to self-manage their abortions. The prevalence of intimate partner violence (IPV) in Bangladesh is high. Whether IPV is associated with self-managed abortion is unknown. Between January and December 2019 we administered cross-sectional surveys to women presenting for MR or post-abortion care (PAC) services at facilities in six cities in Bangladesh assessing if women had ever experienced IPV and if they attempted to self-manage their abortion. We used multivariable logistic regression to assess the association between IPV and self-managed abortion and multinomial logistic regression to the association between IPV by type: (none, any physical, any sexual, or both) and self-managed abortion. Among 2679 women who presented for MR or PAC care and participated in the survey, 473 (17.7%) had previously attempted to self-manage abortion. Women who had ever experienced any IPV were more likely to attempt self-managed abortion prior to presenting for MR or PAC (adjusted odds ratio (aOR) = 1.52, 95% CI 1.24, 1.87). Women who ever experienced physical IPV were more likely to attempt self-managed abortion (adjusted relative risk ratio (aRRR) = 1.62, 95% CI 1.30, 2.03). Women who have ever experienced physical IPV may be more likely to attempt a self-managed abortion because they seek more covert ways of ending a pregnancy out of fear for their safety, or because of limited mobility or lack of resources. Interventions to support women to safely self-manage abortion should focus on populations with higher rates of IPV.
Collapse
Affiliation(s)
- Bonnie Crouthamel
- Physician, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Anvita Dixit
- PhD Candidate, Center on Gender Equity on Health, School of Medicine, University of California San Diego, La Jolla, San Diego, CA, USA
| | - Erin Pearson
- Associate Director of Learning and Innovation, Ipas, Chapel Hill, NC, USA
| | - Jamie Menzel
- Senior Research and Evaluation Advisor, Ipas, Chapel Hill, NC, USA
| | - Dipika Paul
- Senior Research and Evaluation Advisor, Ipas, Dhaka, Bangladesh
| | | | - Jay Silverman
- Professor of Infectious Diseases and Global Public Health, Center on Gender Equity on Health, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sarah Averbach
- Associate Professor Reproductive Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences and Associate Professor Reproductive Medicine, Center on Gender Equity on Health, School of Medicine; University of California San Diego, La Jolla, CA, USA
| |
Collapse
|
18
|
Brenner C, Ugarte WJ, Carlsson I, Salazar M. Men's reproductive coercion of women: prevalence, experiences, and coping strategies-a mixed method study in urban health facilities in León, Nicaragua. BMC WOMENS HEALTH 2021; 21:310. [PMID: 34425798 PMCID: PMC8381564 DOI: 10.1186/s12905-021-01441-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women's reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC. METHODS A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18-35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis. RESULTS Ever RC prevalence was 17.4% (95% CI, 13.8-21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4-16.3) or ever experiencing CS (11.8%, 95% CI 8.7-15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2-16.0) than above. Twelve months PP (7.4%, 95% CI 5.0-10.5) and CS (8.7%, 95% CI 6.1-12.0) were also similar. Women's higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women's long-term fertility autonomy. CONCLUSIONS Our facility-based study showed that men's RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women's reproductive autonomy.
Collapse
Affiliation(s)
- Cecilia Brenner
- Regional Office of Communicable Diseases, Uppsala, Uppsala Region, Sweden
| | - William J Ugarte
- Department of Women's and Children's Health, International Maternal and Reproductive Health and Migration Research Group, Uppsala University, Uppsala, Sweden
| | - Ida Carlsson
- Doctors of the World/Médecins du Monde, Stockholm, Sweden
| | - Mariano Salazar
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77, Stockholm, Sweden.
| |
Collapse
|
19
|
Kalyesubula R, Pardo JM, Yeh S, Munana R, Weswa I, Adducci J, Nassali F, Tefferi M, Mundaka J, Burrowes S. Youths' perceptions of community health workers' delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda. BMC Public Health 2021; 21:666. [PMID: 33827502 PMCID: PMC8028711 DOI: 10.1186/s12889-021-10695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of unintended adolescent pregnancy are a significant health problem in Uganda. To improve access to family planning (FP) services, community-based Village Health Teams (VHTs) are widely employed in Uganda to deliver education and services. However, evaluations of FP programs suggest that mainly older, married women use VHT FP services. METHODS To better understand youth reluctance to use VHTs, we collected quantitative FP and contraceptive-seeking behavior data from a survey of 250 youths aged 15-25 in randomly selected households in Nakaseke District, which we triangulated with data from 3 focus group discussions (FGDs) (n = 15). RESULTS Most respondents received FP services from the formal health sector, not VHTs. Only half had talked to a VHT, but 65% knew that VHTs provide free FP services, and most (82%) felt comfortable talking to VHTs about FP. The main reasons for discomfort were fear that VHTs would violate privacy (mentioned by 60% of those not comfortable), that VHTs would talk to parents (33%), shyness (mentioned by 42% of those ≤18), and fear of being judged (14%). Concern about side effects was the most common reason for not using FP methods. Survey respondents said having VHTs of the same sex was important, particularly those in the youngest age group (OR = 4.45; 95%CI: 1.24, 16.00) and those who were unmarried (OR = 5.02; 95%CI: 2.42, 10.39). However, FGD participants (who were older than survey respondents on average) often preferred older VHTs of the opposite sex, whom they viewed as more professional and trustworthy. Respondents said the primary deciding factors for using VHTs were whether privacy would be respected, the proximity of care, and the respectfulness of care. CONCLUSIONS VHTs are a known source of FP services but not widely used by youth due to privacy and quality of care concerns. VHT messaging and training should increase focus on ensuring privacy, protecting confidentiality, providing respectful care, and addressing concerns about contraceptive side effects. Preferences for VHTs of similar age and sex may be more important for younger adolescents than older youths for whom quality concerns predominate.
Collapse
Affiliation(s)
- Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - Faith Nassali
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - John Mundaka
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | |
Collapse
|
20
|
Dawson A, Ekeroma A, Wilson D, Noovao-Hill A, Panisi L, Takala B, Black K, Bateson D. How do Pacific Island countries add up on contraception, abortion and reproductive coercion? Guidance from the Guttmacher report on investing in sexual and reproductive health. Reprod Health 2021; 18:68. [PMID: 33766064 PMCID: PMC7992794 DOI: 10.1186/s12978-021-01122-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
The Guttmacher-Lancet Commission report on Sexual and Reproductive Health and Rights called for the acceleration of progress to achieve SRHR that is essential for sustainable development. To integrate the essential services defined in this report into universal health coverage in the 11 sovereign nations in the Pacific, quality data is required to ensure needs are met efficiently and equitably. However, there are no comprehensive reports for Pacific Island countries that provide insight into all areas of SRHR. We collated the latest literature to identify the most up-to-date relevant data from United Nations and Guttmacher Institute reports to discern gaps in SRHR information and services relating to contraception, abortion and reproductive coercion. Investment is urgently required to strengthen health information systems for SRHR in the Pacific.
Collapse
Affiliation(s)
- Angela Dawson
- The Australian Centre for Public and Population Health Research, Faculty of Health, University of Technology Sydney, Ultimo, Australia.
| | | | - Donald Wilson
- Institute of Pacific Health Research, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Amanda Noovao-Hill
- Lautoka Hospital, Lautoka, Fiji.,College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Leeanne Panisi
- National Referral Hospital Solomon, Honiara, Solomon Islands
| | - Brooke Takala
- Marshall Islands Women's Research Initiative, Majuro, Marshall Islands
| | - Kirsten Black
- Discipline of Obstetrics, Gynaecology and Neonatology, The Sydney University Central Clinical School, Camperdown, Australia
| | - Deborah Bateson
- The Australian Centre for Public and Population Health Research, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
21
|
Dixit A, Bhan N, Benmarhnia T, Reed E, Kiene SM, Silverman J, Raj A. The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India. Reprod Health 2021; 18:60. [PMID: 33750403 PMCID: PMC7941884 DOI: 10.1186/s12978-021-01116-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws’ early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls. Methods Data were taken from a cross-sectional survey with married girls aged 15–19 years (N = 4893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws’ fertility pressure and each outcome, adjusting for sociodemographic covariates. Results We found that 1 in 5 girls experienced pressure from in-laws’ to have a child immediately after marriage. In-laws’ fertility pressure was associated with lower parity (Adj. β Coef. − 0.10, 95% CI − 0.17, − 0.37) and couple communication about family size (AOR = 1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth. Conclusions Our study adds to the literature identifying that in-laws’ pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01116-9.
Collapse
Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. .,Joint Doctoral Program in Public Health, San Diego State University-University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Nandita Bhan
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, 8622 Kennel Way, La Jolla, CA, 92037, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.,Department of Education Studies, Division of Social Sciences, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| |
Collapse
|
22
|
Sarnak DO, Wood SN, Zimmerman LA, Karp C, Makumbi F, Kibira SPS, Moreau C. The role of partner influence in contraceptive adoption, discontinuation, and switching in a nationally representative cohort of Ugandan women. PLoS One 2021; 16:e0238662. [PMID: 33434205 PMCID: PMC7802956 DOI: 10.1371/journal.pone.0238662] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 12/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Understanding contraceptive use dynamics is critical to addressing unmet need for contraception. Despite evidence that male partners may influence contraceptive decision-making, few studies have prospectively examined the supportive ways that men influence women's contraceptive use and continuation. OBJECTIVE This study sought to understand the predictive effect of partner influence, defined as partner's fertility intentions and support for contraception, and discussions about avoiding pregnancy prior to contraceptive use, on contraceptive use dynamics (continuation, discontinuation, switching, adoption) over a one-year period. METHODS This study uses nationally representative longitudinal data of Ugandan women aged 15-49 collected in 2018-2019 (n = 4,288 women baseline; n = 2,755 women one-year follow-up). Two analytic sub-samples of women in union and in need of contraception at baseline were used (n = 618 contraceptive users at baseline for discontinuation/switching analysis; n = 687 contraceptive non-users at baseline for adoption analysis). Primary dependent variables encompassed contraceptive use dynamics (continuation, discontinuation, switching, and adoption); three independent variables assessed partner influence. For each sub-sample, bivariate associations explored differences in sociodemographic and partner influences by contraceptive dynamics. Multinomial regression models were used to examine discontinuation and switching for contraceptive users at baseline; logistic regression identified predictors of contraceptive adoption among non-users at baseline. RESULTS Among users at baseline, 26.3% of women switched methods and 31.5% discontinued contraceptive use by follow-up. Multinomial logistic regression, adjusting for women's characteristics, indicated the relative risk of contraceptive discontinuation doubled when women did not discuss pregnancy avoidance with their partner prior to contraceptive use. Partner influence was not related to method switching. Among non-users at baseline, partner support for future contraceptive use was associated with nearly three-fold increased odds of contraceptive adoption. SIGNIFICANCE These results highlight the potentially supportive role of male partners in contraceptive adoption. Future research is encouraged to elucidate the complex pathways between couple-based decision-making and contraceptive dynamics through further prospective studies.
Collapse
Affiliation(s)
- Dana O Sarnak
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Shannon N Wood
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Linnea A Zimmerman
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Celia Karp
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda
| | - Simon P S Kibira
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University, Kampala, Uganda
| | - Caroline Moreau
- Department of Population Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.,Soins et Santé Primaire, CESP Centre for Research in Epidemiology and Population Health U1018, Inserm, Villejuif, France
| |
Collapse
|
23
|
Avanigadda DB, Kulasekaran RA. Associations between intimate partner violence and pregnancy complications: A cross-sectional study in India. J Family Community Med 2021; 28:17-27. [PMID: 33679185 PMCID: PMC7927968 DOI: 10.4103/jfcm.jfcm_256_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/30/2020] [Accepted: 11/02/2020] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The high prevalence rates of violence of the intimate partner affects the maternal health of the woman that sometimes ends in maternal mortality as well as the possibility of an adverse effect on the newborn. The purpose of this study was to assess the prevalence and determinants of intimate physical and sexual intimate partner violence (IPV) on mothers and examine the association between IPV and pregnancy complications. MATERIALS AND METHODS Data for the present study were retrieved from the National Family Health Survey-IV (2015-2016). In total, 79,729 women completed the domestic violence questions, but 24,882 were considered for this analysis. The study was restricted to currently married women aged 15-49 who had given birth to at least one child in the 5 years preceding the survey. The association between self-reporting pregnancy complications with the experience of IPV was examined using Chi-square test, followed by multivariate logistic regression. RESULTS The study findings show that IPV, specifically physical and sexual violence, are associated with pregnancy complications. The results show that 31.6% of the women had experienced some form of IPV. The factors associated with IPV included husband's alcohol habit, women who had witnessed parental violence, and women whose husbands had shown high marital controlling behavior. The high level of pregnancy complications was reported by women who had experienced sexual violence, emotional violence, and women whose husbands display three or more specific behaviors. CONCLUSION Confidential screening for IPV and prompt referral to support services could be crucial in improving women's reproductive health.
Collapse
Affiliation(s)
- Durga B Avanigadda
- Department of Population Studies, Annamalai University, Annamalai Nagar, Tamil Nadu, India
| | | |
Collapse
|
24
|
Daruwalla N, Kanougiya S, Gupta A, Gram L, Osrin D. Prevalence of domestic violence against women in informal settlements in Mumbai, India: a cross-sectional survey. BMJ Open 2020; 10:e042444. [PMID: 33328262 PMCID: PMC7745686 DOI: 10.1136/bmjopen-2020-042444] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/09/2020] [Accepted: 11/24/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Domestic violence against women harms individuals, families, communities and society. Perpetrated by intimate partners or other family members, its overlapping forms include physical, sexual and emotional violence, control and neglect. We aimed to describe the prevalence of these forms of violence and their perpetrators in informal settlements in Mumbai. DESIGN Cross-sectional survey. SETTING Two large urban informal settlement areas. PARTICIPANTS 5122 women aged 18-49 years. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence and perpetrators in the last year of physical, sexual and emotional domestic violence, coercive control and neglect. For each of these forms of violence, responses to questions about individual acts and composite estimates. RESULTS In the last year, 644 (13%) women had experienced physical domestic violence, 188 (4%) sexual violence and 963 (19%) emotional violence. Of ever-married women, 13% had experienced physical or sexual intimate partner violence in the last year. Most physical (87%) and sexual violence (99%) was done by partners, but emotional violence equally involved marital family members. All three forms of violence were more common if women were younger, in the lowest socioeconomic asset quintile or reported disability. 1816 women (35%) had experienced at least one instance of coercive control and 33% said that they were afraid of people in their home. 10% reported domestic neglect of their food, sleep, health or children's health. CONCLUSIONS Domestic violence against women remains common in urban informal settlements. Physical and sexual violence were perpetrated mainly by intimate partners, but emotional violence was attributed equally to partners and marital family. More than one-third of women described controlling behaviours perpetrated by both intimate partners and marital family members. We emphasise the need to include the spectrum of perpetrators and forms of domestic violence-particularly emotional violence and coercive control-in data gathering. TRIAL REGISTRATION NUMBER ISRCTN84502355; Pre-results.
Collapse
Affiliation(s)
- Nayreen Daruwalla
- Programme on Prevention of Violence Against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, Maharashtra, India
| | - Suman Kanougiya
- Programme on Prevention of Violence Against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, Maharashtra, India
| | - Apoorwa Gupta
- Programme on Prevention of Violence Against Women and Children, Society for Nutrition, Education and Health Action (SNEHA), Mumbai, Maharashtra, India
| | - Lu Gram
- Institute for Global Health, University College London, London, UK
| | - David Osrin
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
25
|
Tomar S, Dehingia N, Dey AK, Chandurkar D, Raj A, Silverman JG. Associations of intimate partner violence and reproductive coercion with contraceptive use in Uttar Pradesh, India: How associations differ across contraceptive methods. PLoS One 2020; 15:e0241008. [PMID: 33064775 PMCID: PMC7567561 DOI: 10.1371/journal.pone.0241008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 10/06/2020] [Indexed: 11/19/2022] Open
Abstract
Intimate partner violence (IPV) and reproductive coercion (RC)-largely in the form of pressuring pregnancy-appear to contribute to low use of contraceptives in India; however, little is known about the extent to which these experiences differentially affect use of specific contraceptive methods. The current study assessed the association of IPV and RC with specific contraceptive methods (Intrauterine Devices [IUDs], pills, condoms) among a large population-based sample of currently married women (15-49 years, n = 1424) living in Uttar Pradesh. Outcomes variables included past year modern contraceptive use and type of contraceptive used. Primary independent variables included lifetime experience of RC by current husband or in-laws, and lifetime experiences of physical IPV and sexual IPV by current husband. Multivariate logistic regression models were developed to determine the effect of each form of abuse on women's contraceptive use. Approximately 1 in 7 women (15.1%) reported experiencing RC from their current husband or in-laws ever in their lifetime, 37.4% reported experience of physical IPV and 8.3% reported experience of sexual IPV by their current husband ever in their lifetime. Women experiencing RC were less likely to use any modern contraceptive (AOR: 0.18; 95% CI: 0.9-0.36). Such women also less likely to report pill and condom use but were more likely to report IUD use. Neither form of IPV were associated with either overall or method specific contraceptive use. Study findings highlight that RC may influence contraceptive use differently based on type of contraceptive, with less detectable, female-controlled contraceptives such as IUD preferred in the context of women facing RC. Unfortunately, IUD uptake remains low in India. Increased access and support for use, particularly for women contending with RC, may be important for improving women's control over contraceptive use and reducing unintended pregnancy.
Collapse
Affiliation(s)
- Shweta Tomar
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
- * E-mail:
| | - Nabamallika Dehingia
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | - Arnab K. Dey
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
- Joint Doctoral Program, San Diego State University/University of California San Diego, San Diego, CA, United States of America
| | | | - Anita Raj
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| | - Jay G. Silverman
- Division of Global Public Health, Center on Gender Equity and Health, University of California, San Diego School of Medicine, La Jolla, CA, United States of America
| |
Collapse
|
26
|
Abstract
The public health ramifications of marital violence are well documented and include injury, mental health concerns and physical health consequences for women and their offspring. Unfortunately, there remains social tolerance and even acceptance of these abuses against women, and health systems in India have done little to support victims despite their greater health risks. However, there are promising efforts and important advancements in India that could be built on for more effective prevention and support for women. Men and boys should be engaged in gender transformative interventions with male role models to alter men's attitudes of acceptability of and justification for marital violence and consequently their actual abusive behaviours. Given the strong demonstrated connection between men's risky and problem alcohol use and marital violence, alcohol interventions may also be beneficial. We must support women and girls vulnerable to marital violence, a group disproportionately affected by violence in their natal families as well, so they know that violence need not be part of their marriage relationship, and have skills on how to engage and communicate with or even leave their male partners to reduce their risk for violence. Formal services should be expanded for those in immediate danger and particularly for rural areas, where prevalence of marital violence is highest and supports are weakest. Finally, given the pervasiveness of attitudes accepting husbands' marital violence against women, and the fact that these have remained largely unchanged in India for a decade, large scale community and social change efforts are needed.
Collapse
Affiliation(s)
- Anita Raj
- Center on Gender Equity & Health, School of Medicine; Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, USA
| |
Collapse
|
27
|
Silverman JG, Challa S, Boyce SC, Averbach S, Raj A. Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. EClinicalMedicine 2020; 22:100359. [PMID: 32382722 PMCID: PMC7198910 DOI: 10.1016/j.eclinm.2020.100359] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In Niger the prevalence of girl child marriage and low female control over family planning (FP) has resulted in the world's highest adolescent fertility. Male control of FP is associated with intimate partner violence (IPV) and reproductive coercion (RC). We assessed associations of IPV and RC with FP use among married adolescent girls (ages 13-19 years) in Dosso, Niger (N = 1072). METHODS Multivariable, cross-sectional regression models assessed associations between physical IPV, sexual IPV, and RC and any FP use, FP use with husband knowledge (overt use), and FP use without husband knowledge (covert use). FINDINGS One in four married adolescent girls using FP reported doing so without husband's knowledge. Unadjusted and adjusted models indicated that physical IPV and RC were associated with covert FP use (vs. no use and vs. overt use), but not with overt use vs. no use. Only physical IPV remained significantly associated with covert use in models including all three forms of violence (AOR: 1.94 vs. any use; AOR: 3.63 vs. overt use). INTERPRETATION Married adolescents experiencing physical IPV or RC were more likely that others to use FP without their husbands' knowledge. No form of GBV affected odds of FP use with husbands' knowledge. Current results suggest caution regarding promoting engagement of men in decisions to use FP in this context, as this may undermine the reproductive autonomy of girls and women who will choose to use FP without the knowledge of their male partners.
Collapse
Affiliation(s)
- Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sneha Challa
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| |
Collapse
|
28
|
DeLong SM, Brooks MI, Aliou S, Lundgren R, Corneliess C, Johns NE, Challa S, Carter N, Lauro G, Silverman JG. Married very young adolescent girls in Niger at greatest risk of lifetime male partner reproductive coercion and sexual violence. PLoS One 2020; 15:e0231392. [PMID: 32282817 PMCID: PMC7153890 DOI: 10.1371/journal.pone.0231392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/23/2020] [Indexed: 11/24/2022] Open
Abstract
Objective The purpose of this analysis was to compare and contrast reproductive health (RH), gender equity attitudes, and intimate partner violence (IPV) among married very young adolescent (VYA) girls with married older adolescent girls and young women (AGYW) in rural Niger given limited literature on the topic. Methods We conducted an exploratory analysis of baseline data from the Reaching Married Adolescents Trial in Dosso region, Niger. We report counts and percents, by age group (13–14 years (VYA), 15–16 years, 17–19 years), of AGYW’s self-efficacy to use family planning (FP), accurate knowledge of FP, current use of modern FP, and unintended last pregnancy (UIP); lifetime reproductive coercion (RC), physical IPV, and sexual IPV; and gender equity attitudes. We also assess whether percents differ between VYA and older groups using Pearson’s Chi-Square and Fisher’s exact p-values. Results are stratified by parity. Finally, we use logistic regression to consider associations. Results There were 49 VYA, 248 girls aged 15–16, and 775 AGYW aged 17–19 in our sample (n = 1072). Accurate knowledge of FP, self-efficacy to use FP, current use of modern FP, and UIP increased with age; all percents between VYA and AGYW 17–19 were marginally or statistically significantly different. We also saw VYA report higher lifetime RC and sexual IPV versus older groups, with sexual IPV statistically different between VYA and girls 17–19. Parous VYA reported a significantly higher percent of lifetime RC versus older AGYW. Among 17–19 year-olds, odds of current use of FP were higher among AGYW who reported physical IPV, and odds of UIP were higher among those reporting more gender equitable attitudes, both adjusted for parity. Conclusions We observed differences in RH, RC, and sexual IPV among married VYA and older AGYW in rural Niger. VYA should be prioritized in research to confirm and further understand their RH needs.
Collapse
Affiliation(s)
- Stephanie M. DeLong
- University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Mohamad I. Brooks
- Pathfinder International, Watertown, Massachusetts, United States of America
| | | | - Rebecka Lundgren
- University of California, San Diego, La Jolla, California, United States of America
| | - Caitlin Corneliess
- Pathfinder International, Watertown, Massachusetts, United States of America
| | - Nicole E. Johns
- University of California, San Diego, La Jolla, California, United States of America
| | - Sneha Challa
- University of California, San Diego, La Jolla, California, United States of America
| | - Nicole Carter
- University of California, San Diego, La Jolla, California, United States of America
| | - Giovanna Lauro
- Promundo–United States, Washington, DC, United States of America
| | - Jay G. Silverman
- University of California, San Diego, La Jolla, California, United States of America
| |
Collapse
|