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

Sexual and reproductive health outcomes of women who experienced violence in Germany: Analysis of the German health interview and examination survey for adults (DEGS1)

OBJECTIVES

Violence against women is a widespread public health concern with severe effects to women's sexual and reproductive health, including higher risks for miscarriage or stillbirth, unintended pregnancy and induced abortion. This study examined the association between women exposure to physical violence, psychological violence and sexual and reproductive health outcomes (contraceptive use, miscarriage or stillbirth and abortion) in Germany.

METHODS

This study used a cross-sectional research design to analyze data on violence against women and sexual and reproductive health (SRH) outcomes collected through the German Health Interview and Examination Survey for Adults, Wave 1, between 2008 and 2011 (n = 3149 women, aged 18-64 years). Multivariable logistic regression models were used to assess the association between experiences of violence among women and the presence of sexual and reproductive health outcomes, considering the influence of socio-demographic and health-related factors (age, marital status, socioeconomic status, social support, number of children, alcohol consumption, health status, chronic conditions).

RESULTS

Three associations remained significant (p<0.05) in fully-adjusted models: (i) exposure to physical violence by a parent or caregiver and birth control pill utilization (aOR, adjusted Odds Ratio, 95% CI: 1.36, 1.02-1.81) (ii) exposure to physical violence since the age of 16 and miscarriage or stillbirth (aOR, 95%CI: 1.89, 1.17-3.04); and (iii) exposure to psychological violence by a parent or caregiver and abortion (aOR, 95%CI: 1.87, 1.30-2.70).

CONCLUSIONS

The results suggest that adult German women who experienced physical or psychological violence since the age of 16, including violence perpetrated by a parent or caregiver, were more likely to report miscarriage or stillbirth and abortion. Direct assessment of violence experiences against women should be conducted by healthcare professionals in clinical encounters, particularly by obstetrics and gynaecological specialists, for the prevention of women´s adverse sexual and reproductive health outcomes. Furthermore, violence should be treated as a major public health concern and addressed through a multisectoral approach, involving the healthcare and educational sectors, researchers and relevant policymakers.

Role of internet use, mobile phone, media exposure and domestic migration on reproductive health service use in Bangladeshi married adolescents and young women

Numerous studies have identified factors that are associated with increased access to reproductive health services in lower-middle-income countries (LMICs). However, limited studies examined the influence of access to internet or a mobile phone, media exposure and domestic migration on reproductive health services use in LMICs like Bangladesh. This study investigated the role of such factors on the use of contraceptives, antenatal care (ANC) and postnatal care (PNC) by married adolescents and young women in Bangladesh and whether it was varied by area. Secondary data for 1665 married women aged 15-24 years, sourced from the 2019 Multiple Indicator Cluster Surveys, were included in both bivariate analyses and logistic regression modelling to examine the role of access to internet and/or mobile phone, media exposure and domestic migration on the outcome variables (contraceptive, ANC and PNC). All regression models were controlled for age, wealth, education and number of existing children. Among all participants, 69.8% were aged 20-24 years and 85.6% lived in rural areas. Of the total sample, 67.5% used contraceptives, 75.7% utilised ANC and 48.7% accessed PNC. Domestic migration significantly increased contraceptive use, with women who had moved locally within the last five years 1.84 times more likely to use contraception than those who had never moved (95% CI: 1.41-2.41, p<0.001). Women with internet or mobile phone access were more likely to receive ANC (aOR: 1.57, 95% CI: 1.22-2.00, p<0.001) compared to those without internet/mobile phone access. Media exposure was found to increase the likelihood of receiving ANC in urban areas. No significant influence was found on the use of PNC. Internet/mobile-based platforms are promising avenues for public health messaging regarding ANC in Bangladeshi married adolescents and young women. Further research is required into determinants of PNC service use in low-resource settings.

Correlates of Unmet Need for Modern Contraception Among Reproductive-Aged Women Involved in New York City Criminal Legal Systems

Introduction

The population of women involved in criminal legal systems (WICL), a majority of whom are reproductive-aged, has risen steadily in the United States. They contend with numerous barriers to sexual and reproductive health services resulting in high rates of unmet need for contraception and unintended pregnancy.

Materials and Methods

This study included 132 non-pregnancy seeking reproductive-aged WICL enrolled in the baseline assessment of the HIV prevention intervention, "Women on the Road to Health" (WORTH). A multivariate generalized linear logistic regression model with robust estimation examined effects of past 6-month intimate partner violence (IPV; sexual and physical/injurious), past 3-month substance use (binge drinking, cannabis, other illegal drug use), and lifetime mental health diagnoses (anxiety, depression, bipolar disorder) on women's unmet need for modern contraception, adjusting for significant demographic and socioeconomic factors.

Results

Women who were younger in age (odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.63-0.88) and reporting lifetime diagnoses of anxiety disorders (OR: 13.64; 95% CI: 2.71-68.34) were significantly more likely to meet the criteria for unmet need for modern contraception. Women with a regular gynecologist (OR: 0.11; 95% CI: 0.01-0.86) reporting lifetime diagnoses of bipolar disorder and past 6-month sexual IPV histories (OR: 0.04; 95% CI: 0.002-0.86) were significantly less likely to meet the criteria for unmet need for modern contraception.

Conclusions

Distinct mental health diagnoses and experiences of IPV may uniquely impact unmet need for modern contraception among WICL. These findings emphasize the need for a more nuanced comprehension of these relationships to deliver comprehensive and holistic health services that address the intersecting needs of this population.

Trial registration: ClinicalTrials.gov NCT01784809. Registered 6 February 2013.

The Effect of Intimate Partner Violence on the Physical Health and Health-Related Behaviors of Women: A Systematic Review of the Literature

AIM

The long-term effects of intimate partner violence (IPV) on physical health outcomes and health-related behaviors are underresearched in comparison to the effects on mental health and pregnancy. This systematic review examines the recent research in this area from 2012 through 2019.

METHODS

SCOPUS, PubMed, EBSCOhost, and gray literature were searched using the key words "intimate partner violence" and "health." To meet inclusion criteria, studies needed to be original research and focus on IPV during adulthood and its effects on the physical health or health-related behaviors of women. Fifty-two studies were qualitatively analyzed, with results grouped into broad categories of effects, including cardiovascular, endocrine, infectious diseases, and health screening.

RESULTS

IPV was shown to have negative effects on physical health outcomes for women, including worsening the symptoms of menopause and increasing the risk of developing diabetes, contracting sexually transmitted infections, engaging in risk-taking behaviors including the abuse of drugs and alcohol, and developing chronic diseases and pain. It also has significant effects on human immunodeficiency virus outcomes, worsening CD4+ cell depletion. Results varied regarding the effects of IPV on cardiovascular health outcomes.

CONCLUSION

The result of this review demonstrates that women who have experienced violence and abuse are at significantly increased risk of poor health outcomes in a variety of areas and so require specialized and tailored primary care. This review highlights significant gaps in this field of research, particularly in relation to cardiovascular disease, endocrine dysfunction, and neurological symptoms and conditions. It demonstrates a need for additional long-term studies in this field to better inform the health care of women who have experienced IPV and to establish the physiological mediators of these outcomes.

Association Between Intimate Partner Violence and Contraceptive Use in India: Exploring the Moderating Role of Husband's Controlling Behaviors

Existing studies show a mixed relationship between intimate partner violence (IPV) and contraceptive use. This study assesses the association between women's exposure to IPV and contraceptive use in India. Furthermore, we aim to determine whether husband's controlling behaviors play a moderating role in the IPV-contraception link. We used nationally representative data from the recent round of the National Family Health Survey (NFHS-4), conducted in 2015-2016. In this study, the use of contraceptives is the outcome variable, categorized into three groups: no/traditional methods, modern methods, and female sterilization. Women's exposure to IPV in the past year is the key exposure of interest. Socio-economic and demographic variables were used as covariates. Multinomial logistic regression models were performed to examine the association between women's exposure to IPV and contraceptive use. Of the total participants (N = 58,891), approximately one in every four women (24.1%) experienced any form of IPV in the past year. Slightly over half (50.8%) reported using either traditional methods of contraception or no contraceptive at all. About 14% of the respondents were using modern methods of contraception and 34.9% had undergone sterilization. After controlling for confounding factors, women who experienced IPV were 8% (95% CI [.87, .99]) less likely to report using modern contraceptives than those who did not face any IPV. Conversely, women who faced IPV were 14% (95% CI [1.09, 1.20]) more likely to undergo sterilization. Furthermore, women who experienced any form of IPV and whose husbands endorse controlling attitudes were 12% (95% CI [.81, .95]) less likely to report using modern contraceptives and 11% (95% CI [1.04, 1.17]) more likely to undergo sterilization. Interventions should be made to prevent violence against women that would increase their ability to choose appropriate contraception methods to avoid unintended pregnancies.

Modern contraceptive use among women of reproductive age in Zimbabwe: analysis of 1999-2015 Zimbabwe Demographic Health Survey

INTRODUCTION

Modern contraception use is the fundamental fulfilment of women's rights to choose when and how many children to have. The study explored predictors of modern contraceptive use among women in Zimbabwe.

METHOD

Data from the 1999, 2005/2006, 2010/2011 and 2015 Zimbabwe Demographic and Health Survey (ZDHS) was used in a secondary analysis that involved 5474 women of reproductive age. The outcome measure was modern contraceptive use as reported by women. Multiple logistic regression was done to determine the predictors of modern contraceptive use.

RESULTS

The trend showed that since 1999 to 2015 there has been a steadily increase in modern contraceptive use from 54.9% to 72.9%. The use of contraceptives was lower among age 40 to 49 years (aOR = 0.49, p = 0.001)], other religion (aOR = 0.34, p = 0.005), induced abortion (aOR = 0.70; p ≤ 0.001), desire for having children within 2 years (aOR = 0.21; p ≤ 0.001) and polygamy (aOR = 0.43; p ≤ 0.001). The odds of contraceptives used was higher among richer wealth index (aOR = 1.45, p = 0.017), partners with higher education (aOR = 2.00, p = 0.029)], parity 1-2 (aOR = 15.53; p ≤ 0.001), 3-4 (aOR = 19.60; p ≤ 0.001), 5 or more (aOR = 17.50; p ≤ 0.001)] and media exposure (aOR = 1.79; p = 0.003).

CONCLUSIONS

The study asserts that women's financial status, partners educational level, and media exposure might be important in promoting the use of modern contraceptives among women in a union in Zimbabwe and other low-income and middle-income countries.

Women's empowerment and fertility preferences of married women: analysis of demographic and health survey'2016 in Timor-Leste

A recently independent state, Timor-Leste, is progressing towards socioeconomic development, prioritizing women empowerment while its increased fertility rate (4.1) could hinder the growth due to an uncontrolled population. Currently, limited evidence shows that indicators of women's empowerment are associated with fertility preferences and rates. The objective of this study was to assess the association between women empowerment and fertility preferences of married women aged 15 to 49 years in Timor-Leste using nationally representative survey data. The study was conducted using the data of the latest Timor-Leste Demographic and Health Survey 2016. The study included 4040 rural residents and 1810 urban residents of Timor-Leste. Multinomial logistic regression has been performed to assess the strength of association between the exposures indicating women's empowerment and outcome (fertility preference). After adjusting the selected covariates, the findings showed that exposures that indicate women empowerment in DHS, namely, the employment status of women, house and land ownership, ownership of the mobile phone, and independent bank account status, contraceptive use, and the attitude of women towards negotiating sexual relations are significantly associated with fertility preferences. The study shows higher the level of education, the less likely were the women to want more children, and unemployed women were with a higher number of children. Our study also found that the attitude of violence of spouses significantly influenced women's reproductive choice. However, employment had no significant correlation with decision-making opportunities and contraceptive selection due to a lack of substantial data. Also, no meaningful data was available regarding decision-making and fertility preferences. Our findings suggest that women's empowerment governs decision-making in fertility preferences, causing a decline in the fertility rate.

The association between marital violence and reproductive and sexual health outcomes of women: A multi-country study of South Asia

In this study, we examined the relationship between marital violence(MV) and reproductive and sexual health outcomes of women of Bangladesh, India, Nepal and Pakistan. The lifetime MV inflicted by husbands on their wives was highest at 53% in Bangladesh, India(37%), Pakistan(28%) and Nepal(28%) respectively. Overall, our results in this study suggest that MV perpetrated by husbands on their wife is significantly associated with unintended pregnancy, pregnancy termination, current use of any modern contraceptive methods and sexually transmitted infections, but inconsistent associations are appeared across countries. Lifetime sexual violence and physical-sexual force were significantly and positively associated with unintended pregnancy and pregnancy termination respectively, whereas, all types of MV were significantly and positively related with the symptom of sexually transmitted diseases in the women. Appropriate measures should be undertaken to combat Violence against women(VAW) and necessary services should be provided to the victimized women to uphold their reproductive and sexual rights.

Sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa: Evidence from demographic and health surveys

INTRODUCTION

Contraception plays a significant role in fertility regulation and determines the reproductive health rights of women. Studies in other parts of the world have found that sexual violence has negative effects on unmet need for contraception. There has not been any study on the association between these two phenomena in sub-Saharan Africa using current nationally-representative survey data. We investigated the association between sexual violence and unmet need for contraception among married and cohabiting women in sub-Saharan Africa.

MATERIALS AND METHODS

This study was based on secondary datasets from 26 sub-Saharan African countries' Demographic and Health Surveys conducted between 2010 and 2018. A sample of 101,968 women in sexual unions (married and cohabiting) with complete information on sexual violence and all the variables of interest were included in the analyses. Both bivariate and multilevel logistic regression analyses were carried out to examine the association between sexual violence and unmet need for contraception. Other individual and contextual level socio-economic and demographic variables were considered as covariates. Crude odds ratios [cOR] and adjusted odds ratios [aOR] with their corresponding 95% confidence intervals [CI], signifying precision, were presented. Level of statistical significance was declared at p<0.05.

RESULTS

The overall prevalence of sexual violence and unmet need for contraception in the 26 sub-Saharan African countries were 8.7% and 28.7% respectively. Experience of sexual violence within the last 12 months resulted in 10% increase in unmet need for contraception [OR = 1.10, CI = 1.03-1.14] and 5% increase in unmet need for contraception after controlling for individual and contextual level factors [aOR = 1.05, CI = 1.01-1.11]. With the individual level factors, women with 4 or more births [aOR = 4.85, CI = 4.41-5.33], those cohabiting [aOR = 1.43, CI = 1.37-1.47], those in female headed households [aOR = 1.22, CI = 1.18-1.27] and those who watched television at least once a week [aOR = 1.12, CI = 1.07-1.16] had higher odds of unmet need for family planning. However, those aged 30-34 [aOR = 0.56, CI = 0.52-0.61], those with secondary/higher level of education [AOR = 0.80, CI = 0.77-0.84], those who read newspaper less than once a week [aOR = 0.75, CI = 0.71-0.79] and those who listened to radio at least once a week [aOR = 0.94, CI = 0.90-0.97] had lower odds of unmet need for contraception. In terms of the contextual factors, women in rural areas [aOR = 0.87, CI = 0.84-0.91] and those in the richest wealth quintile households [aOR = 0.80, CI = 0.75-0.85] had lower odds of unmet need for contraception.

CONCLUSION

Our study has shown an association between sexual violence and unmet need for contraception in sub-Saharan Africa. Experiencing sexual violence increases the likelihood of unmet need for contraception in sub-Saharan Africa. It is also worthy to note that having four or more children, cohabiting with a male partner, and living in female-headed households are some of the key variables associated with unmet need for contraception in sub-Saharan Africa. Our study recommends that, successful contraceptive initiatives should focus on reducing sexual violence, while taking into consideration other significant factors that increase unmet need for contraception. Meanwhile, in doing this, contextual factors ought to be prioritised.

Exploring the relationship between intimate partner violence and contraception use by Tanzanian women

Intimate partner violence (IPV) can be described as a global epidemic which has long term effects on numerous aspects of life. The effect of IPV on contraception use is also wide-ranging and culturally bound. Among the continents, Africa has the highest IPV prevalence. The relationship between IPV on contraception use by Tanzanian women is explored in this study as an illustrative case. This is a descriptive cross-sectional design study, for which we utilized the Tanzania Demographic and Health Survey Data 2015-2016. Data from the responses of 13,266 ever-partnered women were used in this study. The mean age of the respondents was 28.69 years, median 27. 63% of respondents used contraceptives. Women with more than three pregnancies were more likely to use contraceptives (OR: 1.56, 95% CI, p < .001). Education levels also correlated with contraceptive use. Notably, contraceptive use was also significantly lower among the Tanzanian women who were exposed to IPV, suggesting a need for appropriately tailored social interventions and support. The need for interventions relating to IPV to take into account the multifactorial nature of a woman's uptake of contraceptive methods is underlined.

Influence of parental education on child mortality in Bangladesh: repeated cross-sectional surveys

Reducing the mortality of children under-5 (U5) is an essential part of the Sustainable Development Goal (SDG). Although Bangladesh has made progress in reducing child mortality, there remain inequalities among different sociodemographic groups. Education is one particular key factor with a multidimensional impact on child health and survival. This study assessed the association between parental education and U5 mortality using repeated cross-sectional Bangladesh Demographic and Health Survey data. The risk of child death was substantially low among educated parents. Children of secondary or higher educated mother and father were about 30% (hazard ratio [HR] = 0.697, 95% confidence interval [CI] 0.596 to 0.815, p< .001) and 26% (HR = 0.738, 95% CI 0.635 to 0.858, p < .001), respectively, less likely to die early. Children from wealthier households and born to mothers with long birth spacings were less likely to face an early death. The study findings emphasize on imparting education to parents as an intervention strategy to continue the reduction of child mortality rate in Bangladesh, which could be a policy direction toward achieving the SDGs.

Intimate partner violence as a factor in contraceptive discontinuation among sexually active married women in Nigeria

Background

In spite of the well-established associations between socioeconomic and demographic factors and the high rate of contraceptive discontinuation among sexually active married contraceptive users, little is known in Nigeria about the relationship between contraceptive discontinuation and sexually active married women who have experienced Intimate Partner Violence (IPV).

Methods

The 2013 Nigeria Demographic and Health Survey data on women’s reproductive calendars and domestic violence were used to investigate the relationship between IPV and contraceptive discontinuation in a year period. A weighted sample size of 1341 women in a union in the domestic violence module, who have experienced IPV, and are using any contraceptive and are not sterilized in the 12 months periods was analyzed using frequency tables and chart, Pearson’s chi-square test, and binary logistic regression model.

Results

The results showed that women who have experienced any type of IPV are 1.28 times more likely to have discontinued contraceptive use although they are still at risk of becoming pregnant (aOR = 1.28, CI: 1.15–1.91; p < 0.05) than those who have not experienced IPV. The tertiary level of education (aOR = 3.94, CI = 1.67–9.29; p < 0.05), unemployed status (aOR = 1.97, CI = 1.07–3.62; p < 0.05), and higher marital duration of 20 years and above (aOR = 4.89, CI = 2.26–10.57; p < 0.05) significantly influenced women who have experienced any types of IPV to discontinue contraceptives even though they are still at risk of becoming pregnant than those who have not experienced IPV.

Conclusion

The study revealed that women who have experienced any form of IPV were significantly influenced by their education, occupation, the number of living children, and marital duration to discontinue contraception while still at risk of becoming pregnant. Thus, the study concludes that intervention programmes aimed at increasing contraceptive prevalence rate should be mindful of IPV which may affect women’s use of contraceptives.

A cross-sectional analysis of intimate partner violence and family planning use in rural India

BACKGROUND

Intimate partner violence (IPV) has been shown to be associated differentially with contraceptive use based on type, with IPV more likely among pill users and less likely among condom users. Recent increases in IUD uptake allow consideration of this type of contraceptive. We assessed the association between self-reported IPV and self-reported contraceptive use, by type, among non-pregnant married women in rural India in a region with higher than average IUD use.

METHODS

We assessed the association between past 12-month IPV (physical, sexual, or any) and past 3-month contraceptive use (condom, pill, IUD, or any modern method) using crude and adjusted multinomial logistic regression models.

FINDINGS

Among the 1001 women included, 109 (10·9%) reported experiencing physical IPV and 27 (2·7%) reported experiencing sexual IPV in the past 12 months. Women experiencing physical IPV were significantly less likely to use condoms (adjusted relative risk ratio [RRR]: 0·54, 95% confidence interval [CI]: 0·30-0·98, p = 0·042) than women not experiencing violence. There was a trend towards increased IUD use among women experiencing physical IPV (adjusted RRR: 1·78, 95% CI: 0·91-3·41, p = 0·091) compared to those not experiencing physical IPV, but this did not reach statistical significance.

INTERPRETATION

Our findings suggest that women who experience physical IPV in India are less likely to use condoms and may be more likely to use IUDs than women without exposure to IPV. This research expands on prior findings suggesting higher uptake of women-controlled contraceptives among women contending with IPV in India.

Sexual autonomy and contraceptive use among women in Nigeria: findings from the Demographic and Health Survey data

CONTEXT

The persistent low contraceptive use and high fertility in Nigeria despite improvements in educational achievements calls for an examination of the role of factors, which may moderate the use of modern contraception. This article explores the influence of sexual autonomy on the use of modern contraceptive methods among women and its relative importance compared with other, more traditional, indicators of women's autonomy such as education and occupation.

DATA AND METHODS

Data from two Demographic and Health Surveys (DHS), 2008 and 2013, were used in this study. An index of sexual autonomy was constructed by combining related DHS variables, and its association with current use of modern contraception was examined at each time point as well as over time using multivariate regression analysis.

RESULTS

The observed prevalence for use of modern contraception was 2.8 and 2.6 times higher among women who had high sexual autonomy in 2008 and 2013, respectively. The corresponding figures for women with secondary or higher education were 8.2 and 11.8 times higher, respectively, compared with women with no education. But after controlling for wealth index, religion, place of residence, autonomy and experience of intimate partner violence (IPV), the likelihood of use of modern contraception was lowered to about 2.5 (from 8.2) and 2.8 (from 11.8) times during 2008 and 2013, respectively, among women with secondary or higher education. The likelihood of use of modern contraception lowered only to 1.6 (from 2.8) and 1.8 (from 2.6) times among women with high sexual autonomy after controlling for other covariates, respectively, during the same period.

CONCLUSION

Sexual autonomy seems to play an important role in women's use of modern contraceptive methods independent of education and a number of other factors related to women's status. Sexual autonomy needs to be simultaneously promoted alongside increasing educational opportunities to enhance women's ability to use modern contraception.

"Side effects affected my daily activities a lot": a qualitative exploration of the impact of contraceptive side effects in Bangladesh

Purpose

In a country like Bangladesh that has made great progress in contraceptive use with one of the lowest levels of fertility and highest levels of contraceptive use, understanding what factors influence women’s decisions to discontinue a contraceptive method and not switch to a new method is critical in designing interventions and programs that will help enable Bangladesh to reach its FP2020 goals. Research on side effects has focused on physical manifestations like headaches, moodiness, abdominal pain, and menstrual irregularities. While physical effects alone may stop women from continuing a contraceptive method, less is known about how side effects influence women’s daily activities and lives. The purpose of this study is to understand the ways that side effects affect Bangladeshi women’s participation in different social settings.

Methods

Thirty-five in-depth interviews with married women who recently discontinued or switched to a different contraceptive method were conducted in Sylhet and Khulna Divisions. Interviews explored reasons for discontinuation including experience of side effects and impact of side effects on women’s lives.

Results

Key themes emerged including that side effects are not only experienced physically but are barriers to women’s participation in many aspects of their lives. The spheres of life that most commonly appeared to be influenced by side effects include religion, household, and sexual intimacy irrespective of method used or residence.

Conclusion

Family planning providers need to be aware of these additional consequences associated with contraceptive side effects to provide tailored counseling that recognizes these issues and helps women to mitigate them. For Bangladesh to achieve its FP2020 goals, understanding the broader context in which family planning decisions are made vis-à-vis side effects is critical to design programs and interventions that meet all the needs of women beyond just their fertility intentions.

Determinants of modern contraceptive practice in Yaoundé-Cameroon: a community based cross sectional study

BACKGROUND

Despite numerous efforts put in place to increase modern contraceptive use in Cameroon as a means to fight maternal and infant mortality, the prevalence of modern contraception has shown only a slow increase and maternal mortality is constantly rising. This paper attempts to identify barriers to contraceptive use in Biyem-Assi, Yaoundé-Cameroon so as to clearly define in which domain and how to intervene concerning contraceptive use in Cameroon.

METHODS

It was a community-based cross sectional study involving a two-steps cluster sampling. Data were collected from November 2014 to April 2015 and analysis done with Epi-Info version 3.5.4. Association between contraceptive use and independent factors was estimated by calculating odds ratio (OR) and confidence interval at 95%. Significance of association in univariate analysis was estimated by calculating the p value with chi2 test. Potential confounder (pregnancy intention) controlled in a multiple logistic regression.

RESULTS

A total of 613 sexually active women were enrolled into the study with a mean age of 27.2 (δ ± 6.2) years. Among the women, 293 (47.8%) were in a union and 530 (86.8%) of them had attended at least a secondary education. Also, 107 (17.5%) responded that their beliefs do not approve contraceptive use and 101 (16.6%) said their partners do not approve contraception. At the moment of data collection, 361 (58.9 [54.9-62.8] %) were currently using a modern contraceptive method. The rate of use of modern contraception was significantly lower in women in a union (OR 0.57, p = 0.0002) and in those with age greater than 30 years (OR 0.45, p = 0.0004). Conversely, the rate of use was significantly higher in women whose partners approved contraception (OR 4.14, p = 0.0000) or when family planning was discussed within the couple (OR 1.93, p = 0.0028).

CONCLUSION

The rate of use of modern contraception in Biyem-Assi Health District is relatively high. Women in a union and those aged greater than 30 years turn to be less likely to use a contraceptive method than the rest of the population meanwhile women whose partner approve contraceptive-use or who discuss about family planning with their partners, are most likely to use a contraceptive method than others. To increase the rate of use of modern contraception in Yaoundé-Cameroon, interventions should target more of couples and not women alone.

INTIMATE PARTNER VIOLENCE AND CONTRACEPTIVE USE IN INDIA: THE MODERATING INFLUENCE OF CONFLICTING FERTILITY PREFERENCES AND CONTRACEPTIVE INTENTIONS

Several studies report that women exposed to intimate partner violence (IPV) are less likely to use contraception, but the evidence that violence consistently constrains contraceptive use is inconclusive. One plausible explanation for this ambiguity is that the effects of violence on contraceptive use depend on whether couples are likely to have conflicting attitudes to it. In particular, although some men may engage in violence to prevent their partners from using contraception, they are only likely to do so if they have reason to oppose its use. Using a longitudinal follow-up to the Indian National Family Health Survey (NFHS-2), conducted among a sample of rural, married women of childbearing age, this study investigated whether the relationship between IPV and contraceptive use is contingent on whether women’s contraceptive intentions contradict men’s fertility preferences. Results indicate that women experiencing IPV are less likely to undergo sterilization, but only if they intended to use contraception and their partners wanted more children (Average Marginal Effect (AME)=−0.06; CI=−0.10, −0.01). Violence had no effect on sterilization among women who did not plan to use contraception (AME=−0.02; CI=−0.06, 0.03) or whose spouses did not want more children (AME=−0.01; CI=−0.9, 0.06). These results imply that violence enables some men to resolve disagreements over the use of contraception by imposing their fertility preferences on their partners. They also indicate that unmet need for contraception could be an intended consequence of violence.

Intimate Partner Violence: Associated Factors and Acceptability of Contraception Among the Women

Objective:

To determine the prevalence of various types of domestic violence and to find out the impact of intimate partner violence (IPV) on adoption of contraceptive measures among the women who are victim to this.

Materials and Methods:

This questionnaire-based, cross-sectional study was conducted in the department of obstetrics and gynecology of a tertiary care hospital in Delhi. Four hundred and one postpartum females were randomly selected over a period of 5 months and were questioned about their age, parity, educational status, occupation, husband's education, monthly family income, and, if present, IPV in detail. These study participants were enquired about their contraceptive knowledge and use.

Results:

Sexual violence was seen in 38.4% of the cases, physical violence in 22.4% of the cases, and verbal abuse was seen in nearly 32.7% of the cases. In response to any of the three violence faced, only 23 women (11.79%) reacted by discussing with parents and friends. In 4.61% of the cases, the violence was so severe that she had to inform police. This study showed that higher percentage of women without IPV accepted immediate postpartum contraception methods as compared to those with IPV (35.9% vs. 25%, P = 0.023), but the overall frequency of using contraceptive methods was higher in those with IPV as compared to those without IPV (49% vs. 47%, P = 0.690).

Conclusion:

IPV is associated with increased contraceptive adoption.

Prevalence and correlates of intimate partner violence among family planning clients in Conakry, Guinea

BACKGROUND

Intimate partner violence (IPV) is a global public health problem that affects women's physical, mental, sexual and reproductive health. Very little data on IPV experience and FP use is available in resource-poor settings, such as in West Africa. The aim of this study was to describe the prevalence, patterns and correlates of IPV among clients of an adult Family Planning clinic in Conakry, Guinea.

METHODS

The study data was collected for four months (March to June 2014) from women's family planning charts and from an IPV screening form at the Adult Family Planning and Reproductive Health Clinic of "Association Guinéenne pour le Bien-Etre Familial", a non-profit organization in Conakry, Guinea. 232 women out of 245 women who attended the clinic for services during the study period were screened for IPV and were included in this study.

RESULTS

Of the 232 women screened, 213 (92%) experienced IPV in one form or another at some point in their lifetime. 169 women reported psychological violence (79.3%), 145 reported sexual violence (68.1%) and 103 reported physical violence (48.4%). Nearly a quarter of women reported joint occurrence of the three forms of violence(24%).Half of the IPV positive women were current users of family planning (51.2%) and of these, 77.9% preferred injectable contraceptives. The odds of experiencing IPV was higher in women with secondary or vocational level of education than those with higher level of education (AOR: 8.4; 95% CI 1.2-58.5). Women residing in other communes of Conakry (AOR: 5.6; 95% CI 1.4-22.9) and those preferring injectable FP methods (AOR: 4.5; 95% CI 1.2-16.8) were more likely to experience lifetime IPV.

CONCLUSIONS

IPV is prevalent among family planning clients in Conakry, Guinea where nine out of ten women screened in the AGBEF adult clinic reported having experienced one or another type of IPV. A holistic approach that includes promotion of women's rights and gender equality, existence of laws and policies is needed to prevent and respond to IPV, effective implementation of policies and laws, and access to quality IPV services in Guinea and countries with higher rates of IPV.

Exploring the Paradox of Intimate Partner Violence and Increased Contraceptive Use in sub-Saharan Africa

We question the positive effect of intimate partner violence on women's modern contraceptive use in sub-Saharan Africa found in previous studies. The explanations offered for this counter-intuitive result are either that women make greater efforts to avoid childbearing in conflictual relationships, or that endogeneity bias exists. Endogeneity bias stems from the inability of researchers to attribute a specific cause to one variable when they are unable to control for related missing covariates. Demographic and Health Survey data from 13 countries in sub-Saharan Africa provide evidence for the latter but not the former. Indeed, using simple probit regression models, we observe a positive relationship between intimate partner violence and modern contraceptive use in Burkina Faso, Mali, Nigeria, Tanzania, and Zimbabwe. This effect remains unchanged when controlling for various measures of women's autonomy in the household, showing that these two variables interact with contraceptive use independently. However, the use of recursive bivariate probit and Rosenbaum bounds sensitivity analysis to control for endogeneity biases erodes the initial positive effect in the five countries, although only partially in Burkina Faso. Our research shows that the previously reported findings arise from poor model specification and highlights the need for more appropriate data to assess the effect of intimate partner violence on modern contraceptive use in sub-Saharan Africa.

Associations of marital violence with different forms of contraception: cross-sectional findings from South Asia

OBJECTIVE

To assess associations between marital violence and type of contraception among women in South Asia.

METHODS

Cross-sectional analyses were conducted using marital violence data collected during the most recent Demographic and Health Surveys from Bangladesh (n=3665), India (n=56357), and Nepal (n=3037). Data were pooled to assess associations of marital violence (physical or sexual) with modern contraception use (current spacing or sterilization).

RESULTS

Sexual marital violence was associated with both modern spacing contraception (adjusted odds ratio [AOR] 1.30; 95% confidence interval [CI], 1.13-1.49) and sterilization (AOR 0.79; 95% CI, 0.70-0.88). Sexual violence was reported more often by pill users (9.8% vs 5.5% for non-users) but less often by condom users (4.5% vs 5.8% for non-users).

CONCLUSION

Sexual marital violence might increase use of contraception that need not require husband involvement (pill) but decrease use of methods that require his cooperation (condom) or support for mobility, funds, or time (sterilization).

Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia

OBJECTIVE

To assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.

STUDY DESIGN

Cross-sectional analyses were conducted using the most recent Demographic and Health Surveys from Bangladesh, India and Nepal for married, pregnant women aged 15-49 years who responded to IPV assessments specific to current marriage (N=4738). Adjusted logistic and multinomial regression analyses were conducted with pooled data to assess associations of IPV ever (sexual only, physical only, sexual plus physical or none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional or modern) for the current pregnancy.

RESULTS

IPV was not associated with a mistimed or unwanted pregnancy. Sexual IPV was associated with pre-pregnancy modern contraceptive use (aOR=2.32, 95% CI=1.24, 4.36); sexual plus physical IPV was associated with pre-pregnancy traditional contraceptive use (aOR=1.85, 95% CI=1.12, 3.07). Post hoc analysis of reasons for pre-pregnancy contraceptive discontinuation revealed that women with a history of IPV, particularly sexual IPV, had higher prevalence of contraceptive failure (sexual only, 37.3%; sexual plus physical, 30.9%; physical only, 22.6%; no IPV, 13.6%).

CONCLUSION

Pregnant women who experienced sexual IPV from husbands were more likely to use contraceptives pre-pregnancy but had no reduced risk unintended pregnancy, possibly due to higher rates of pre-pregnancy contraceptive failure among those with this history. These findings suggest that victims of sexual IPV are able to acquire and use family planning services but require more support to sustain effective contraceptive use.

IMPLICATIONS

Family planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy.

The association and a potential pathway between gender-based violence and induced abortion in Thai Nguyen province, Vietnam

Background

Gender-based violence (GBV) has profound adverse consequences on women's physical, mental, and reproductive health. Although Vietnam has high rates of induced abortion and GBV, literature examining this relationship is lacking.

Objective

This study examines the association of GBV with induced abortion among married or partnered women of reproductive age in Thai Nguyen province, Vietnam. In addition, we explore contraceptive use and unintended pregnancy as mediators in the pathway between GBV and induced abortion.

Design and methods

Data were drawn from a cross-sectional survey of 1,281 women aged 18–49 years in four districts of Thai Nguyen province. Bivariate and multivariate logistic regression analyses were applied to examine the associations between lifetime history of GBV, contraceptive use, unintended pregnancy, induced abortion, and repeat abortion, controlling for other covariates.

Results

One-third of respondents had undergone induced abortion in their lifetime (33.4%), and 11.5% reported having repeat abortions. The prevalence of any type of GBV was 29.1% (17.0% physical violence, 10.4% sexual violence, and 20.1% emotional violence). History of GBV was associated with induced abortion (OR=1.61, 95% CI: 1.20–2.16) and repeat abortion (OR=2.22, 95% CI: 1.48–3.32). Physical violence was significantly associated with induced abortion, and all three types of violence were associated with repeat abortion. Abused women were more likely than non-abused women to report using contraceptives and having an unintended pregnancy, and these factors were in turn associated with increased risk of induced abortion.

Conclusions

GBV is pervasive in Thai Nguyen province and is linked to increased risks of induced abortion and repeat abortion. The findings suggest that a pathway underlying this relationship is increased risk of unintended pregnancy due in part to ineffective use of contraceptives. These findings emphasize the importance of screening and identification of GBV and incorporating women's empowerment in reproductive health and family planning programs.

Community-level influences on women's experience of intimate partner violence and terminated pregnancy in Nigeria: a multilevel analysis

Background

Intimate partner violence (IPV) is a major public health problem with serious consequences for women’s physical, mental, sexual and reproductive health. Reproductive health outcomes such as unwanted and terminated pregnancies, fetal loss or child loss during infancy, non-use of family planning methods, and high fertility are increasingly recognized. However, little is known about the role of community influences on women's experience of IPV and its effect on terminated pregnancy, given the increased awareness of IPV being a product of social context. This study sought to examine the role of community-level norms and characteristics in the association between IPV and terminated pregnancy in Nigeria.

Methods

Multilevel logistic regression analyses were performed on nationally-representative cross-sectional data including 19,226 women aged 15–49 years in Nigeria. Data were collected by a stratified two-stage sampling technique, with 888 primary sampling units (PSUs) selected in the first sampling stage, and 7,864 households selected through probability sampling in the second sampling stage.

Results

Women who had experienced physical IPV, sexual IPV, and any IPV were more likely to have terminated a pregnancy compared to women who had not experienced these IPV types.

IPV types were significantly associated with factors reflecting relationship control, relationship inequalities, and socio-demographic characteristics. Characteristics of the women aggregated at the community level (mean education, justifying wife beating, mean age at first marriage, and contraceptive use) were significantly associated with IPV types and terminated pregnancy.

Conclusion

Findings indicate the role of community influence in the association between IPV-exposure and terminated pregnancy, and stress the need for screening women seeking abortions for a history of abuse.