Violence against women and unintended pregnancies in Nicaragua: a population-based multilevel study

The Relationship Between Childhood Abuse and Unintended Pregnancy Among Married Women of Reproductive Age in Bangladesh

Childhood abuse has been associated with adverse medical, psychological, behavioral, and socioeconomic outcomes in adulthood. Despite this, limited research explores the connection between childhood abuse and unintended pregnancy during adulthood. Notably, existing studies have predominantly focused on high-income countries, leaving a significant gap regarding low- and middle-income nations. This study aims to investigate the impact of childhood physical, sexual, and psychological abuse on the prevalence of unintended pregnancies and explore the interaction effects of childhood abuse on unintended pregnancy occurrences. The cross-sectional survey study was conducted between October 2015 and January 2016 in the Chandpur District of Bangladesh. Data were collected from 426 married women aged 15-49 years who had at least one child of six months or younger. The assessment of child abuse pertains to the mother's own experiences of childhood abuse and not abuse inflicted on her child. The prevalence of childhood physical, psychological, and sexual abuse was 37%, 26%, and 15%, respectively. About 25.1% of their most recent pregnancies were unintended. Notably, women with a history of childhood sexual abuse were twice as likely to experience unintended pregnancy compared to those without such a history. Furthermore, a dose-response connection was observed between the combined exposure of all categories of childhood abuse and a higher risk of unintended pregnancy. These findings highlight the need for targeted interventions, such as comprehensive sex education, accessible mental health support, and improved child protection frameworks, to address the potential repercussions of maternal childhood abuse and reduce the incidence of unintended pregnancies.

Intimate partner violence as a determinant of pregnancy termination among women in unions: evidence from the 2016-2018 Papua New Guinea Demographic and Health Survey

There is a demonstrated link between intimate partner violence (IPV) and pregnancy termination, and this association has received much attention in developed settings. Despite the high prevalence of IPV in Papua New Guinea (PNG), little is known about the association between these experiences and pregnancy termination. This study examined the association between IPV and pregnancy termination in PNG. The present study used population-based data from the PNG's first Demographic and Health Survey (DHS) conducted in 2016-2018. The analysis involved women aged 15-49 years who were in intimate unions (married or co-habiting). We used binary logistic regression modelling to analyse the association between IPV and pregnancy termination. Results were reported as crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CIs). Overall, 6.3% of women involved in this study had ever terminated a pregnancy, and 6 in 10 women (61.5%) reported having experienced IPV in the last 12 months preceding the survey. Of those women who experienced IPV, 7.4% had ever terminated a pregnancy. Women who had experienced IPV had a 1.75 higher odds of reporting pregnancy termination (cOR: 1.75; 95% CI: 1.29-2.37) than women who did not experience IPV. After controlling for theoretically and empirically relevant socio-demographic and economic factors, IPV remained a strong and significant determinant of pregnancy termination (aOR: 1.67, 95% CI: 1.22-2.30). The strong association between IPV and pregnancy termination among women in intimate unions in PNG calls for targeted policies and interventions that address the high prevalence of IPV. The provision of comprehensive sexual reproductive health, public education, and awareness creation on the consequences of IPV, regular assessment, and referral to appropriate services for IPV may reduce the incidence of pregnancy termination in PNG.

Magnitude of Spousal Violence and Associated Factors among Midlife Women in Ethiopia

Background

Intimate partner violence is the most common form of gender-based violence and has enormous maternal health consequences. There is limited evidence concerning the magnitude and determinants of intimate partner violence amongst midlife women. Thus, this study aimed to determine the extent of and the factors contributing to spousal violence amongst midlife Ethiopian women.

Methods

The 2016 Ethiopia Demographic and Health Survey (EDHS) data were examined, and a sample of 1628 ever-married midlife women was included. The analysis was performed using SPSS version 20. Bivariate and multivariable logistic regression analysis was conducted to examine the determinants of intimate partner violence. All statistical significance was declared at p value < 0.05.

Results

The prevalence of spousal violence among midlife women in Ethiopia was 31.8%. Age of women, divorced, and working status were significantly associated with spousal violence. The likelihood of spousal violence is increase among midlife women who had no formal education, less decision-making power in household, and had partner who had drinking habit.

Conclusion

This study showed that nearly one-thirds of midlife Ethiopian women have experienced spousal violence in their lifetime. Empowering midlife women by giving them decision-making tools and educating them to deal with, and prevent spousal violence may be effective strategies in reducing this problem.

Intimate Partner Violence and Pregnancy Termination Among Women in Sub-Saharan Africa

Intimate partner violence (IPV) is predominant in sub-Saharan Africa (SSA) and has serious adverse effects on the physical, psychological, and reproductive health of those who experience it. For reproductive health outcomes, experiencing IPV has been linked to higher odds of unintended pregnancies that can result in abortion. Hence, we examined the association between IPV and pregnancy termination among women in SSA. This study used data from the Demographic and Health Surveys (DHSs) of 25 countries in SSA, which adopted a cross-sectional study design. Bivariable and multivariable binary logistic regression models were used to examine the association between IPV and pregnancy termination. The results were presented as crude odds ratios (cORs) and adjusted odds ratios (aORs), with 95% confidence intervals (CIs). The prevalence of IPV and pregnancy termination were 40.8% and 16.5%, respectively. The odds of pregnancy termination was higher among women who had experienced IPV [cOR = 1.57, 95% CI = 1.52-1.61] compared to those who had never experienced IPV. This persisted after controlling for potential confounders [aOR = 1.56, 95% CI = 1.51-1.61]. At the country level, IPV had a significant association with pregnancy termination in all the countries considered, except Sierra Leone and Namibia. These findings highlight the need for laws and policies to protect women from IPV in SSA, especially in the countries that recorded higher odds of IPV and pregnancy termination.

Men's reproductive coercion of women: prevalence, experiences, and coping strategies-a mixed method study in urban health facilities in León, Nicaragua

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.

Individual and community factors associated with unintended pregnancies among women of advanced reproductive age in Nigeria

Studies have examined individual and community level factors associated with unintended pregnancies. However, existing studies tends to focus the general population of reproductive age women without isolating women of advanced reproductive age (women at the age range of 35-49 years) for specific research attention. There is need for specific attention on this group of women because pregnancies among them whether intended or unintended elevate obstetric risks for both mother and child. This study examines associated individual and community factors of unintended pregnancies among women of advanced reproductive age in Nigeria. Data were extracted from the 2018 Nigeria Demographic and Health Survey. A weighted sample of 12,509 women was analyzed. Three multilevel logistic regression models were estimated. The study revealed a 10.3% prevalence of unintended pregnancies. Individual characteristics such as maternal age, number of living children, delayed marriage, and community characteristics such as high community poverty and high community unmet contraceptive need were significantly associated with unintended pregnancies. Variations in unintended pregnancies across the communities were more attributable to individual factors. Interventions should develop specific strategies tailored toward women of advanced reproductive age.

Survival analysis and prognostic factors of time to first domestic violence after marriage among Nigeria, Kenya, and Mozambique women

OBJECTIVES

How soon an ever-married woman falls a victim of domestic violence after marriage is not documented in Africa. This study sought to assess the timing of first domestic violence (FDV) against women after marriage and determined the factors associated with the timings in Nigeria, Kenya, and Mozambique.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data of 29,793 ever-married women of reproductive age consisting of 21,564, 4237 and 3992 from Demographic and Health Survey conducted in Nigeria (2013), Kenya (2014) and Mozambique (2011), respectively, were used. The timing of FDV was the time interval between marriage date and date of the FDV for those with reported violence but censored as the time interval between marriage date and the survey date for those without domestic violence. Survival analysis techniques were used to assess the timing and the factors influencing the timing at (P = 0.05).

RESULTS

The lifetime prevalence of domestic violence among the ever-married women in Nigeria, Kenya and Mozambique was 15.4%, 39.0% and 31.0%, respectively. The overall median time to FDV was 3 years. The risk of FDV was twice higher in Kenya (adjusted hazard ratio (aHR) = 1.934; 95% confidence interval (CI): 1.729-2.132) and 15% higher in Mozambique (aHR = 1.156; 95% CI: 1.156-1.223) than in Nigeria. The hazard of domestic violence was significantly higher among separated/divorced women across the three countries (aHR = 1.326; 95% CI: 1.237-1.801). Other factors associated with the timing of FDV against women were respondents' education, age at first marriage, region and location of residence, religion, ethnicity, employment status, wealth quintile, spouse consuming alcohol and husbands' educational attainment.

CONCLUSIONS

Domestic violence against married women by their intimate partners is prevalent across Mozambique, Nigeria and Kenya, with earlier occurrences in Kenya and Mozambique. Age at first marriage, education factors, religion, ethnicity and region of residence in each country affected the timing of the first incidence of domestic violence.

Is unintended birth associated with physical intimate partner violence? Evidence from India

A growing number of studies have tested the association between intimate partner violence (IPV) and the unintendedness of pregnancy or birth, and most have suggested that unintendedness of pregnancy is a cause of IPV. However, about nine in every ten women face violence after delivering their first baby. This study examined the effects of the intendedness of births on physical IPV using data from the National Family Health Survey (2015-16). The multivariate logistic regression model analysis found that, compared with women with no unwanted births (2.9%), physical IPV was higher among those women who had unwanted births (6.9%, p<0.001), followed by those who had mistimed births (4.4 %, p<0.001), even after adjusting for several women's individual and socioeconomic characteristics. Thus, the reduction of women with mistimed and unwanted births could reduce physical IPV in India. The study highlights the unfinished agenda of family planning in the country and argues for the need to integrate family planning and Reproductive, Maternal and Child Health Care (RMNCH) services to yield multi-sectoral outcomes, including the elimination of IPV.

"We keep quiet": exploring the context of pregnancy intention in a low-resource community in Ecuador

Unintended pregnancies are both a consequence and a cause of socioeconomic inequality. Family planning prevents unintended pregnancy and reduces health disparities. The purpose of this study is to describe the structural, social, economic context of pregnancy intention in a peri-urban, diverse, low-resource community in Ecuador. A qualitative descriptive methodology was used. Semi-structured individual interviews were performed with 19 female participants of reproductive age. Interviews were professionally transcribed in Spanish, translated into English, and analysed in MAXQDA using content analysis. The majority of pregnancies were reported as unintended and four themes emerged to describe the context. (1) Women's autonomy is limited by men, (2) Women keep quiet, (3) Systems failed women, and (4) Building resilience. Health systems, gender-based violence, limited education and financial means, and policies yet to be enforced served as barriers to both empowerment and family planning. In spite of this, many women were able to transition into safety, and prevent or delay pregnancy with new partners. Ecuador has made significant economic gains in the past two decades, but these findings suggest that inequality persists in some regions of Ecuador. The women in this study report needing to feel safe, productive and valued to plan their families. Public health professionals need to involve multi-sectors in solutions to reduce health disparities and address determinants of maternal/child health including gender-based violence, economic and systemic limitations. DOI:10.1080/26410397.2019.1686198

Do Community Characteristics Influence Unintended Pregnancies in Kenya?

Background

Most existing studies on unintended pregnancies tend to examine the influence of individual socio-demographic and health characteristics without sufficient attention to community characteristics. This study examines community characteristics influencing unintended pregnancies in Kenya.

Methods

Data were extracted from the 2014 Kenya Demographic and Health Survey (KDHS). The outcome variable was unintended pregnancy. The explanatory variables were selected individual and community level variables. The Multilevel mixed-effects logistic regression was applied.

Results

Findings show 41.9% prevalence of unintended pregnancies. Community characteristics such as community education, community timing for initiation of childbearing, community fertility norms, and community media exposure significantly influence the likelihood of unintended pregnancies. The Intra-Cluster Correlation (ICC) provided evidence that community characteristics had effects on unintended pregnancies.

Conclusion

There is evidence that community characteristics influence the prevalence of unintended pregnancies in Kenya. Community sensitisation and mobilisation should be central to all efforts aiming to reduce prevalence of unintended pregnancies.

Prevalence of unmet need for contraception and its association with unwanted pregnancy among married women in Angola

Background

Unmet need for contraception and unwanted pregnancy are recognised as significant barriers to promoting women’s reproductive health and well-being. Currently there is no research evidence on these two crucial indicators of reproductive care in Angola. Therefore, we conducted this study with the objectives of exploring the current prevalence of unmet need for contraception and unintended pregnancy as well as their relationship among married women in Angola.

Methods

This study was based on cross-sectional data from Angola Demographic and Health Survey (DHS) conducted in 2015–16. Participants were 7,808 married women aged 15–49 years. Unwanted pregnancy was measured in terms of the mistimed and unintended conception for the last-born child. Unmet need for contraception included those who reported unmet need for spacing and limiting. Data were analysed using bivariate and multivariable techniques.

Results

The combined prevalence of mistimed and unwanted pregnancy was 38.3% (95%CI = 35.9–40.7), and that of unmet need for contraception for spacing and limiting was 51.7% (49.9–53.5). Among the 18 regions, Luanda had the highest prevalence of unmet need for contraception and of unwanted pregnancy with the prevalence being higher than more than one-third of the women. Multivariable analysis significantly revealed a significantly positive association between unmet need and unwanted pregnancy. In all the models, the odds of unwanted pregnancy were found to be as high as four times among women with unmet need compared with those had no unmet need. Compared to women who had no unmet need, those who had unmet need had respectively four (OR = 4.380; 95%CI = 3.690–5.198) and seven (OR = 6.951; 95%CI = 4.642–10.410) times higher odds of experiencing unwanted pregnancy.

Conclusion

This study concludes that the prevalence of unmet need for contraception and unwanted pregnancy are high with significant disparities across the regions. Women in the capital city had the highest prevalence of both unmet need for contraception and unwanted pregnancy. Although the data were cross-sectional and do not indicate causal relationships, the findings showed a strong positive association between unmet need for contraception and unwanted pregnancy. However, it is recommended to conduct further studies to replicate the findings and to explore the influence behavioural and cultural practices on unwanted pregnancy.

Women decision-making capacity and intimate partner violence among women in sub-Saharan Africa

Background

Violence against women is a common form of human rights violation, and intimate partner violence (IPV) appears to be the most significant component of violence. The aim of this study was to examine the association between women decision-making capacity and IPV among Women in Sub-Saharan Africa. The study also looked at how socio-demographic factors also influence IPV among Women in Sub-Saharan Africa.

Methods

The study made use of pooled data from most recent Demographic and Health Survey (DHS) conducted from January 1, 2010, and December 3, 2016, in 18 countries in Sub-Saharan Africa. For the purpose of the study, only women aged 15–49 were used (N = 84,486). Univariate and multivariate logistic regression models were used to investigate the relationship between the explanatory variables and the outcome variable.

Results

The odds of reporting ever experienced IPV was higher among women with decision-making capacity [AOR = 1.35; CI = 1.35–1.48]. The likelihood of experiencing IPV was low among young women. Women who belong to other religious groups and Christians were more likely to experience IPV compared to those who were Muslims [AOR = 1.73; CI = 1.65–1.82] and [AOR = 1.87; CI = 1.72–2.02] respectively. Women who have partners with no education [AOR = 1.11; CI = 1.03–1.20], those whose partners had primary education [AOR = 1.34; CI = 1.25–1.44] and those whose partners had secondary education [AOR = 1.22; CI = 1.15–1.30] were more likely to IPV compared to those whose partners had higher education. The odds of experiencing IPV were high among women who were employed compared to those who were unemployed [AOR = 1.33; CI = 1.28–1.37]. The likelihood of the occurrence of IPV was also high among women who were cohabiting compared to those who were married [AOR = 1.16; CI = 1.10–1.21]. Women with no education [AOR = 1.37; CI = 1.24–1.51], those with primary education [AOR = 1.65; CI = 1.50–1.82] and those with secondary education [AOR = 1.50; CI = 1.37–1.64] were more likely to experience IPV compared to those with higher education. Finally, women with poorest wealth status [AOR = 1.28; CI = 1.20–1.37], those with poorer wealth status [AOR = 1.24; CI = 1.17–1.32], those with middle wealth status [AOR = 1.27; CI = 1.20–1.34] and those with richer wealth status [AOR = 1.11; CI = 1.06–1.17] were more likely to IPV compared to women with richest wealth status.

Conclusion

Though related socio-demographic characteristics and women decision-making capacity provided an explanation of IPV among women in sub-Saharan Africa, there were differences in relation to how each socio-demographic variable predisposed women to IPV in Sub-Saharan Africa.

Intimate partner violence as a predictor of antenatal care service utilization in Honduras

OBJECTIVE

To describe the relationship between exposure to physical and/or sexual intimate partner violence (IPV) and indicators of antenatal care (ANC) service utilization among Honduran women of reproductive age.

METHODS

Data from the 2011-2012 Honduras Demographic and Health Survey were analyzed to describe the relationship between self-reported exposure to IPV and two ANC outcomes: (1) sufficient ANC visits (defined by the Honduran Ministry of Health as five or more visits) and (2) early ANC initiation (within the first trimester). Multiple logistic regression was used to estimate effects of physical and sexual IPV on the outcomes, controlling for women's age, education, literacy, residence, household size, religion, parity, wealth, husband's age, and husband's education.

RESULTS

Of women who were married, had at least one living child 5 years or younger, and completed the IPV module (N = 6 629), 13.5% of them reported any physical IPV, and 4.1% reported both physical and sexual IPV. There was no significant association between IPV and early ANC; however, a significant relationship between IPV and sufficient ANC was found. Women who experienced any physical IPV (adjusted odds ratios (aOR) = 1.25; 95% confidence interval (CI): 1.00-1.56) or sexual IPV (aOR = 1.53; 95% CI: 1.08-2.16) were, respectively, 25% and 53% more likely to receive insufficient ANC.

CONCLUSIONS

Honduras has one of highest rates of interpersonal violence of any nation in the world. In Honduras, IPV is a contributor to this broader category of interpersonal violence as well as a risk factor for insufficient ANC. Our findings suggest that universal IPV screening during ANC as well as future initiatives aimed at reducing IPV might improve ANC utilization in the country.

Transforming narratives into educational tools: the collaborative development of a transformative learning tool based on Nicaraguan adolescents' creative writing about intimate partner violence

The use of narrative has become increasingly popular in the public health, community development, and education fields. Via emotionally engaging plotlines with authentic, captivating characters, stories provide an opportunity for participants to be carried away imaginatively into the characters' world while connecting the story with their own lived experiences. Stories have been highlighted as valuable tools in transformative learning. However, little published literature exists demonstrating applications of stories in group-based transformative learning curricula. This paper describes the creation of a narrative-based transformative learning tool based on an analysis of Nicaraguan adolescents' meaning-making around intimate partner violence (IPV) in their creative narratives. In collaboration with a Nicaraguan organization, US researchers analyzed a sample of narratives ( n = 55; 16 male-authored, 39 female-authored) on IPV submitted to a 2014 scriptwriting competition by adolescents aged 15-19. The data were particularly timely in that they responded to a new law protecting victims of gender-based violence, Law 779, and contradicted social-conservative claims that the Law 779 destroys family unity. We incorporated results from this analysis into the creation of the transformative learning tool, separated into thematic sections. The tool's sections (which comprise one story and three corresponding activities) aim to facilitate critical reflection, interpersonal dialogue, and self- and collective efficacy for social action around the following themes derived from the analysis: IPV and social support; IPV and romantic love; masculinity; warning signs of IPV; and sexual abuse. As a collaboration between a public health research team based at a US university and a Nicaraguan community-based organization, it demonstrates the potential in the age of increasingly smooth electronic communication for novel community-university partnerships to facilitate the development of narrative-based tools to support transformative learning.

Domestic Violence among Pregnant Mothers in Northwest Ethiopia: Prevalence and Associated Factors

Background. Domestic violence against women is a serious public health concern and human rights violation among pregnant mothers because of its negative effect on the life of both the mother and the fetus. Thus, the aim of this study was to assess the prevalence of domestic violence and associated factors among pregnant women. Methods. An institution based quantitative cross-sectional study was conducted among 418 women using a systematic random sampling technique. Binary logistic regression analysis and adjusted odds ratio with 95% confidence interval were used to identify the associated factors. Results. Overall, the prevalence of domestic violence was found to be 25.4%. Of this, the prevalence of psychological, physical, and sexual violence was 24.5%, 8.1%, and 2.4%, respectively. Low educational status (AOR = 4.59, CI: 1.496, 14.070), rural residency (AOR = 5.53, CI: 2.311, 13.249), unplanned pregnancy (AOR = 4.34, CI: 2.345, 8.020), and late initiation of antenatal care (AOR = 5.41, CI: 1.493, 19.696) were factors associated with domestic violence at p value < 0.05. Conclusion. Overall, more than quarter of the study participants had experienced domestic violence. Lower educational status, rural residency, unplanned pregnancy, and late initiation of antenatal care were factors associated with domestic violence. Thus, the authors suggest strengthening provision of women’s reproductive health information.

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.

Who is using the morning-after pill? Inequalities in emergency contraception use among ever partnered Nicaraguan women; findings from a national survey

INTRODUCTION

Few studies have described the inequalities in hormonal emergency contraception (HEC) use in developing countries. Thus, the main aim of this manuscript is to study socio-demographic inequalities in HEC use among Nicaraguan women, and to study if inequalities in HEC use arise from exposure to different forms of intimate partner violence (IPV).

METHODS

Data from a national cross-sectional study conducted from 2006 to 2007 was used. This study included data from 8284 ever partnered, non-sterilized women. Separate multivariate logistic regressions with each form of IPV were conducted to study how different forms of IPV were associated with HEC. Women's age, residency, education, socioeconomic status, parity, and current use of reversible contraception were included in the multivariate logistic regressions to obtain adjusted odds ratios showing inequalities in HEC use.

RESULTS

Six percent of the women had ever used HEC (95% CI 5.1-6.9). Multivariate analyses showed that urban residency, higher education, and higher socioeconomic status were significantly associated with higher odds of ever using HEC, and age was associated with decreased odds of HEC use. A key finding of this study is that after controlling for socio-demographic factors, the odds of using HEC were higher for those women ever exposed to emotional IPV (AOR 1.58, 95% CI 1.16-2.00), physical IPV (AOR 1.82, 95% CI 1.30-2.55), sexual IPV (AOR 1.63, 95% CI 1.06-2.52), and controlling behavior by partner (AOR 1.51 95% CI 1.13-2.00) than those not exposed.

CONCLUSIONS

This study provides sound evidence supporting the hypothesis that there are inequalities in HEC use even in countries where inequalities in use to other forms of contraceptive technology has been reduced. HEC use among Nicaraguan women is strongly influenced by individual factors such as age, residency, educational level, socioeconomic status, and exposure to different forms of IPV. It is paramount that actions are taken to diminish these gaps.