Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis

Disparities in adult women's access to contraception during COVID-19: a multi-country cross-sectional survey

During the COVID-19 pandemic, family planning services over the world have been disrupted. There are still uncertainties about the impact on access to contraception, particularly among marginalised populations. This study aimed to assess the effect of COVID-19 on women's access to contraception, focusing on those experiencing loss of income and self-isolation. The International Sexual Health and Reproductive Health (I-SHARE) survey collected data from 5,216 women in 30 countries. Multivariable logistic regression was conducted to assess the association between loss of income during the pandemic, self-isolation and reduced access to contraception. Women experiencing loss of income and those who had self-isolated had reduced access to contraception (respectively aOR 2.3 and 1.7, for both p < 0.001). Most women reported inaccessibility of health centres, fear of COVID-19, and stockouts as reasons for reduced access. This study highlights how socio-demographic differences may have impacted access to contraception during the pandemic. People experiencing income loss and self-isolation might have faced increased barriers to family planning during the pandemic. Contraception should be prioritised in times of crisis: when planning services, financial support, telehealth and other measures should be implemented in order to increase access and reduce inequalities.

Association between physical intimate partner violence and postpartum contraceptive use in the United States-evidence from PRAMS 2016-2021

OBJECTIVE

Intimate Partner Violence (IPV) continues to be a major global public health concern, impacting physical and psychological well-being of individuals, including their reproductive and sexual health. The objective of this study is to examine the association between physical intimate partner violence and the utilization of contraception during the postpartum period in the United States.

METHOD

This study used data from the CDC's Pregnancy Risk Assessment Monitoring System (PRAMS) survey study phase 8, covering 2016-2021. The sample included 165,204 women reporting physical IPV during pregnancy or 12 months before their last pregnancy and their postpartum contraceptive use. Descriptive, bivariate, and logistic regressions were used to analyze the relationship between IPV and postpartum contraceptive use, adjusting for relevant factors and addressing sampling weights.

RESULTS

The study found a 3.2% prevalence of physical IPV, with state variances ranging from 2.2% to 5.5%. Among women who experienced physical IPV, 91.0% used contraception, compared to 94.5% of those who did not experience physical IPV. Experiencing physical IPV significantly decreased the likelihood of using any postpartum contraceptive method by 42% (aOR: 0.58; 95% CI: 0.48-0.70) compared to those who did not experience physical IPV during the same period, after adjusting for covariates. Factors that increased the probability of using contraception during the postpartum period included women's higher educational attainment, being married or cohabitating, being employed anytime during pregnancy, and having an unintended last pregnancy.

CONCLUSION

This study highlights the significant association between physical IPV and reduced use of postpartum contraception in the United States. It calls for the integration of IPV considerations into public health policies and clinical initiatives to improve maternal well-being.

Preexposure Prophylaxis and Intimate Partner Violence Among Gay, Bisexual, and Other Men Who Have Sex With Men: A Global Scoping Review of the Literature

ABSTRACT

Men who have sex with men (MSM) experience intimate partner violence (IPV) and are at an elevated risk of HIV acquisition. Preexposure prophylaxis (PrEP) is an effective preventative measure against HIV. However, its adoption and consistent use among MSM, especially those experiencing IPV, is low. This scoping review summarizes literature relevant to HIV PrEP, focusing on MSM who experience IPV. Of the 110 studies identified, eight eligible studies met the inclusion and exclusion criteria. Most of these were conducted in the United States, focusing exclusively on adult MSM. Most studies evaluated daily oral PrEP. The studies assessed the impact of IPV on respondent's knowledge, willingness, preference, and PrEP use and revealed varying levels of association between IPV and PrEP. Future research is essential to develop practice guidelines and policy to enhance PrEP uptake in this vulnerable population.

Experience of Pelvic Examination and Uptake of Gynecological Care Following Domestic or Sexual Violence: a Systematic Review

Pelvic examination, a routine practice for gynecological care, can cause anxiety and be considered traumatic. This study aimed to define the association between domestic or sexual violence and the experience of pelvic examination, as well as the uptake of gynecological care following domestic or sexual violence. Pubmed, Cochrane Library, ScienceDirect, and Google Scholar were searched, up to April 30, 2023. Cohort, cross-sectional, case-control studies and controlled trials assessing perception of pelvic examination or the use of gynecological care for women with a history of violence were selected and analyzed. Each study underwent a descriptive analysis and was assessed for bias using the Newcastle-Ottawa scale and the RoB2 tool. Twenty-three articles met the inclusion criteria. Eleven studies, including 7,329 women, investigated the experience of pelvic examination following lifetime or childhood sexual violence. Most reported an association between violence and adverse experiences of pelvic examination, such as discomfort, anxiety, distress, and pain perceptions. Ten studies, including 9,248 women, investigated the uptake of gynecological care following domestic or sexual violence and reported mixed results, such as a decreased or an increased uptake, particularly for acute symptoms. Two studies, including 1,304 women, examined both outcomes. The present study highlights the association between violence and adverse experiences of pelvic examination, as well as mixed results on the uptake of gynecological care. It argues for the necessity to screen for violence in consultations, particularly when considering a pelvic examination, to guarantee the utility of pelvic examinations, and to consider the traumatic impact of sexual violence in care.

Sexual choking/strangulation and its association with condom and contraceptive use: Findings from a survey of students at a university in the Midwestern United States

INTRODUCTION

Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condoms and other contraceptives.

METHODS

We administered a cross-sectional campus-representative survey to 4989 undergraduate students at a large public Midwestern US university.

RESULTS

Half of respondents (n = 1803) had ever been choked during sex. Having been choked was associated with a significantly lower likelihood of event-level condom use (OR = 0.32 [0.19, 0.54] for >5 times lifetime choking among men and OR = 0.35 [0.27, 0.45] for >5 times lifetime choking among women compared to those with no choking experiences) and in the past 6 months (OR = 0.42 [0.24, 0.72] for >5 times lifetime choking among men and OR = 0.59 [0.43, 0.81] for >5 times lifetime choking among women compared to those with no choking experiences). Also, having ever been choked was associated with a significantly greater likelihood of having used an implant/intra-uterine device in the past 6 months (OR = 1.85 [1.28, 2.68] for >5 times lifetime choking compared to those with no choking experiences).

CONCLUSION

Recognition that sexual choking is prevalent among young people has only recently emerged and educational programs are lacking. Study findings could be used to engage people in discussions about choking in relation to gender, power, and reproductive health agency.

Multi-stakeholder analysis of needs, perceptions, and sociocultural influences on multipurpose prevention technologies (MPT) in India

BACKGROUND

To ensure the acceptability and effectiveness of potential Multipurpose Prevention Technologies (MPTs), understanding user needs, and preferences are crucial to inform the design of MPTs. This article aims to explore the perceptions towards potential MPT use and to explore the needs of multiple stakeholders in India within their social and behavioural contexts.

METHODS

A qualitative multicentric study was conducted in three Indian states-Maharashtra, Karnataka, and Tamil Nadu. The study involved a total of 222 interviews: 77 in-depth interviews with women, including those from the general population, HIV-positive women, and street and brothel-based Female Sex Workers (FSWs); 84 in-depth interviews with men and 61 key informant interviews were conducted. Three focus group discussions were conducted with FSWs. Interviews explored perceptions of the potential MPTs, needs, and factors that may potentially affect their use and adherence. Interviews and FGDs were transcribed and translated verbatim. Thematic analysis approach was used to analyse the data in NVivo version 8.

RESULT

The following themes highlight the need and preferences among women for the potential MPT product: 1) Overall perceptions about new MPT, 2) People at high risk need long acting products, 3) Condom versus new MPT: potential of MPT, 4) Women empowerment through MPTs 5) Secrecy and confidentiality 6) Non-stigmatising MPT product positioning.

CONCLUSION

Several stakeholders in this study expressed their need for new MPTs, but concerns regarding confidentiality, privacy, stigma and, adherence were identified. Besides efficacy, characteristics such as the size, packaging, formulation, and texture of MPTs, should be taken into account when designing the MPT products, also considering the needs of women, specially, female sex workers.

State Divorce Laws, Reproductive Care Policies, and Pregnancy-Associated Homicide Rates, 2018-2021

Importance

Barriers to divorce and reproductive health care can threaten the health and safety of pregnant and recently pregnant females.

Objective

To examine state laws about divorce, reproductive health care (access to contraception, family planning services, and abortion), and pregnancy-associated homicide rates in US states over a 4-year period (2018-2021).

Design, Setting, and Participants

In this cross-sectional study, bivariate tests and regressions were used to analyze crude rates of pregnancy-associated homicide from the National Violent Death Reporting System in 181 state-years for calendar years 2018 to 2021, with analyses conducted on September 8, 2024.

Exposures

Access to divorce while pregnant and reproductive health care over a 4-year period in the US.

Main Outcomes and Measures

Primary outcomes (pregnancy-associated homicide by intimate partners vs non-intimate partners and rates among younger Black, Hispanic, and White females) were assessed using the National Violent Death Reporting System. Negative binomial regression was used to test 2 hypotheses: access to divorce while pregnant and reproductive health care are associated with pregnancy-associated homicide rates.

Results

Individual level data, including exact sample size, were not available in this study of state-level homicide rates. Negative binomial regression analysis showed that, where finalizing divorce during pregnancy is prohibited, intimate partner homicide rates (incidence rate ratio [IRR], 2.11; 95% CI, 1.09-4.08; P = .03) and rates among younger (age 10-24 years) White females (IRR, 2.39; 95% CI, 1.12-5.09; P = .02) were significantly higher. In state-years with greater access to reproductive health care, rates were significantly lower for non-intimate partner homicide (IRR, 0.92; 95% CI, 0.87-0.98; P = .01) and for younger Black females (IRR, 0.91; 95% CI, 0.87-0.96; P < .001) and younger Hispanic females (IRR, 0.87; 95% CI, 0.79-0.96; P = .007).

Conclusions and Relevance

In this cross-sectional study of pregnancy-associated homicide rates, barriers to divorce were associated with higher homicide rates and access to reproductive health care was associated with lower homicide rates. This study highlights the association between state legislation and pregnancy-associated homicide in the US, which is important information for policymakers.

Investigating the relationship between health and gender equality: What role do maternal, reproductive, and sexual health services play?

Examining the causal nexus between health services and gender equality is of paramount significance in policy formulation and academic inquiry. This paper concentrates on maternal, sexual, and reproductive health, offering a critical narrative review of empirical research exploring the causal relationship between enhanced women's health, stemming from either overall healthcare amelioration or specific interventions, and broader gender equality objectives. A conceptual framework is devised to elucidate the causal pathways between health and gender equality across various dimensions. The final review encompasses 30 empirical papers, revealing both direct and indirect effects of improved maternal, reproductive, and sexual health outcomes on labour participation and educational investment, with fertility decisions and autonomy serving as primary intermediary factors. Evidence predominantly indicates that interventions like contraception, family planning, and abortion policies yield enduring effects beyond health, influencing reproductive choices. Specific medical procedures, such as caesarean deliveries and sterilization, also impact fertility and labour market outcomes. Furthermore, public healthcare infrastructure contributes to combating gender-based violence by facilitating incident reporting and access to protection. Recognizing, documenting, and monitoring these co-benefits arising from improved women's health are pivotal for delineating future health sector priorities and advancing the global gender equality and sustainable development agenda.

Power to choose? Examining the link between contraceptive use decision and domestic violence

Contraception is a crucial tool that empowers women to control their bodily autonomy. Concurrently, domestic violence remains a pressing public health issue, depleting women's autonomy. We establish a causal link between a woman's contraceptive use decision and the occurrence of intimate partner violence. We use an instrumental variable approach to estimate our causal effects by utilizing nationally representative data for India. Using exogenous variation in the neighbourhood average of women's exposure to family planning messages via radio, we find that if a woman independently makes the decision to use contraceptives, she is at a significantly higher risk of physical, sexual and emotional domestic violence. We estimate the bounds of our effects by assuming the IV to be plausibly exogenous, where we relax the exogeneity condition. Our findings underscore the importance of reproductive health in initiatives that reduce domestic violence and targeted policies that provide support to younger and employed women and those from backward caste and rural areas.

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.

Prevalence and severity of physical intimate partner violence during pregnancy among adolescents in eight sub-Saharan Africa countries: A cross-sectional study

Globally, intimate partner violence (IPV) is highly prevalent, with adolescents being particularly vulnerable, especially during pregnancy. This study examines the prevalence and severity of physical IPV among pregnant adolescents in sub-Saharan Africa (SSA). We analyzed data from Demographic Health Surveys collected between 2017-2021 from eight SSA countries, involving 2,289 ever-pregnant adolescents aged 15-19. Physical IPV during pregnancy was defined as experiencing physical harm while pregnant by a husband, former partner, current boyfriend, or former boyfriend. Severity of physical IPV included experiences such as kicking, choking, weapon threats, and serious injuries. Logistic regression analysis was conducted, with results presented as unadjusted and adjusted odds ratios with 95% confidence intervals. The prevalence of physical IPV during pregnancy among adolescents in the eight SSA countries ranged from 2.9% to 12.6%, with 5.6% experiencing severe lifetime physical IPV and 6.3% severe physical injuries. We found a strong association between physical IPV during pregnancy and severe lifetime physical IPV (aOR: 6.8, 95% CI: 4.5-10.4) and severe injuries (aOR: 9.2, 95% CI: 6.0-14.2), even after adjusting for covariates. Physical IPV during pregnancy is common among adolescents in SSA and is associated with severe physical lifetime IPV. Addressing this issue in low-resource settings requires collaborative efforts among community stakeholders, health system practitioners, and policymakers to protect vulnerable adolescent girls during pregnancy.

Using Vignettes to Gain Insights Into Social Norms Related to Voluntary Family Planning and Gender-Based Violence in South Sudan

Social norms are the shared expectations about behaviors that are held within collective groups. These differ from attitudes and beliefs, which are individually held. In South Sudan, social norms can affect the use of voluntary family planning and reproductive health (FP/RH); some of these norms even present risks for women seeking FP/RH care and their FP/RH providers. This cross-sectional, descriptive study conducted in 5 counties in South Sudan used vignettes as a qualitative method to explore social norms related to FP/RH and decisions related to contraceptive use and gender-based violence. Participants were asked to respond to vignettes about a fictional couple during various life stages of care-seeking. Vignettes allow respondents to share their opinions and feelings without directly speaking about their own experiences. Respondents included community members, FP/RH providers, and key influencers (e.g., religious leaders, traditional leaders, elders). The study identified restrictive social norms related to FP/RH, including entrenched, dominant gender roles (i.e., requiring male consent to use contraceptives) and risk for the woman and her provider if she accesses FP/RH services. Of note, supportive social norms are gaining acceptance regarding women's voice and agency; it was found that some women can negotiate their reproductive choice with their partners and participate in planning their families, which has not always been a widely accepted norm. The use of vignettes can lead to a better understanding of the challenges and provide insights on effective implementation approaches. It is essential for programs working to promote the use of FP/RH services in South Sudan to consider the challenges presented by social norms. Findings from this study were shared with stakeholders and communities to codesign interventions aimed at increasing the use of FP/RH services. Additionally, the dialogue stimulated by this study should lead to an organic transformation toward supportive social norms through collective agency.

"I have come to remove it because of heavy bleeding": a mixed-methods study on early contraceptive implant removal and the underlying factors in eastern Uganda

BACKGROUND

Early contraceptive implant removal without intentions to conceive predisposes women to unintended pregnancies.. Some of the unintended pregnancies end in unsafe abortions which further increases the risk of maternal mortality and morbidity. Therefore, we assessed the proportion of women who had early contraceptive implant removal. We also explored the reasons for early contraceptive implant removalamong women at Mbale Regional Referral Hospital in eastern Uganda.

METHODS

We conducted a sequential explanatory mixed methods study at Mbale Regional Referral Hospital between November 2022 to December 2022. For quantitative data, we performed a secondary analysis on data extracted from the integrated family planning registers. We used systematic random sampling to select 600 clients' serial numbers from the registers. The outcome variable was early contraceptive implant removal defined as removal of the implant by the woman before 18 months from the time of insertion. For qualitative data, we conducted 11 in-depth interviews among women who had come for contraceptive implant removal at the family planning clinic. We also conducted two key informant interviews with midwives working at the family planning unit. Quantitative data were analysed using Stata version 14.0 (Stata Corp LLC, College Station, Texas, USA) while qualitative data were analysed by thematic content analysis.

RESULTS

In this study, 15% (91/600) of the women discontinued contraceptive implants within 12 months, 29% (175/600) within 18 months, 38% (230/600) within 24 months and 40% (240/600) within 36 months of insertion. Among the women who discontinued contraceptive implant use, only 6.7% (40/600) switched to another family planning method. Out of the 175 women who removed contraceptive implants early, side effects 61.1% (107/175) desire to conceive 53.1% ( 93/175),, and gender-based violence 8.6% (15/175) were the major reasons for removal. From the qualitative interviews, the major reasons for early contraceptive implant removal were side effects such as heavy menstrualbleeding.

CONCLUSION

A third of women discontinued contraceptive implant use within 18 months. Addressing concerns regarding side effects and male partner disapproval of modern contraceptives may improve continued use of implants.

Intimate partner violence and postpartum healthcare access in Kenya: a cross-sectional study

BACKGROUND

Intimate partner violence (IPV) impacts physical health, mental health, and healthcare use. IPV during pregnancy, in particular, is associated with lower rates of antenatal care, but no studies have assessed the association between IPV and postpartum healthcare. This study aims to examine the link between IPV (emotional, physical, and sexual) and two outcomes: postpartum healthcare use and access to family planning.

METHODS

This study uses data from a cross-sectional survey of 859 women in Nairobi and Kiambu counties in Kenya who gave birth during the COVID-19 pandemic in 2020.

RESULTS

In this sample, 36% of women reported ever experiencing IPV. Of those, 33% indicated the frequency of IPV stayed the same or increased during COVID-19. Nearly 17% of women avoided postpartum healthcare and 10% experienced issues accessing family planning. Those who experienced any form of IPV during pregnancy had approximately twice the odds of avoiding postpartum healthcare compared to those who did not experience any form of IPV. Compared to those who did not experience IPV during pregnancy, experiencing sexual IPV was associated with 2.25 times higher odds of reporting issues accessing family planning. Additionally, reporting fair or poor self-rated health was associated with both avoiding postpartum healthcare and reporting issues accessing family planning. Experiencing food insecurity was also associated with avoiding postpartum healthcare.

CONCLUSIONS

To our knowledge, this is the first study to establish the link between IPV during pregnancy and postpartum healthcare access. During COVID-19 in Kenya, postpartum women who had experienced IPV were at increased risk of disengagement with healthcare services. Women should be screened for IPV during pregnancy and postpartum in order to better support their healthcare needs. In times of crisis, such as pandemics, policymakers and healthcare providers must address barriers to healthcare for postpartum women.

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.

Sexual Coercion, Intimate Partner Violence, and Homicide: A Scoping Literature Review

The specific relationship between sexual coercion, intimate partner violence (IPV) during pregnancy, and intimate partner homicide (IPH) is poorly understood. Through a scoping literature review, we identified 101 studies on sexual coercion, IPV during pregnancy, and IPH and created a conceptual model suggesting unintended pregnancies may serve as both a risk factor for and a product of IPV that may escalate to IPH. We illustrate a healthcare systems intervention implication of this model in the context of the Colorado Family Planning Initiative (CFPI). Descriptive statistics suggest an inverse association between contraception access and IPH, which declined by 62% during the first 4 years of the CFPI. Interventions aimed at improving reproductive agency, including improving contraception access and reducing unintended pregnancy, may be a useful opportunity for clinician and health systems to contribute to reducing both lethal and nonlethal IPV.

Contraceptive Sabotage and Contraceptive Use at the Time of Pregnancy: An Analysis of People with a Recent Live Birth in the United States

Contraceptive sabotage and other forms of intimate partner violence (IPV) can interfere with contraceptive use. We used 2012 to 2015 Pregnancy Risk Assessment Monitoring System data from 8,981 people residing in five states who reported that when they became pregnant, they were not trying to get pregnant. We assessed the relationships between ever experiencing contraceptive sabotage and physical IPV 12 months before pregnancy (both by the current partner) and contraceptive use at the time of pregnancy using multivariable logistic regression. We also assessed the joint associations between physical IPV 12 months before pregnancy and ever experienced contraceptive sabotage with contraceptive use at the time of pregnancy. Few people ever experienced contraceptive sabotage (1.8%; 95% confidence interval [CI]: 1.4, 2.3) or physical IPV 12 months before pregnancy (2.8%; 95% CI: 2.3, 3.3). In models adjusted for age, race/ethnicity, marital status, education, and state of residence, ever experiencing contraceptive sabotage was associated with contraceptive use at the time of pregnancy (adjusted odds ratio [aOR]: 1.73; 95% CI: 1.06, 2.82), but not with physical IPV 12 months before pregnancy (aOR: 0.69; 95% CI: 0.46, 1.02). When examining the joint association, compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy, ever experiencing contraceptive sabotage was significantly related to contraceptive use at the time of pregnancy (aOR: 1.72; 95% CI: 1.00, 2.95). However, it was not associated with experiencing physical IPV 12 months before pregnancy (aOR: 0.68; 95% CI: 0.45, 1.04) or with experiencing both contraceptive sabotage and physical IPV 12 months before pregnancy (aOR: 1.21; 95% CI: 0.42, 3.50), compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy. Our study highlights that current partner contraceptive sabotage may motivate those not trying to get pregnant to use contraception; however, all people in our sample still experienced a pregnancy.

Breaking down relationship barriers to increase PrEP uptake and adherence among adolescent girls and young women in Kenya: safety and preliminary effectiveness results from a pilot cluster-randomized trial

INTRODUCTION

Oral pre-exposure prophylaxis (PrEP) has the potential to reduce HIV acquisition among adolescent girls and young women (AGYW) in sub-Saharan Africa, a priority population for epidemic control. However, intimate partner violence (IPV) and low relationship power can create significant challenges to PrEP use. The Tu'Washindi intervention aimed to increase PrEP use by addressing relationship- and violence-related barriers among AGYW enrolled in the DREAMS Initiative in Siaya County, Kenya.

METHODS

Our multi-level, community-based intervention was piloted in a cluster-randomized controlled trial conducted at six DREAMS sites from April to December 2019 (NCT03938818). Three intervention components were delivered over 6 months: an eight-session empowerment-based support club, community sensitization targeted towards male partners and a couples' PrEP education event. Participants were ages 17-24, HIV negative and either eligible for, or already taking, PrEP. Over 6 months of follow-up, we assessed IPV (months 3 and 6) and PrEP uptake and continuation (month 6) through interviewer-administered questionnaires; PrEP adherence was assessed with Wisepill electronic monitoring devices. These outcomes were compared using adjusted Poisson and negative binomial regression models.

RESULTS

We enrolled 103 AGYW with median age of 22 years (IQR 20-23); one-third were currently taking PrEP and 45% reported IPV in the past 3 months. Retention was 97% at month 6. Compared to the control arm, intervention arm participants were more likely to initiate PrEP, if not already using it at enrolment (52% vs. 24%, aRR 2.28, 95% CI 1.19-4.38, p = 0.01), and those taking PrEP had more days with device openings (25% of days vs. 13%, aRR 1.94, 95% CI 1.16-3.25, p = 0.01). Twenty percent of participants reported IPV during follow-up. There were trends towards fewer IPV events (aIRR 0.66, 95% CI 0.27-1.62, p = 0.37) and fewer events resulting in injury (aIRR 0.21, 95% CI 0.04-1.02, p = 0.05) in the intervention versus control arm.

CONCLUSIONS

Tu'Washindi shows promise in promoting PrEP uptake and adherence among AGYW without concomitant increases in IPV; however, adherence was still suboptimal. Further research is needed to determine whether these gains translate to increases in the proportion of AGYW with protective levels of PrEP adherence and to evaluate the potential for the intervention to reduce IPV risk.

Male characteristics and contraception in four districts of the central region, Ghana

BACKGROUND

A lack of male involvement in contraception can negatively affect its practice. To promote male participation in family planning, there is a dire need to understand male attributes that play a role in contraception. This study focuses on the male characteristics that influence the practice of traditional and modern methods of contraception.

METHODS

This study is a secondary analysis of quantitative data obtained from the baseline assessment of the Ghana Community-Based Action Teams Study that aimed to prevent violence against women in the Central Region of Ghana in 2016. The analysis included 1742 partnered males aged 18-60 years. Chi-square test, t-test and logistic regression analyses were used to assess the association between male characteristics and the practice of contraception (significance level = 0.05).

RESULTS

The prevalence of contraception was 24.4% (95% CI = 20.8-28.5). Significant male characteristics that were positively associated with the practice of contraception in adjusted models were: post-primary education (AOR = 1.96, 95% CI = 1.27-3.04), perpetration of Intimate Partner Violence (AOR = 1.83, 95% CI = 1.49-2.26), and the number of main sexual partners (AOR = 1.78, 95% CI = 1.15-2.75). However, wanting the first child (AOR = 0.71, 95% CI = 0.54-0.94) and male controlling behaviour (AOR = 0.7, 95% CI = 0.49-0.99) statistically significantly associated with reduced odds of practicing contraception.

CONCLUSION

Male partner characteristics influence the practice of contraception. Family planning sensitization and education programs should target males who are less likely to practice contraception.

Development of a relationship counselling website to identify and mitigate risk of intimate partner violence in the context of women's PrEP use

Discreet, accessible interventions are urgently needed to mitigate the risk of intimate-partner violence (IPV) and other relationship barriers that women encounter to using HIV prevention methods such as pre-exposure prophylaxis (PrEP). We adapted a counsellor-administered intervention, CHARISMA, into a mobile-optimized website to enhance accessibility and reduce human resources required for HIV prevention and relationship counseling. Using human-centered design and participatory methods, CHARISMA was adapted through workshops with former CHARISMA in-person intervention participants (n = 14; ages 18-45) and web development 'sprints' combined with cognitive interviews (n = 24). 'CHARISMA mobile' was then beta-tested with 81 women naïve to the in-person intervention. In beta-testing, participants used a 'think aloud' process to provide feedback on ease of use and rated design, functionality, comprehension, confidentiality, safety, and usefulness on a scale of 1 to 5 via a survey. Data were conducted in four rounds, interspersed with rapid assessment according to go/no-go criteria, and website adaptations. The updated website was pilot tested for 'real-world' feasibility and acceptability among 159 women using their own smartphones at a location of their choice. Feedback was measured via surveys and website analytics. Workshops and cognitive interviews generated insights on technology use, contextual adaptations, and confidentiality, which were integrated into the beta version. The beta version met all 'go' criteria and was further adapted for pilot testing. In pilot testing, users found the website was useful (mean rating 4.54 out of 5), safe (4.5 out of 5), and had few concerns about confidentiality (1.75, representing low concern). On average, users rated the website more than 4 stars out of 5. Beta and pilot-testing suggested the smartphone-optimized website was well-accepted, relevant, engaging, feasible to administer, discreet and safe. Results contributed to a refined website, suitable for adaptations to other contexts and further evaluation where outcomes related to PrEP use and relationships should be assessed.

Women with substance use disorders are highly impacted by the overturning of Roe v. Wade: Advocacy steps are urgently needed

The Supreme Court's ruling to overturn the 1973 Roe v. Wade verdict represents a major setback for women's reproductive freedoms in the United States. This ruling revokes constitutional protection for abortion rights and returns the decision to the states. Since this ruling in June 2022, numerous states have adopted total or near total abortion bans, with many of these bans offering no exception for rape, incest, or nonfatal maternal health risks. Legal experts also warn that this ruling can open the door to restrict contraceptive rights previously protected under the same implied constitutional right to privacy as abortion. Already, this decision has increased momentum for states to place restrictions on specific forms of contraception. Certain groups of women will be disproportionately harmed by these bans, such as women with substance use disorders (SUDs). Women with SUDs face unique barriers to sexual and reproductive health services that exist at the structural level (e.g., criminalization; costs and accessibility), interpersonal level (e.g., higher rates of intimate partner violence) and individual level (e.g., reduced reproductive autonomy). These synergistic barriers interact to produce lower contraceptive use, increased unintended pregnancy rates, and subsequently a greater need for abortion services among this population. This ruling will exacerbate the effects of these barriers on women with SUDs, resulting in even greater difficulties accessing contraceptive and abortion services, and ultimately increasing rates of criminalization among pregnant and parenting women with SUDs. This commentary describes these barriers and highlights potential advocacy steps that are urgently needed to assist reproductive-aged women with SUDs during these challenging times when essential health services are increasingly inaccessible.

Determinants of spousal physical violence against women in Zambia: a multilevel analysis

BACKGROUND

Violence against women and girls is a major public health issue, a violation of human rights, and is linked to a number of harmful effects on one's physical, mental, sexual, and reproductive health. Studies conducted in other parts of sub-Saharan Africa (SSA) suggest that there is an association between contextual factors and experience of intimate partner violence. However, in Zambia, this association is not well documented. Thus, this study was conducted to examine how individual and community-level characteristics influence spousal violence against women in Zambia.

METHODS

Data from the most recent Zambia Demographic and Health Survey conducted in 2018 was used. A sample of 7,358 ever-married women aged 15-49 years was used in the analysis. Two level multilevel binary logistic regression models were employed to examine the association between individual and contextual-level factors and experience of spousal violence.

RESULTS

The prevalence of spousal physical violence against women in Zambia was 21.1% [95% CI, 19.8, 22.5]. Women aged 15-19 [aOR = 2.36, 95% CI = 1.34-4.14] and 20-24 [aOR = 2.11, 95% CI = 1.38-3.22], who did not own mobile phone [aOR = 1.36, 95% CI = 1.10-1.69], and had low decision making autonomy [aOR = 1.24, 95% CI = 1.01-1.54] were more likely experience spousal physical violence. Furthermore, communities which had a low proportion of women with decision making power [aOR = 1.66, 95% CI = 1.26-2.19] were more likely experience spousal physical violence. Additionally, women whose partners' drank alcohol [aOR = 2.81, 95% CI = 2.30-3.45] and those whose partners exhibited jealous behaviour [aOR = 2.38, 95% CI = 1.88-3.21] were more likely to experience spousal physical violence.

CONCLUSION

Both individual and community-level factors influenced spousal physical violence in Zambia. Integrating community level factors when designing interventions to address gender-based would be key to reduce women's vulnerability to gender based violence in the country. There is need to re-evaluate and re-strategize current strategies being implemented to address gender based violence in the country to make them context specific.

Barriers and facilitators to pharmacists' engagement in response to domestic violence: a qualitative interview study informed by the capability-opportunity-motivation-behaviour model

BACKGROUND

Domestic and sexual violence and abuse (DSVA) is a global public health problem resulting in health inequalities. Community pharmacies are uniquely placed to help people affected by DSVA. We examined factors that impact pharmacists' engagement in response to DSVA when providing public health services.

METHODS

Semi-structured qualitative interviews with community pharmacists (n = 20) were analyzed thematically, with inductive themes mapped to the Capability-Opportunity-Motivation Behaviour (COM-B) model.

RESULTS

Pharmacists were confident in providing public health services, but a lack of DSVA training meant there is a need to support their 'Capability' to respond to DSVA. Pharmacies were perceived as highly accessible healthcare providers on the high street, with sexual health consultations offering an ideal 'Opportunity' to enquire about DSVA in a private consultation room. Pharmacist's 'Motivation' to enquire about DSVA was driven by potential positive client outcomes and a desire to be more involved in public heath interventions, but organisation- and system-level support and remuneration is needed.

CONCLUSIONS

Community pharmacy offers opportunities for integrating DSVA work in existing public health services. Pharmacists need training on DSVA, ongoing support, allocated funding for DSVA work, and awareness raising campaign for the public on their extended public health role.

Women Want Choices: Opinions from the Share.Learn.Shape Global Internet Survey About Multipurpose Prevention Technology (MPT) Products in Development

Women need multipurpose prevention technologies (MPTs) to simultaneously prevent sexually transmitted infections (STIs), including HIV, with or without contraception. User feedback early in product development is critical for maximizing uptake and continuation. Our global online survey (April 2017-December 2018) explored women's opinions about MPT formulations in development (e.g., fast-dissolving vaginal inserts, vaginal films, intravaginal rings, injectables, implants), preferences for long-acting or "on-demand" methods, and interest in a contraceptive MPT versus products for HIV/STI prevention alone. Of the 630 women in our final analysis (mean 30 years old; range 18-49), 68% were monogamous, 79% completed secondary education, 58% had ≥ 1 child, 56% were from sub-Saharan Africa and 82% preferred a cMPT versus HIV/STI prevention alone. There were no clear preferences for any specific product or product type (long-acting, on-demand, daily). No single product will appeal everyone, however, adding contraception is likely to increase uptake of HIV/STI prevention methods for most women.

The impact of depression at preconception on pregnancy planning and unmet need for contraception in the first postpartum year: a cohort study from rural Malawi

BACKGROUND

The impact of depression on women's use of contraception and degree of pregnancy planning in low-income settings has been poorly researched. Our study aims to explore if symptoms of depression at preconception are associated with unplanned pregnancy and nonuse of contraception at the point of conception and in the postpartum period.

METHODS

Population-based cohort of 4244 pregnant women in rural Malawi were recruited in 2013 and were followed up at 28 days, 6 months and 12 months postpartum. Women were asked about symptoms of depression in the year before pregnancy and assessed for depression symptoms at antenatal interview using the Self-Reporting Questionnaire-20, degree of pregnancy planning using the London Measure of Unplanned Pregnancy and use of contraception at conception and the three time points postpartum.

RESULTS

Of the 3986 women who completed the antenatal interview, 553 (13.9%) reported depressive symptoms in the year before pregnancy and 907 (22.8%) showed current high depression symptoms. History of depression in the year before pregnancy was associated with inconsistent use of contraception at the time of conception [adjusted relative risk (adjRR) 1.52; 95% confidence interval (1.24-1.86)] and higher risk of unplanned [adjRR 2.18 (1.73-2.76)] or ambivalent [adj RR 1.75 (1.36-2.26)] pregnancy. At 28 days post-partum it was also associated with no use of contraception despite no desire for a further pregnancy [adjRR 1.49 (1.13-1.97)] as well as reduced use of modern contraceptives [adj RR 0.74 (0.58-0.96)]. These results remained significant after adjusting for socio-demographic factors known to impact on women's access and use of family planning services, high depression symptoms at antenatal interview as well as disclosure of interpersonal violence. Although directions and magnitudes of effect were similar at six and 12 months, these relationships were not statistically significant.

CONCLUSIONS

Depression in the year before pregnancy impacts on women's use of contraception at conception and in the early postpartum period. This places these women at risk of unplanned pregnancies in this high fertility, high unmet need for contraception cohort of women in rural Malawi. Our results call for higher integration of mental health care into family planning services and for a focus on early postnatal contraception.

Intimate partner violence and HIV treatment adherence in urban South Africa: Mediating role of perinatal common mental disorders

Background

Antiretroviral therapy (ART) has potential to eliminate perinatal HIV infections, but adherence to ART in late pregnancy and postpartum is often suboptimal. Intimate partner violence (IPV) may influence non-adherence among perinatal women living with HIV (WWH), but few quantitative studies have examined this over time or explored mechanisms for this association.

Methods

We used secondary data from a parent trial in Johannesburg comprising WWH from the control arm (n=63) and WWH ineligible for the trial (n=133). Trained nurse researchers administered questionnaires at first antenatal visit on past-year psychological, physical, and/or sexual IPV (WHO instrument), socio-demographics (age, food security, education), and perinatal common mental symptoms of depression (Hospital Anxiety and Depression Screener-d); anxiety (HADS-a); post-traumatic stress disorder (PTSD; Harvard Trauma Questionnaire). At endline visit 2-4 months postpartum, nurse researchers assessed self-reported ART adherence using a visual analog scale (with ≥95% considered "good"). We fitted structural equation models (SEM) in MPlus to explore direct and indirect effects of IPV on ART adherence.

Results

Of 196 perinatal WWH, 53.1% reported IPV exposure at baseline. The majority of participants (85.7%) had good perinatal ART adherence. In adjusted models, IPV at baseline was associated with halved odds of good adherence (aOR=0.51, 95%CI=0.20-0.96). IPV was associated with higher adjusted odds of probable depression (aOR=4.64), anxiety (aOR=2.85), and PTSD (aOR=3.42). In SEM, IPV had a direct (standardized coef=-0.22) and indirect effect (coef=-0.05) on ART via common mental disorders. The total effect of IPV on perinatal adherence was of moderate size (coef= -0.27) and the model had good fit (CFI=0.972; TLI=0.969; RMSEA=0.045; SRMR=0.076).

Conclusion

IPV was longitudinally associated with perinatal ART non-adherence in part due to its relationship with mental health symptomology. Addressing IPV within clinical care has potential to improve perinatal mental health, maternal HIV outcomes, and HIV-free infant survival.

Recent Intimate Partner Violence and Oral Contraceptive Pill Adherence in a Cohort of Reproductive-Aged Women

Objective: Intimate partner violence (IPV) is an important public health problem that impacts reproductive decision-making. Although previous literature has reported a negative impact on contraceptive adherence overall, this study specifically aims to investigate the association between IPV and oral contraceptive pill (OCP) adherence. Methods: We analyzed baseline survey data from 373 OCP users participating in the MyNewOptions study. Recent IPV was defined as any positive response to HARK, a 4-question tool assessing emotional, sexual, and physical abuse in the past year, or self-report of sexual coercion in the past 6 months. High OCP adherence was defined by self-report of missing ≤1 pill per month, which was then corroborated by pharmacy claims data. Multivariable regression analyses were performed to assess the influence of recent IPV history and patient-level variables on OCP adherence. Results: Just over half of our participants were highly adherent to OCPs (53.6%), and approximately one-quarter reported recent IPV exposure (25.2%). Women with recent IPV were significantly less likely to be OCP adherent than those without IPV (adjusted odds ratio (AOR) 0.54, 95% confidence interval (CI): 0.32-0.92). Protestant religion was also associated with high OCP adherence (AOR 2.41, 95% CI: 1.24-4.65, compared with no religious affiliation), while younger age groups (18-25 and 26-33 years) were less likely to have high OCP adherence compared with the 34-40 age group (AOR 0.45, 95% CI: 0.20-1.00 and AOR 0.40, 95% CI: 0.18-0.91, respectively). Conclusion: Recent IPV exposure is associated with low OCP adherence among women of reproductive age. ClinicalTrials.gov identifier: NCT02100124.

Intimate Partner Violence and Contraception among Adolescent Girls and Young Women: A Longitudinal Analysis of the Girl Power-Malawi Cohort

PURPOSE

In sub-Saharan Africa, sexually active adolescent girls and young women (AGYW) experience high rates of intimate partner violence (IPV) and low levels of contraceptive use, but the effect of IPV on contraceptive use is not well understood.

METHODS

In the Girl Power-Malawi study, AGYW aged 15-24 were recruited from 4 health centers in Lilongwe, Malawi, and followed for 1 year. At baseline, AGYW were assessed for IPV using the modified Conflict Tactics Scale. AGYW reported contraceptive method use at 6 and 12 months, characterized as barrier, non-barrier, or any modern method. Modified Poisson regression was implemented to estimate risk ratios (RRs) and 95% confidence intervals (CIs) to examine the effect of IPV on contraceptive use.

RESULTS

One thousand AGYW were enrolled, and 954 non-pregnant participants were included. Baseline prevalence of IPV with the most recent partner was 35.5% (physical), 46.2% (sexual), and 76.9% (emotional). Baseline IPV did not affect contraceptive use at 6 months (aRR [95% CI]: physical 0.98 [0.91-1.05]; sexual 1.00 [0.94-1.07]; emotional 1.03 [0.94-1.12]) or 12 months (physical 0.95 [0.89-1.02]; sexual 0.96 [0.90-1.02]; emotional 0.98 [0.91-1.05]). None of the 3 IPV categories affected contraceptive use when the outcome was restricted to either barrier or non-barrier methods.

CONCLUSIONS

In this cohort, IPV was not a key driver of contraceptive use in longitudinal analyses. Interventions are needed to address the alarming rates of IPV in this population, but addressing IPV alone might be insufficient to address low contraceptive use, and multifaceted youth-friendly health services might be necessary.

Exploring intimate partner violence among pregnant Eswatini women seeking antenatal care: How agency and food security impact violence-related outcomes

Women with agency (i.e. the ability to make choices and act on them) may experience reduced food insecurity (FI) and intimate partner violence (IPV). Reducing FI and IPV among women are global goals; however, research focused on agency among Eswatini women has been overlooked, though they experience high rates of FI and IPV. We analysed cross-sectional data from 406 Swazi women who sought care at one rural and one urban-public antenatal clinic in 2013-2014 to understand how FI and agency, our independent variables, are associated with IPV. We assessed the incidence rate ratio (IRR) of number of violent events (including emotional, physical and sexual IPV) in the previous 12 months using Poisson regressions. We found significant relationships between FI and IPV, where higher levels of FI were associated with IPV risk (weekly: IRR = 2.18, 95% CI = 1.82-2.61; Daily: IRR = 3.53, 95% CI = 2.89-4.32) and constrained agency increased women's risk of IPV (IRR = 1.44; 95% CI = 1.22-1.70). Our findings suggest that FI and agency independently impact women's experience(s) of IPV. Interventions focused on women simultaneously experiencing severe FI and constrained agency may have the highest impact; however, providing focused and moderate FI relief (e.g. reducing FI daily to monthly) could potentially reduce women's risk of experiencing violence.

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.

Spousal Violence and Contraceptive Use among Married Afghan Women in a Nationally Representative Sample

OBJECTIVE

Afghanistan is one of the countries with the highest prevalence of spousal violence (56%) and a low prevalence of contraceptive use (23%), yet there is no study assessing how spousal violence is related to contraceptive use, and what methods are most used by women. Therefore, this study examined the association between the number of types of spousal violence and contraceptive use.

METHOD

Using data from 18,985 Afghan married women, aged 15 to 49, who responded to the 2015 Afghanistan Demographic and Health Survey, the current contraceptive method was grouped into five categories: male-involved methods, pills, injectables, long-acting reversible contraception, female sterilization, and Lactation Amenorrhea Method. The number of types of spousal violence in the past 12 months was categorized as none, one type, or two or more types, based on women's experiences with verbal, physical, and sexual violence. For analysis, binary and multinomial logistic regression were used.

RESULTS

After adjusting for the covariates, the experience of any spousal violence was associated with contraception use (adjusted odds ratio (aOR) = 1.93, 95% CI: 1.64-2.27, p = 0.0001). Among those using contraception, experiencing two or three types of spousal violence was associated with using pills (adjusted risk ratio (aRRR) = 2.12, 95% CI: 1.63-2.77, p = 0.0001), injections (aRRR = 1.75, 95% CI: 1.26-2.41, p = 0.001), and LAM (aRRR = 3.27, 95% CI: 2.05-5.20, p = 0.0001), compared to male-involved methods.

CONCLUSIONS

The findings of this study may inform policymakers and program implementers in designing interventions to address the pervasive problem of violence against women, and make pills and injectables more accessible to Afghan women, since these methods are under women's control and more often used in Afghanistan.

Intimate Partner Violence and Its Associations with Adverse Pregnancy Outcomes in Saudi Arabia: A Cross-Sectional Study

Intimate partner violence (IPV) during pregnancy is a significant issue. Nevertheless, the prevalence of IPV and its adverse outcomes in pregnant women in Saudi Arabia are not well documented. This study examines the prevalence of IPV, its relationship with women's background characteristics, and its effect on adverse pregnancy outcomes. A cross-sectional study was conducted using a convenience sample of 684 women who were either pregnant or in the first six weeks postpartum in Riyadh, Saudi Arabia. IPV severity was measured using the Composite Abuse Scale. The results showed that 28.9% of the women included in this study experienced IPV. Smoking habit, income, polygamous marriage, presence of chronic diseases and sexual dysfunction, and number of children were significantly associated with IPV severity. In each one-unit increase in total IPV severity, the possibility of the occurrence of preterm labor, vaginal bleeding, dehydration, gestational diabetes, urinary tract infection, spontaneous abortion, and intrauterine growth retardation significantly increases. Furthermore, regarding the types of abuse, we found that for each one-unit increase in verbal abuse, the possibility of the occurrence of preterm labor, dehydration, urinary tract infection, and intrauterine growth retardation significantly increases. Moreover, for each one-unit increase in physical abuse and one-unit increase in controlling behavior, the possibility of the occurrence of intrauterine growth retardation significantly increases. The current results highlight the importance of paying substantial attention to IPV and its types as a health issue that increases the risk of adverse pregnancy outcomes in women. A clinical assessment during pregnancy is needed to identify and manage cases of IPV survivors and ultimately reduce their risk of IPV.

Eviction, intimate partner violence and HIV: Expanding concepts and assessing the pathways through which sexual partnership dynamics impact health

Over 2 million renters in the United States are legally evicted annually, and even more renters experience other landlord-related forced moves each year. While past research has documented an association between legal eviction and HIV risk, no studies have examined the relationship between forced moves and sexual partnership dynamics longitudinally, or the pathways through which forced moves impact such risk. Addressing this gap is imperative, particularly given inequities that place Black renters and women at disproportionate risk of eviction. This study leverages data from a longitudinal cohort study of 282 adults in New Haven to examine whether landlord-related forced moves reported at baseline (including, but not limited to, legal eviction) is associated with HIV sexual risk reported six months later. We use bootstrapped path analyses to examine intimate partner violence (IPV) victimization and perpetration as potential mediators. One-fifth of participants (21.2%) had experienced a landlord-related forced move at baseline. At follow up, nearly two-thirds (63.8%) reported at least one HIV sexual risk factor, one in seven (14.2%) reported IPV victimization, and one in ten (10.3%) reported IPV perpetration. Individuals who reported landlord-related forced moves were more likely to report IPV victimization (standardized β = 0.19, SE = 0.08, p = .02) and IPV perpetration (β = 0.25, SE = 0.09, p = .003). Both IPV victimization and perpetration mediated the association between landlord-related forced moves and HIV sexual risk (indirect victimization effect, β = 0.09, SE = 0.05, p = .06; indirect perpetration effect, β = 0.16, SE = 0.07, p = .02), though IPV victimization was only marginally significant. In conclusion, IPV is itself a negative consequence of forced moves that also contributes to other negative health effects, like HIV risk. Therefore, providers should offer violence screening and referral for clients who have recently faced a forced move. Simultaneously, policy-level solutions to prevent eviction and increase housing affordability are urgently needed to address the rising burden - and inequitable distribution - of evictions among low-income renters.

Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England

INTRODUCTION

Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking.

METHODS AND ANALYSIS

This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services.

ETHICS AND DISSEMINATION

The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors.

TRIAL REGISTRATION NUMBER

ISRCTN30846825.

Intimate Partner Violence and Pregnancy Termination among Tajikistan Women: Evidence from Nationally Representative Data

Intimate partner violence is the most common kind of violence and a significant public health issue. The relationship between intimate partner violence and pregnancy termination among Tajikistan women was investigated in this study. The data for this research was collected from the Tajikistan Demographic and Health Survey 2017. This research has used the data of married women aged between 15 to 49 years. The findings from the study indicate that around 23.2% of married women in Tajikistan have experienced physical violence. The respondent’s age, region, and employment status was significantly associated with pregnancy termination (p < 0.05). Similarly, women who can refuse sex with their partner and ask their partner to use a condom are more likely to terminate pregnancy (p < 0.05). The characteristics of the husband or partner that had a significant positive association with pregnancy termination of married women in Tajikistan are age, educational level, and alcohol drinking status of their husbands (p < 0.05). This study also establishes the significant relationship between pregnancy termination and physical or emotional violence experienced by women (p < 0.05). The dynamics of domestic abuse need to be understood by healthcare providers to aid women in making decisions on whether or not to terminate their pregnancy.

Global measurement of intimate partner violence to monitor Sustainable Development Goal 5

BACKGROUND

One third of women experience intimate partner violence (IPV) and potential sequelae. Sustainable Development Goal (SDG) 5.2-to eliminate violence against women, including IPV-compels states to monitor such violence. We conducted the first global measurement-invariance assessment of standardised item sets for IPV.

METHODS

Demographic and Health Surveys (DHS) from 36 Lower-/Middle-Income Countries (LMICs) administering 18 IPV items during 2012-2018 were included. Analyses were performed separately for two items sets: lifetime physical IPV (seven items) and controlling behaviours (five items). We performed country-specific exploratory and confirmatory factor analyses (EFA/CFA). Datasets meeting benchmarks for acceptable item loadings and model-fit statistics were included in multiple-group CFA (MGCFA) to test for exact measurement invariance. Based on findings, alignment optimization (AO) was performed to assess approximate measurement invariance (< 25% of model parameters non-invariant). For each item set, national rankings based on AO-derived scores and on prevalence estimates were compared. AO-derived scores were correlated with type-specific IPV prevalences to assess correspondence.

RESULTS

National rates of physical IPV (5.6-50.5%) and controlling behavior (25.9-84.7%) varied. For each item set, item loadings and model-fit statistics were adequate in country-specific, unidimensional EFAs and CFAs. Both unidimensional constructs lacked exact invariance in MGCFA but achieved approximate invariance in AO analysis (12.3% of model parameters for physical IPV and 6.7% for controlling behaviour non-invariant). For both item sets, national rankings based on AO-derived scores were distributed similarly to rankings based on prevalence. However, estimates often were not significantly different cross-nationally, precluding national-level comparisons regardless of estimation strategy. Three physical-IPV items (slap, twist, choke) and two controlling-behaviour items (meet female friends; contact with family) warrant cognitive testing to improve their psychometric properties. Correlations of AO-derived scores for physical IPV (0.48-0.66) and controlling behaviours (0.49-0.87) with prevalences of lifetime physical, sexual, psychological IPV as well as controlling behaviour varied.

CONCLUSIONS

Seven DHS lifetime physical-IPV items and five DHS controlling-behaviour items were approximately invariant across 36 LMICs spanning five world regions, such that cross-national comparisons of factor means are reasonable. Measurement-invariance testing over time will inform their utility to monitor SDG5.2.1; cross-national, cross-time measurement-invariance testing of improved sexual and psychological IPV item-sets is needed.

Physical and Emotional Intimate Partner Violence and Women's Health in the First Year After Childbirth: An Australian Pregnancy Cohort Study

Intimate partner violence (IPV) can comprise physical, sexual, and emotional abuse, and is a widespread public health concern. Despite increasing recognition that women experience different types of IPV, the majority of research has focused on physical IPV. The present study aims to examine associations between different types of IPV (physical, emotional, physical, and emotional) and women's mental, physical, and sexual health by analyzing longitudinal data from a prospective pregnancy cohort of 1,507 first-time mothers in Melbourne, Australia. Questionnaires included validated measures of physical and mental health (Short Form Health Survey, Edinburgh Postnatal Depression Scale) and IPV (Composite Abuse Scale). Emotional IPV alone was the most commonly reported type of IPV (n = 128, 9.5%), followed by both physical and emotional IPV (n = 76, 5.7%), and then physical IPV alone (n = 30, 2.2%). Women reporting emotional IPV or physical and emotional IPV had increased odds of poor health compared with women reporting no IPV. Experience of physical and emotional IPV was most strongly associated with mental health issues, including depressive symptoms (adjusted odds ratio [OR] 4.6, 95% confidence interval [CI] = [2.9, 7.1]) and self-reported anxiety (adjusted OR 2.9, 95% CI = [1.9, 4.4]). Experience of emotional IPV alone was associated with poor mental health as well as physical factors, including poor general physical health (adjusted OR 1.9, 95% CI = [1.2, 3.1]), and pain during sex (adjusted OR 1.8, 95% CI = [1.2, 2.7]). Increased odds of poor body image were also observed for women reporting emotional IPV alone and physical and emotional IPV. These findings highlight the need for greater awareness of the diversity in women's experiences of IPV among health care providers. This includes understanding the prevalence of emotional IPV among new mothers, and the range of health problems that are more common for women experiencing IPV.

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.

A Women's Rights-Based Approach to Reducing Child Mortality: Data from 193 Countries Show that Gender Equality does Affect Under-five Child Mortality

OBJECTIVES

Mother's health and wellbeing significantly affects child health. Women's autonomy can improve healthcare-seeking behaviour, utilisation of healthcare services, and planned pregnancy, thereby improving child health. The global under-five mortality rate (U5MR) has seen the fastest decline in the past two decades, but the influence of gender equality on child mortality remains unaddressed. A strategic approach addressing gender equality is needed to reduce the U5MR further. The study aimed to identify and investigate the association between indicators of gender equality and U5MR using a human rights-based approach.

METHODS

We analysed open-source secondary data from international agencies comprising 521 gender-sensitive variables for 193 countries. Nine variables were included for the final Structural Equation Model based on the theoretical model. Model 1 consisted of 193 countries, and Model 2 comprised a subgroup analysis of 11 variables for 158 countries. Gender equality was a latent variable, and the U5MR was the outcome variable.

RESULTS

Gender equality was significantly associated with U5MR (Z = - 7.47, 95% CI = - 754.67 to - 440.98, p < 0‧001, n = 193 for Model 1, and Z = - 7.71, 95% CI = - 808.26 to - 480.72, p < 0‧001, n = 158 for Model 2). Female education, women's waged and salaried employment, women as employers, and women's representation in leadership and parliament enhanced gender equality, whereas the prevalence of child marriage and intimate partner violence (IPV) negatively affected gender equality. Improvement in gender equality significantly reduced U5MR. CONCLUSIONS FOR PRACTICE: Improving women's economic, educational, and social position and increasing female representation in higher leadership and policymaking positions is the key to reducing child mortality. Notably, eliminating child marriage and IPV is the key to achieving gender equality and is needed at the forefront of national policies. Gender equality can significantly improve women's reproductive autonomy, a critical factor in improving healthcare utilisation for women and their children.

Associations between adverse childhood experiences and contraceptive use among young adults in Honduras

OBJECTIVE

Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men.

METHODS

We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use.

FINDINGS

Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22).

CONCLUSION

The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.

Preparing student pharmacists to care for patients exposed to intimate partner violence

INTRODUCTION

Intimate partner violence (IPV) is a serious public health problem. Little is known about pharmacists' IPV knowledge and awareness. This study assessed student pharmacists' knowledge, attitudes, and awareness of IPV and examined the impact of a brief curricular unit on these factors.

METHODS

The Physician Readiness to Manage Intimate Partner Violence Survey was adapted for use with student pharmacists and administered at two pharmacy schools, one private (n = 88) and one public institution (n = 104). Students at one institution were exposed to a curricular unit on IPV tailored for pharmacy practice and completed a post-assessment.

RESULTS

Students at both institutions had low levels of IPV-related knowledge, answering <60% of items correctly. Students reported low levels of perceived knowledge and preparation. After exposure to the educational intervention (n = 60), knowledge scores increased on a matched post-assessment. Students across both institutions (n = 29) provided comments indicating that they believed IPV is an important issue, that this topic was novel and that pharmacists should address IPV, that pharmacists should be trained on IPV and a desire for training, and that there are barriers to addressing IPV in the pharmacy setting.

CONCLUSIONS

Preparing student pharmacists to care for patients exposed to IPV may improve patient outcomes and positively impact the lives of the patients they serve. A brief educational intervention improved students' knowledge about IPV and confidence in screening patients for IPV.

Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods : The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49 49 (nested within 1,400 communities), who were sexually active and were not pregnant at the time of the survey. Results : Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion : The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.

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.

Professional counseling in women with serious mental illness: achieving a shift toward a more effective contraceptive method

OBJECTIVES

Mental disorders in reproductive-aged women have significant implications for the risk of unintended pregnancies. The objective of this study is to assess the professional counseling in clinical practice based on motivational interview in women with serious mental illness (SMI) in order to achieve a change to a more effective contraceptive method.

STUDY DESIGN

A prospective observational cohort study (2012-2017) was conducted in a convenience sample of women with severe-moderate psychiatric disorders (n = 91). Information related to psychiatric health, contraceptive use, sexual and reproductive health and socio-demographics was collected. To assess the variation in the contraceptive method, follow-up visits were planned before and after medical counseling. All participants underwent an evidence-based individual motivational interview for contraception counseling. A multivariate logistic model was carried out to identify the factors involved in changing to a more effective contraceptive method.

RESULTS

After evidence-based counseling, 51.6% of participants changed their contraceptive method to a more effective one. This change was associated with gender violence (β coefficient = 1.58, p value = .006). The relation between changing to a more effective contraceptive method and both previous abortions and having children was also positive, although the coefficients did not reach statistical significance.

CONCLUSIONS

Evidence-based contraception counseling in clinical practice, based on an adapted protocol to patients with SMI, has shown, in this study, to be adequate to promote the shift to more effective contraceptive methods, avoiding the need of daily compliance in this population. Gender violence has been significantly associated with the shift to very high effectiveness methods as well as previous abortions and having children, not significantly.

Integrating reproductive health care into substance use disorder services

People who use drugs face layered stigma and barriers to accessing reproductive health care services. At the same time, they have unique needs for compassionate, trauma-informed, low-barrier reproductive health care. We review the literature on collocated reproductive health care and substance use treatment services in this population and advocate for expansion of reproductive health care services at sites providing care for substance use disorder. Through this review article, we outline the evidence for and best practices in collocating reproductive health care within substance use disorder services.

Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics

OBJECTIVES

This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan.

METHODS

Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis.

RESULTS

Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality.

CONCLUSIONS

This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.

Community-level influences on women’s experience of intimate partner violence and modern contraceptive use in Nigeria: a multilevel analysis of nationally representative survey

Background: Modern contraceptives (MC) are important strategies for reducing unwanted pregnancies, unsafe abortion and maternal mortality, but MC remains low at 18% in Nigeria. Similarly, while there is increasing prevalence of intimate partner violence (IPV) in Nigeria, its effects on contraceptive use remain unclear. This study examined the influence of IPV on MC use, while adjusting for individual- and community-level confounders. Methods: The study utilized 2018 Nigeria Demographic and Health Survey data. We performed multilevel binary logistic regression analysis on 24,973 married women aged 15-49, who were sexually active and were not pregnant at the time of the survey. Results: Findings show that use of MC was higher among married women who reported experience of IPV than those without IPV exposure. After adjusting for individual-level and contextual factors, the odds of using MC was significantly higher among women who experienced any form of IPV (OR: 1.61, 95% CI: 1.17-2.21, p<0.005) compared to those who reported no IPV experience. Around one-quarter of the total variance in contraceptive use with respect to the different types of IPV could be explained at the community level. Conclusion: The study provides empirical evidence that there is significant community effect on IPV exposure and women’s contraceptive uptake. Attention must therefore be given to the context-specific social and gender norms that affect women’s sexual and reproductive health in Nigeria.

Delayed Visits for Contraception Due to Concerns Regarding Pelvic Examination Among Women with History of Intimate Partner Violence

BACKGROUND

Concern regarding pelvic examinations may be more common among women experiencing intimate partner violence.

OBJECTIVE

We examined women's attitudes towards pelvic examination with history of intimate partner violence (pressured to have sex, or verbal, or physical abuse).

DESIGN

Secondary analysis of data from a cluster randomized trial on contraceptive access.

PARTICIPANTS

Women aged 18-25 were recruited at 40 reproductive health centers across the USA (2011-2013).

MAIN MEASURES

Delays in clinic visits for contraception and preference to avoid pelvic examinations, by history of ever experiencing pressured sex, verbal, or physical abuse from a sexual partner, reported by frequency (never, rarely, sometimes, often). We used multivariable logistic regression with generalized estimating equations for clustered data.

KEY RESULTS

A total of 1490 women were included. Ever experiencing pressured sex was reported by 32.4% of participants, with 16.5% reporting it rarely, 12.1% reporting it sometimes, and 3.8% reporting it often. Ever experiencing verbal abuse was reported by 19.4% and physical abuse by 10.2% of participants. Overall, 13.2% of participants reported ever having delayed going to the clinic for contraception to avoid having a pelvic examination, and 38.2% reported a preference to avoid pelvic examinations. In multivariable analysis, women reporting that they experienced pressured sex often had significantly higher odds of delaying a clinic visit for birth control (aOR 3.10 95% CI 1.39-6.84) and for reporting a preference to avoid pelvic examinations (aOR 2.91 95% CI 1.57-5.40). We found no associations between delay of clinic visits or preferences to avoid a pelvic examination and verbal or physical abuse.

CONCLUSIONS

History of pressured sex from an intimate partner is common. Among women who have experienced pressured sex, concern regarding pelvic examinations is a potential barrier to contraception. Communicating that routine pelvic examinations are no longer recommended by professional societies could potentially reduce barriers and increase preventive healthcare visits.

Youths' perceptions of community health workers' delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda

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.

Prevalence of unintended pregnancy and its associated factors: Evidence from six south Asian countries

AIM

Unintended pregnancy is a significant public health concern in South Asian countries because of its negative association with the socioeconomic and health outcomes for both children and mothers. The present study aimed to explore the prevalence of unintended pregnancy and explore its determinants among women of reproductive age in six South Asian countries.

METHODS

Nationwide latest demography and health survey data from six South Asian countries, including Bangladesh (2014), Pakistan (2017-2018), Nepal (2016), Afghanistan (2015), Maldives (2016-2017) and India (2015-2016) were pooled for the present study. Multivariate analysis was performed to explore the association between unintended pregnancy and its associated factors.

RESULTS

Amongst the total women (n = 41,689), overall, 19.1% pregnancies were reported as unintended (ranging from 11.9% in India to 28.4% in Bangladesh). The logistic regression model showed that younger women (15-19 years) had 1.42 times higher chance of unintended pregnancies. The odds of unintended pregnancies was 1.24 times higher for poorest women and 1.19 times higher for poorer women. Further, urban women (aOR = 0.70, 95% CI = 0.50-0.80), women having no children (aOR = 0.10, 95% CI = 0.09-0.12), smaller (≤4) family (aOR = 0.72, 95% CI = 0.67-0.78), those who intent to use contraceptive (aOR = 0.72, 95% CI = 0.60-0.86), currently living with partner (aOR = 0.90, 95% CI = 0.81-0.99), first cohabitation in teenage (≤19 years) (aOR = 0.85, 95% CI = 0.78-0.92) were less likely to report unintended pregnancies.

CONCLUSIONS

This study has showed that women's age, wealth index, place of residence, number of children, family size, the intention of contraceptive use, living with a partner, and first cohabitation age are essential determinants of unintended pregnancy. These factors should be considered when trying to reduce unintended pregnancy in six South Asian countries. However, there is a need to improve health education, counselling, skills-building, sex education, modern contraceptive use and its access in this region. Intervention programs regarding reproductive health and policies are warranted to reduce rates of unintended pregnancy in South Asian countries.