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

Grace L Chen,Jay G Silverman,Anvita Dixit,Shahina Begum,Mohan Ghule,Madhusudana Battala,Nicole E Johns,Anita Raj,Sarah Averbach

doi:10.1016/j.eclinm.2020.100318

Abstract

BackgroundIntimate partner violence (IPV) has been shown to be associated differentially with contraceptive use based on type, with IPV more likely among pill users and less likely among condom users. Recent increases in IUD uptake allow consideration of this type of contraceptive. We assessed the association between self-reported IPV and self-reported contraceptive use, by type, among non-pregnant married women in rural India in a region with higher than average IUD use. MethodsWe assessed the association between past 12-month IPV (physical, sexual, or any) and past 3-month contraceptive use (condom, pill, IUD, or any modern method) using crude and adjusted multinomial logistic regression models. FindingsAmong the 1001 women included, 109 (10·9%) reported experiencing physical IPV and 27 (2·7%) reported experiencing sexual IPV in the past 12 months. Women experiencing physical IPV were significantly less likely to use condoms (adjusted relative risk ratio [RRR]: 0·54, 95% confidence interval [CI]: 0·30–0·98, p = 0·042) than women not experiencing violence. There was a trend towards increased IUD use among women experiencing physical IPV (adjusted RRR: 1·78, 95% CI: 0·91–3·41, p = 0·091) compared to those not experiencing physical IPV, but this did not reach statistical significance. InterpretationOur findings suggest that women who experience physical IPV in India are less likely to use condoms and may be more likely to use IUDs than women without exposure to IPV. This research expands on prior findings suggesting higher uptake of women-controlled contraceptives among women contending with IPV in India.

Highlights

Intimate partner violence (IPV) affects one in three women worldwide [1]
Of the 1201 women enrolled in CHARM2, 1001 (83¢3%) were not pregnant and provided complete answers to all study measures about IPV and contraceptive use and were included in the present analysis
After adjusting for covariates, women reporting physical IPV were significantly less likely to use condoms than women without exposure to violence

Summary

Introduction

Intimate partner violence (IPV) affects one in three women worldwide [1]. In a recent nationwide survey, 23% of ever-married Indian women reported past-year physical IPV, while 5% of ever-married women nationwide reported past-year sexual IPV [2]. We assessed the association between self-reported IPV and self-reported contraceptive use, by type, among non-pregnant married women in rural India in a region with higher than average IUD use. Methods: We assessed the association between past 12-month IPV (physical, sexual, or any) and past 3month contraceptive use (condom, pill, IUD, or any modern method) using crude and adjusted multinomial logistic regression models. Women experiencing physical IPV were significantly less likely to use condoms (adjusted relative risk ratio [RRR]: 0¢54, 95% confidence interval [CI]: 0¢30À0¢98, p = 0¢042) than women not experiencing violence. Interpretation: Our findings suggest that women who experience physical IPV in India are less likely to use condoms and may be more likely to use IUDs than women without exposure to IPV.

Objectives

Methods

Results

Conclusion