Abstract
Objective Although the impact of marital violence on women’s reproductive health is recognized globally, there is little research on how women’s experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. Method This study analyzes data on 9,639 currently married women from India’s 2006–2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married women’s reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. Results Currently married women’s experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171–1.588] for physical violence; OR, 1.649 [95% CI, 1.323–2.054] for sexual violence; OR, 1.273 [95% CI, 1.117–1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533–0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458–0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. Conclusion This study suggests that experiencing marital violence may have a negative impact on multiple aspects of women’s reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality.
Highlights
Our analyses focus on the impact of indicators of violence experienced by currently married women on the two outcomes of reporting an sexually transmitted infection (STI) symptom and seeking care
We examined whether currently married women who 1) experienced aspects of marital violence and 2) accepted any justification of marital physical violence would be more likely to report STI symptoms and be less likely to seek care in Uttar Pradesh (UP) state
Our results suggest that experiencing aspects of marital violence is associated with increased chance of women reporting STIs, and experiencing and justifying physical violence lower chances of seeking care
Summary
We used data from India’s Third National Family Health Survey (2005–2006), a cross-sectional, community-based survey that used a systematic, multistage, stratified, random sample of households in urban and rural sampling domains to cover over 99% of the population in all 29 major states and Union Territories of India (IIPS & Macro International, 2007). The study controlled for women’s demographic characteristics including age (women aged 15– 24 vs older women), and number of children borne (0 vs any); household socioeconomic characteristics including rural residence, household standard of living index (IIPS & Macro International, 2007), membership in scheduled caste/tribe/other “backward” groups as designated by the Government of India, religious affiliation, and husbands education. Measures of women’s autonomy and personal empowerment comprised four variables: a) Women’s freedom of mobility and role in household decision making (grouped into one measure); b) health care decision making autonomy; c) economic autonomy; and d) whether or not a woman felt she could refuse to have sex with her husband. Our analyses focus on the impact of indicators of violence experienced by currently married women on the two outcomes of reporting an STI symptom and seeking care. Emotional, sexual violence, and attitudes toward violence may all be considered aspects of gender-based violence, we examine how each of these factors influences the dependent variables, especially to highlight the role of women’s attitudes toward violence, which has been less examined
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