Intimate partner violence and condom versus other modern contraception use among married women in rural India

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Article (peer-reviewed)

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Background: Data from India document that spousal intimate partner violence (IPV) is associated with both unintended pregnancy and spacing contraceptive use. Analysis of IPV by type of contraception is lacking. Condom use may be less likely than other spacing contraception in the context of IPV, as it is under male control. This study aims to assess associations of physical and sexual IPV with condom and other contraception use among married women in rural India. We hypothesize that women reporting physical and sexual IPV victimization are significantly less likely to report condom use but not other contraception use, relative to women reporting no such victimization. Methods: Study participants were from the randomized control trial evaluation of CHARM, a male-centered family planning intervention for young married couples in rural Maharashtra, India. Baseline data from women (age 18-30, residing with husbands) were used for analyses; data were restricted to those who were not pregnant at interview (n¼867). Surveys assessed socio-demographics, husband’s physical and sexual IPV perpetration, and an item on primary form of contraception used by women in the past 3 months (subsequently categorized as none, condom, other modern spacing contraception). Multinomial logistic regression analyses assessed associations between past 6 month physical and sexual IPV and contraceptive use, adjusting for age, education, length of marriage, caste, parity, and husband’s alcohol use. All participants provided written informed consent; all study procedures were approved by Institutional Review Boards at UCSD, and ICMR. Findings: Participants were aged 18-30 (SD: 2.5), and 17% reported no formal education.12% and 4% of women reported past 6 month physical 218 Social and Environmental Determinants of Health and sexual IPV, respectively. The majority (72%) reported not using any modern spacing method of contraceptive in the past 3 months; 14% reported condom use and other modern spacing contraception, respectively. Physical IPV was significantly associated with condom use (AOR: 1.89, 95% CI: 1.04, 3.28) but not other contraception use. Sexual violence was associated with other modern contraceptive use (AOR: 2.78, 95% CI: 1.11, 7.00), but not condom use. Interpretation: Women contending with sexual violence were more likely to engage in other modern contraceptive use but not condom use. This finding may indicate that women contending with sexual violence may depend on forms of contraception more within their control. To our knowledge, this study is the first of its kind to examine such associations between IPV and contraception use by type of method. These findings are limited due to the cross-sectional nature of the data, and are not generalizable to the larger population of women in India. Further research is needed to explain the association between recent physical IPV and condom use, a finding inconsistent with prior research.