Women who are abused by their partner or ex-partner are much less likely to use contraception, which exposes them to sexually transmitted diseases and more frequent unintended pregnancies and abortions.
When they do use contraception, these women are less likely to use condoms and more likely to resort to contraceptive methods that they don’t need to discuss with their partners, like contraceptive injections or sterilization in developing countries, or intrauterine devices in Western countries.
The findings could help doctors know the best way to go about contraceptive counseling, researchers say.
For a new study, researchers combined studies on the subject, mostly done in the United States, and also in India, South Africa, Zimbabwe, and Nicaragua. The results suggest more than a mere correlation, indicating that partner violence has a causal effect on women’s use of contraception.
The research team selected studies that took into account other potential factors and studies in which questions on violence were always asked before questions on contraception.
“When talking to abused women, I had often heard them mention they were opting for contraception methods their male partner could not refuse,” says Lauren Maxwell, a PhD student at McGill University.
“I wanted to know whether, across countries, women who experience intimate partner violence are less able to use contraception, which might explain why rates of abortion and HIV transmission are higher among women abused by their partners.”
In African countries, women who experience partner violence are three times more likely to contract HIV than women who do not, according to studies cited by the World Health Organization.
The current study, published in PLOS ONE, indicates global efforts to improve access to contraception, like the Family Planning 2020 initiative recently announced by the United Nations, need to take domestic violence into account. One of the Millennium Development Goals set by the UN in 2000 was to achieve universal access to reproductive health by 2015.
“We have not met our targets in terms of access to contraception,” Maxwell says. “This is detrimental to maternal and child health and to women’s education. To improve both, we should consider partner violence when creating programs designed to improve women’s access to contraception.”
For example, some NGOs involve male partners in contraceptive counselling. The new research suggests it is important to screen for intimate partner violence before including men in the conversation around contraception. If not, the presence of violent partners could undermine efforts to offer women contraception.
Other researchers from McGill University and from Johns Hopkins University contributed to the study. The Maternal and Child Health Equity Project funded by the Canadian Institutes of Health Research, supported the work.
Source: McGill University