title: Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia.
abstract: OBJECTIVE
  To assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.
  
  
  METHODS
  Cross-sectional analyses were conducted using the most recent Demographic and Health Surveys from Bangladesh, India and Nepal for married, pregnant women aged 15-49 years who responded to IPV assessments specific to current marriage (N=4738). Adjusted logistic and multinomial regression analyses were conducted with pooled data to assess associations of IPV ever (sexual only, physical only, sexual plus physical or none) with the outcomes of pregnancy intendedness (wanted, mistimed or unwanted) and pre-pregnancy contraceptive use (no, traditional or modern) for the current pregnancy.
  
  
  RESULTS
  IPV was not associated with a mistimed or unwanted pregnancy. Sexual IPV was associated with pre-pregnancy modern contraceptive use (aOR=2.32, 95% CI=1.24, 4.36); sexual plus physical IPV was associated with pre-pregnancy traditional contraceptive use (aOR=1.85, 95% CI=1.12, 3.07). Post hoc analysis of reasons for pre-pregnancy contraceptive discontinuation revealed that women with a history of IPV, particularly sexual IPV, had higher prevalence of contraceptive failure (sexual only, 37.3%; sexual plus physical, 30.9%; physical only, 22.6%; no IPV, 13.6%).
  
  
  CONCLUSIONS
  Pregnant women who experienced sexual IPV from husbands were more likely to use contraceptives pre-pregnancy but had no reduced risk unintended pregnancy, possibly due to higher rates of pre-pregnancy contraceptive failure among those with this history. These findings suggest that victims of sexual IPV are able to acquire and use family planning services but require more support to sustain effective contraceptive use.
  
  
  CONCLUSIONS
  Family planning services are reaching women affected by sexual IPV, and programs should be sensitive to this concern and the heightened vulnerability to contraceptive failure these women face. Long-acting reversible contraception could be beneficial by allowing women to have greater reproductive control in situations of compromised sexual autonomy.
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA 92093, USA; Center on Gender Equity and Health, University of California, San Diego, CA 92093, USA; Clinical Addiction Research and Education, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA 02118, USA. Electronic address: anitaraj@ucsd.edu.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California, San Diego School of Medicine, San Diego, CA 92093, USA; Center on Gender Equity and Health, University of California, San Diego, CA 92093, USA. Electronic address: lmcdouga@ucsd.edu.
authors.forename: Lotus
authors.initials: L
authors.lastname: McDougal
mesh_terms: D000293:Adolescent; D000328:Adult; D001211:Asia, Western; D003268:Contraception Behavior / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D000066511:Intimate Partner Violence / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D011275:Pregnancy, Unwanted; D012307:Risk Factors; D012725:Sexual Behavior; D018454:Spouses; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Contraceptive use; Intimate partner violence; South Asia; Unintended pregnancy