title: Intimate partner violence and constraints to reproductive autonomy and reproductive health among women seeking abortion services in Bangladesh.
abstract: OBJECTIVE
  To understand intersections between intimate partner violence (IPV) and other constraints to women's reproductive autonomy, and the influence of IPV on reproductive health.
  
  
  METHODS
  A secondary analysis examined cross-sectional data from a facility-based sample of women seeking abortion care (for spontaneous or induced abortion) between March 1 and October 31, 2013. Women aged 18-49 years, who received abortion services and selected a short-acting contraceptive method or no contraception completed an interviewer-administered survey after treatment. Adjusted prevalence ratios (aPRs) were calculated for associations between IPV experience and potential constraints to reproductive autonomy and health outcomes.
  
  
  RESULTS
  There were 457 participants included in the present analysis and 118 (25.8%) had experienced IPV in the preceding year. IPV was associated with discordance in fertility intentions with husbands/partners and in-laws, with in-law opposition to contraception, with perceived religious prohibition of contraception, and with presenting unaccompanied (all P<0.05). IPV was also associated with receiving post-abortion care after an induced abortion compared with accessing legal menstrual regulation, and with the use of medication abortion compared with manual vacuum aspiration (both P<0.05).
  
  
  CONCLUSIONS
  Intimate partner violence was associated with additional constraints on reproductive autonomy from husbands/partners, in-laws, and religious communities. Seeking induced abortion unaccompanied and using medication abortion could be strategies to access abortion covertly among women experiencing IPV. Ensuring women's reproductive freedom requires addressing IPV and related constraints.
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Pearson
authors.affiliation: Research and Evaluation Unit, Ipas, Chapel Hill, NC, USA.
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Andersen
authors.affiliation: Research and Evaluation Unit, Ipas Bangladesh, Dhaka, Bangladesh.
authors.forename: Kamal
authors.initials: K
authors.lastname: Biswas
authors.affiliation: Research and Evaluation Unit, Ipas Bangladesh, Dhaka, Bangladesh.
authors.forename: Rezwana
authors.initials: R
authors.lastname: Chowdhury
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Sherman
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Decker
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D000022:Abortion, Spontaneous / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D001459:Bangladesh; D003267:Contraception / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011446:Prospective Studies; D060728:Reproductive Health / Q000592:standards*; D012307:Risk Factors; D013179:Spouse Abuse / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Abortion; Bangladesh; Intimate partner violence