Raj Anita, McDougal Lotus
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.
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.
Contraception. 2015 Jun;91(6):456-63. doi: 10.1016/j.contraception.2015.03.008. Epub 2015 Mar 10.
To assess associations of intimate partner violence (IPV) with pregnancy intendedness and pre-pregnancy contraceptive use among pregnant women in South Asia.
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.
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%).
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.
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.
评估南亚地区孕妇亲密伴侣暴力（IPV）与妊娠意愿及孕前避孕措施使用之间的关联。
利用孟加拉国、印度和尼泊尔最新的人口与健康调查数据，对15 - 49岁、回应了当前婚姻特定IPV评估的已婚孕妇进行横断面分析（N = 4738）。采用汇总数据进行调整后的逻辑回归和多项回归分析，以评估曾遭受的IPV（仅性暴力、仅身体暴力、性暴力加身体暴力或无暴力）与当前妊娠的妊娠意愿（想要、时机不当或不想要）及孕前避孕措施使用（未使用、传统或现代）结果之间的关联。
IPV与时机不当或意外妊娠无关。性暴力IPV与孕前现代避孕措施使用有关（调整后比值比[aOR]=2.32，95%置信区间[CI]=1.24, 4.36）；性暴力加身体暴力IPV与孕前传统避孕措施使用有关（aOR = 1.85，95% CI = 1.12, 3.07）。对孕前停用避孕措施原因的事后分析显示，有IPV史的女性，尤其是性暴力IPV史的女性，避孕失败的患病率更高（仅性暴力，37.3%；性暴力加身体暴力，30.9%；仅身体暴力，22.6%；无IPV，13.6%）。
遭受丈夫性暴力IPV的孕妇孕前更有可能使用避孕措施，但意外妊娠风险并未降低，这可能是由于有此病史的女性孕前避孕失败率较高。这些发现表明，性暴力IPV受害者能够获得并使用计划生育服务，但需要更多支持以维持有效的避孕措施使用。
计划生育服务已覆盖受性暴力IPV影响的女性，项目应关注这一问题以及这些女性面临的更高的避孕失败脆弱性。长效可逆避孕措施可能有益，因为它能让女性在性自主权受损的情况下对生育有更大的控制权。
