Kidman Rachel, Palermo Tia, Bertrand Jane
Program in Public Health, Department of Preventive Medicine, Stony Brook University, Health Sciences Tower, Level 3, Room 078, Stony Brook, NY 11794, USA.
Department of Global Health Systems and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 1900, New Orleans, LA 70112, USA.
Soc Sci Med. 2015 May;133:2-10. doi: 10.1016/j.socscimed.2015.03.034. Epub 2015 Mar 16.
Intimate partner violence (IPV) has been found to be negatively associated with contraceptive use in developing countries, but evidence from Africa is mixed. This study examines whether the above association differs in conflict settings, which have the potential for both higher levels of violence and more limited access to family planning. We use nationally representative data from the Democratic Republic of the Congo to examine the relationship between individual- and community-level IPV and modern contraceptive use, and to explore whether conflict modifies the relationship between IPV and contraceptive use. Nationally, only 6% of women reported current modern contraceptive use, while 53% reported experiencing physical IPV and 32% reported experiencing sexual IPV. In multivariate models, we found that individual-level sexual IPV was positively associated with current using modern contraceptive use, but that a combined measure of physical and sexual IPV did not demonstrate a similar association. Community-level IPV was not associated with individual-level contraceptive use. Conflict exposure was neither an independent predictor nor modifier of contraceptive use. Results suggest improved access to family planning should be a priority for programming in DRC, and efforts should ensure that sufficient resources are allocated towards the reproductive health needs of women in both conflict and non-conflict regions.
在发展中国家，亲密伴侣暴力（IPV）与避孕措施的使用呈负相关，但非洲的证据并不一致。本研究考察了上述关联在冲突环境中是否有所不同，因为冲突环境可能导致更高程度的暴力以及更有限的计划生育服务获取途径。我们使用刚果民主共和国具有全国代表性的数据，来研究个人层面和社区层面的亲密伴侣暴力与现代避孕措施使用之间的关系，并探讨冲突是否会改变亲密伴侣暴力与避孕措施使用之间的关系。在全国范围内，只有6%的女性报告当前正在使用现代避孕措施，而53%的女性报告曾遭受身体暴力形式的亲密伴侣暴力，32%的女性报告曾遭受性暴力形式的亲密伴侣暴力。在多变量模型中，我们发现个人层面的性暴力形式的亲密伴侣暴力与当前使用现代避孕措施呈正相关，但身体暴力和性暴力形式的亲密伴侣暴力综合衡量指标并未显示出类似关联。社区层面的亲密伴侣暴力与个人层面的避孕措施使用无关。冲突暴露既不是避孕措施使用的独立预测因素，也不是其调节因素。结果表明，改善计划生育服务的可及性应成为刚果民主共和国规划工作的优先事项，并且各项工作应确保为冲突地区和非冲突地区的妇女的生殖健康需求分配足够的资源。
