Save the Children Nepal/Global Fund, Kathmandu, Nepal.
Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
BMC Womens Health. 2022 Jun 8;22(1):215. doi: 10.1186/s12905-022-01780-4.
Intimate partner violence (IPV) adversely affects women's reproductive health outcomes but to what extent women's justification of IPV affects maternal health care service utilization is unexplored.
The secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women's justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT).
A total of 26,029 women aged 15-49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94).
Women's justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women's condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women's utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.
亲密伴侣暴力（IPV）对女性的生殖健康结果有不利影响，但女性对 IPV 的辩解在多大程度上影响孕产妇保健服务的利用尚不清楚。
使用了 2010 年至 2015 年期间在阿富汗、不丹、尼泊尔和巴基斯坦进行的多项指标群集调查的二次横断面数据集。我们使用具有随机效应的广义线性混合模型，在群集和国家层面上，确定区域层面上孕产妇保健服务利用的优势比，并在国家层面上使用多变量逻辑回归模型调整复杂调查设计。使用似然比检验（LRT）检查 IPV 辩解与居住地点之间的相互作用，以及与 IPV 辩解水平升高相关的孕产妇保健服务利用的线性趋势。
共纳入 26029 名年龄在 15-49 岁、与伴侣同住且在调查前 2 年内有妊娠结局的妇女。对 IPV 进行辩解的妇女利用避孕方法的可能性较小（优势比[aOR]）=0.86，95%置信区间[CI]0.84，0.88），至少一次产前护理[aOR=0.80，95%CI0.72，0.88），四次或更多次产前护理服务[aOR=0.81，95%CI0.76，0.86），机构分娩[aOR=0.87，95%CI0.80，0.94）和产后护理[aOR=0.76，95%CI0.62，0.95）服务。随着 IPV 辩解程度的增加，四次或更多次 ANC 就诊（LRT P=0.96）和机构分娩（LRT P=0.80）呈下降的线性趋势。与农村地区相比[aOR 0.83，95%CI 0.73，0.94），在城市地区对 IPV 进行辩解的妇女接受至少一次 ANC 就诊的可能性较小[aOR 0.67，95%CI 0.60，0.75）。
女性对 IPV 的辩解与区域层面上广泛利用孕产妇保健服务的可能性降低有关。尽管在制定公共卫生干预措施之前，进行可能有助于确定因果关系的进一步研究很重要，但我们的研究表明，针对女性对 IPV 的宽容态度的干预措施，如果尽早实施，可能有助于提高南亚地区（包括阿富汗、不丹、尼泊尔和巴基斯坦）妇女对基本孕产妇保健服务的利用。
