Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
Bill & Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
BMJ Open. 2023 May 10;13(5):e065697. doi: 10.1136/bmjopen-2022-065697.
Among nationally representative cross-sections of women in need of contraception from Burkina Faso, Côte d'Ivoire and Kenya, we aimed to: (1) examine the intersection of past-year physical/sexual intimate partner violence (IPV), emotional IPV and reproductive coercion (RC) and (2) assess the impact of physical/sexual IPV, emotional IPV and RC on women's contraceptive use outcomes, including current contraceptive use, method type and covert use.
The present analysis uses cross-sectional female data collected in Burkina Faso (December 2020-March 2021), Côte d'Ivoire (October-November 2021) and Kenya (November-December 2020).
Burkina Faso, Côte d'Ivoire and Kenya PARTICIPANTS: Analytical samples were restricted to partnered women with contraceptive need who completed a violence module (Burkina Faso n=1863; Côte d'Ivoire n=1105; Kenya n=3390).
The exposures of interest-past-year emotional IPV, physical/sexual IPV and RC-were assessed using abridged versions of the Revised Conflict and Tactics Scale-2 and Reproductive Coercion Scale, respectively. Outcomes of interest included current contraceptive use, contraceptive method type (female controlled vs male compliant), and covert contraceptive use, and used standard assessments.
Across sites, 6.4% (Côte d'Ivoire) to 7.8% (Kenya) of women in need of contraception experienced RC; approximately one-third to one-half of women experiencing RC reported no other violence forms (31.7% in Burkina Faso to 45.8% in Côte d'Ivoire), whereas physical/sexual IPV largely occurred with emotional IPV. In multivariable models, RC was consistently associated with covert use (Burkina Faso: aOR 2.84 (95% CI 1.21 to 6.64); Côte d'Ivoire: aOR 4.45 (95% CI 1.76 to 11.25); Kenya: aOR 5.77 (95% CI 3.51 to 9.46)). Some IPV in some settings was also associated with covert use (emotional IPV, Burkina Faso: aOR 2.99 (95% CI 1.56 to 5.74); physical/sexual, Kenya: aOR 2.35 (95% CI 1.33 to 4.17)).
Across settings, covert use is a critical strategy for women experiencing RC. Country policies must recognise RC as a unique form of violence with profound implications for women's reproductive health.
在布基纳法索、科特迪瓦和肯尼亚有避孕需求的全国代表性女性横断面中，我们旨在：(1) 研究过去一年的身体/性亲密伴侣暴力(IPV)、情感 IPV 和生殖胁迫(RC)之间的交集，以及 (2) 评估身体/性 IPV、情感 IPV 和 RC 对女性避孕效果的影响，包括当前的避孕使用、方法类型和隐蔽使用。
本分析使用了 2020 年 12 月至 2021 年 3 月在布基纳法索(1863 名女性)、2021 年 10 月至 11 月在科特迪瓦(1105 名女性)和 2020 年 11 月至 12 月在肯尼亚(3390 名女性)收集的女性横断面数据。
布基纳法索、科特迪瓦和肯尼亚。
分析样本仅限于有避孕需求且完成暴力模块的伴侣女性(布基纳法索 n=1863；科特迪瓦 n=1105；肯尼亚 n=3390)。
感兴趣的暴露因素包括过去一年的情感 IPV、身体/性 IPV 和 RC，分别使用修订后的冲突和策略量表-2 和生殖胁迫量表的简化版本进行评估。感兴趣的结果包括当前的避孕使用、避孕方法类型(女性控制型与男性顺从型)和隐蔽使用，并使用了标准评估。
在所有地点，6.4%(科特迪瓦)至 7.8%(肯尼亚)有避孕需求的女性经历了 RC；大约三分之一到一半经历 RC 的女性报告没有其他暴力形式(布基纳法索 31.7%，科特迪瓦 45.8%)，而身体/性 IPV 主要与情感 IPV 同时发生。在多变量模型中，RC 与隐蔽使用始终相关(布基纳法索：aOR 2.84(95%CI 1.21-6.64)；科特迪瓦：aOR 4.45(95%CI 1.76-11.25)；肯尼亚：aOR 5.77(95%CI 3.51-9.46))。在某些情况下，一些 IPV 也与隐蔽使用相关(情感 IPV，布基纳法索：aOR 2.99(95%CI 1.56-5.74)；身体/性，肯尼亚：aOR 2.35(95%CI 1.33-4.17))。
在所有地点，隐蔽使用都是经历 RC 的女性的一种重要策略。国家政策必须认识到 RC 是一种独特的暴力形式，对女性的生殖健康有深远的影响。
