CONTEXT: Intimate partner violence is associated with a number of reproductive and mental health problems. However, the relationship between intimate partner violence and women's ability to control their fertility has not been adequately explored, especially in developing countries.

METHODS: Data from the 2000 Demographic and Health Survey for Colombia were used in multivariate logistic regressions to explore the relationship between intimate partner violence and unintended pregnancy, which was included as a measure of fertility control. Regional differences in the relationship were also explored, and populationattributable risk estimates were calculated. The sample consisted of 3,431 ever-married women aged 15-49 who had given birth in the last five years or were currently pregnant.

RESULTS: Fifty-five percent of respondents had had at least one unintended pregnancy, and 38% had been physically or sexually abused by their current or most recent partner. Women's adjusted odds of having had an unintended pregnancy were significantly elevated if they had been physically or sexually abused (odds ratio, 1.4); the association was observed in the Atlántica and Central regions (1.7 each), but was not significant elsewhere in thecountry. Eliminating intimate partner violence in Colombia would result in an estimated 32,523-44,986 fewer unintended pregnancies each year.

CONCLUSIONS: These findings indicate the need to include intimate partner violence screening and treatment in reproductive health programs, to promote men's involvement in fertility control programs, and to improve the social and political response to intimate partner violence.

International Family Planning Perspectives, 2004,30(4):165-173

The infliction of violence by intimate partners is common in many societies and affects millions of women throughout the world each year. Partner abuse's private nature has made it difficult to quantify its prevalence, understand its risk factors or address its consequences. In the last decade, however, research has revealed high rates of intimate partner violence in the United States and worldwide,1 and has identified some of the direct and indirect health consequences of abuse, including mental and reproductive health problems.2 Studies have also reported high rates of abuse during pregnancy3 and have linked such abuse to intrauterine growth restriction, low birth weight, fetal and infant death and other maternal complications.4

However, the relationship between intimate partner violence and women's ability to control their fertility has not been adequately explored, especially among women in developing countries.5 One indicator of a lack of fertility control is unintended (i.e., mistimed or unwanted) pregnancy, which has been associated with adverse outcomes for women, fetuses and infants.6 Therefore, it is important to understand the risk factors for unintended pregnancy, particularly those related to intimate partner violence.

Some of the existing research on intimate partner violence and fertility control has focused on women's fear of violence as a barrier to contraceptive use in general.7 Other researchers have explored relationships between partner abuse and the use oi male methods, because women may face violence when attempting to negotiate condom use,8 and between abuse and female methods, because partners may become abusive when they discover covert use or suspect infidelity.9 While the anecdotal evidence from these studies helps clarify the mechanisms through which violence and fear of violence could affect fertility control, the issue merits further investigation.

With the exception of a few studies based on data from postpartum women in the United States, limited quantitative research has directly explored the relationship between intimate partner violence and fertility control.10 Several studies found that women who had experienced intimate partner violence during pregnancy were more likely than nonabused women to report that the pregnancy was unplanned or closely spaced, or that they had had unhappy feelings about it.11 However, these studies examined bivariate relationships without controlling for other factors. Another study found no significant association between abuse and unwanted pregnancy, but the fact that mistimed pregnancies were categorized with wanted pregnancies may have affected the findings.12

Most induced abortions are of pregnancies that were unintended. Studies exploring intimate partner violence among women obtaining abortions therefore provide important information about the association between intimate partner violence and unintended pregnancy.13 One such study revealed a significant association between abuse and abortion.14 Three others found that rates of prior abortion were significantly higher among abused women than among nonabused women.15

These studies provide some evidence that a relationship exists between partner abuse and unintended pregnancy. However, more investigation is needed to determine whether the relationship would be significant in a multivariate analysis and whether similar results would be found in other contexts, particularly in developing countries. In this study, we used multivariate logistic regressions to explore the relationship between intimate partner violence and unintended pregnancy in a population-based sample of Colombian women. It is the first study to explore this issue in a Latin American setting.

METHODS

Data

Analyses are based on cross-sectional data from the 2000 Demographic and Health Survey (DHS) for Colombia.le We used information from the women's questionnaire, in which women of reproductive age (15-49) were asked about their reproductive and sexual history, contraceptive knowledge and practices, knowledge and attitudes about HIV/AIDS, fertility desires, nutritional status, family violence experience and births in the last five years. Of the 11,585 women surveyed, 7,716 had ever been married (i.e., legally married or in a cohabiting relationship) and answered a series of questions related to intimate partner violence; lack of privacy prevented interviewers from asking these questions of an additional 31 ever-married respondents. The remaining 3,838 women had never been married and thus could not have experienced abuse by an intimate partner (which is defined in this study as a legal spouse or cohabiting partner).

Of the 7,716 respondents who completed the partner violence module, 3,431 reported that they had given birth in the last five years or were currently pregnant, and therefore could have had an unintended pregnancy.* This subgroup, which we refer to as "recently pregnant women," makes up the sample for our analysis.

Abuse Variables

A woman was categorized as having experienced physical abuse if she answered affirmatively when asked if her partner had pushed her, hit her with his hand, hit her with a hard object, bitten her, kicked or dragged her, threatened her with a knife or gun, attacked her with a knife or gun, or tried to choke or burn her, either sometimes or frequently. A woman was classified as having experienced sexual abuse if she stated that her partner had forced her to have sex, either sometimes or frequently. We pooled this information to create an aggregate measure of abuse, which was coded positive for all women who reported either physical or sexual violence at any frequency.

It should be noted that respondents were asked about their experience of abuse in their current or most recent partnership, rather than over their lifetime. As a result, we assume that this analysis underestimates actual rates of abuse and indicates a weaker relationship between abuse and unintended pregnancy than actually exists. In addition, because respondents were not asked when abuse occurred relative to each unintended pregnancy, they could have been abused by a partner other than one with whom they had an unintended pregnancy.

Unintended Pregnancy Variable

Respondents were asked about the intendedness of all pregnancies they had had in the last five years that had ended in live births, and about the inlendedness of their current pregnancy (if relevant). For each pregnancy, women were asked whether they had wanted the pregnancy at the time of conception, had wanted it later or had not wanted it at all. We categorized women as having had an unintended pregnancy if they reported their current or any past pregnancy as wanted later or not at all. We chose to make this variable dichotomous rather than continuous because 79% of the 1,900 women who reported at least one unintended pregnancy reported only one.

Explanatory Variables