Elsevier

Women and Birth

Volume 28, Issue 2, June 2015, Pages 101-105
Women and Birth

Original Research – Quantitative
Unintended pregnancy and intimate partner violence around pregnancy in a population-based study

https://doi.org/10.1016/j.wombi.2015.01.003Get rights and content

Abstract

Background

Intimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. However, the relationship between IPV and women's ability to control their fertility has not been adequately explored.

Aim

To investigate the association between unintended pregnancy and emotional or physical violence perpetrated by partners around pregnancy.

Methods

A population-based study was undertaken, recruiting women (n = 779) at the hospital obstetric departments and gathering social and family data. IPV was diagnosed by using the Index of Spouse Abuse (ISA). Data were gathered by trained midwives in 15 public hospitals in southern Spain and multivariate logistic regression analysis was performed.

Findings

The pregnancy was reported to be unintended by 118 (15.1%) of the study population. Unintended pregnancy was significantly associated with: physical and/or emotional IPV around pregnancy, age, marital status, cohabitation, educational level, and employment status. After adjusting for socio-demographic characteristics, emotional IPV around pregnancy was significantly associated with an unintended pregnancy (AOR = 2.5; 95% CI = 1.5–4.3). Being in a non-committed relationship was a risk factor (AOR = 3.5; 95% CI = 1.8–6.1) and being in employment a protective factor (AOR = 0.4; 95% CI = 0.2–0.8) for an unintended pregnancy.

Conclusion

Women who report an unintended pregnancy may be experiencing emotional IPV. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. A better understanding of the relationship between unintended pregnancy and violence can aid midwives about potential reproductive health risk factors associated with abuse.

Introduction

Intimate partner violence (IPV) and unintended pregnancy are public health issues that can affect the health and well-being of women and their children. The infliction of violence by intimate partners is common in many societies and affects millions of women throughout the world every year. Studies have reported high rates of abuse during pregnancy and have linked this abuse to intrauterine growth restriction, low birth weight, fetal and infant death, and other maternal complications.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

Previous studies have described a link between IPV and unintended (i.e., mistimed or unwanted) pregnancy.13 Unintended pregnancy has been associated with adverse outcomes for women, fetuses, and infants. It has been associated with shorter lactation periods, a lower likelihood of recognizing early signs of pregnancy, a greater likelihood of delayed entry into prenatal care, a lower-quality relationship between mother and child, and child abuse and neglect.13 Most induced abortions are unintended pregnancies and have been significantly associated with abuse,14 and unsafe abortion is one of the leading causes of maternal mortality worldwide, being more frequent in countries where abortion is illegal or severely restricted.8, 15

The relationship between IPV and unintended pregnancy has not been sufficiently explored. Out of all of the studies that have addressed IPV during or around the time of pregnancy, only a few have considered the intendedness of the pregnancy as a potential influential factor.1, 16, 17 Some authors specifically focused on the association between unintended pregnancy and IPV but applied only bivariate analyses to examine the empirical relationship between them.18, 19, 20, 21, 22, 23 More recently, researchers directly examined the association between IPV and unintended pregnancy in study populations from Colombia,24 Bangladesh25, 26 and a group of low- and middle-income countries,15 using multivariate logistic regression analysis to control for potential confounders.

Hence, further knowledge is required of the risk factors for unintended pregnancy, including those related to IPV, in different ethnic and socio-cultural settings. We analyzed the association of unintended pregnancy with IPV around pregnancy and with socio-demographic characteristics in a population-based study in Spain, a developed country. Previous studies have analyzed whether women experiencing IPV were more likely to have unintended pregnancies.15, 23, 24, 25, 26 The hypothesis of the present study was that women who report an unintended pregnancy may be experiencing IPV.

It is widely argued that heightened levels of fear and control within abusive relationships can impair women's ability to prevent pregnancy or negotiate contraceptive methods, leading to unintended pregnancy.13, 15, 18 Although emotional violence is the most frequent type of IPV, previous studies have focused on the association of physical and/or sexual abuse with unintended pregnancy.14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26 To the best of our knowledge, this is the first exploration of the association of unintended pregnancy with emotional and physical IPV around pregnancy.

The purpose of this study was to explore the potential association between unintended pregnancy and emotional and physical IPV around pregnancy, controlling for socio-demographic characteristics in a population-based sample of women who have recently given birth.

Section snippets

Study subjects, population, and sample size

A population-based study was designed based on statistics published in 2009 by the health service for all public hospitals in the region, including data on the number of deliveries in each type of hospital (regional, specialist, or district). Details of the calculation of the population for this study of IPV during pregnancy have been described elsewhere.12 A cluster sampling approach was adopted, considering the hospitals as clusters and grouping by hospital type. A sample size of 750 women

Results

The study sample included 779 women. Their mean age was 29.9 ± 5.6 years (63% aged between 25 and 34 years); 64% were married at the time of the interview, 14% had a committed relationship (unmarried) and 22% a non-committed relationship; 48% had studied for 7–12 years, 38% for <7 years, and 14% had university studies; 56% were employed at the time of the interview, 22% were housewives, 20% unemployed, and 2% were students; 91% were of Spanish origin, while the other 9% were largely from

Discussion

In this population-based sample, 15.1% of the women had not intended their recent pregnancy. In a WHO multi-country study on women's health and domestic violence in 10 low and middle-income countries,15 a mean of 38% of the women reported that the pregnancy was unwanted or mistimed at the time of the pregnancy (range, 13–68%); similar percentages to the present finding were reported in Samoa (13%) or Japan (19.7%), but the percentage was above 30% in the remaining countries. In Bangladesh,

Conclusion

Our study has shown that women who report an unintended pregnancy may be experiencing emotional IPV around pregnancy. The risk of emotional IPV is higher if women reporting an unintended pregnancy are in a committed relationship, married, or in employment. Further research is warranted on the relationship between unintended pregnancy and emotional IPV in different socio-cultural settings. The knowledge obtained could help midwives to be more aware of the potential reproductive health risk

Acknowledgements

The study was partially funded by Research Group BIO-253 of the Education and Science Department of the Regional Government of Andalusia, Spain. The authors are grateful to all of the midwives who participated in this study and to all of the women who shared their experiences.

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