Views from the London School of Hygiene & Tropical Medicine

Domestic violence deters contraception

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Women who are abused by their partner or ex-partner are much less likely to use contraception, exposing them to sexually transmitted diseases and leading to more frequent unplanned pregnancies and abortions, according to a study published in PLOS ONE.

These findings could influence how doctors and nurses provide advice and support on contraception.

Karen Devries, Senior Lecturer in Social Epidemiology at the London School of Hygiene & Tropical Medicine, was a co-author on the study, which was led by McGill University in Canada.

A striking result was that when they do use contraception, women who experience intimate partner violence – physical or sexual – are less likely to use condoms. Instead, they often resort to contraceptive methods that they don’t need to negotiate with their partners: for example, contraceptive injections or sterilisation in developing countries, or intrauterine devices in Western countries.

The team analysed the best studies existing on the subject, mostly done in the US, as well as in India, South Africa, Zimbabwe and Nicaragua. The results suggest more than a mere correlation, indicating that partner violence has a causal effect on women’s use of contraception. The research team selected studies that took into account other potential factors and studies in which questions on violence were always asked before questions on contraception.

Dr Devries said: “Studies have shown that HIV transmission and abortion rates are higher among women who have been abused by their partners. This research could help explain why this is the case. If women are too afraid to raise the issue of contraception with their partners or only feel able to use methods which don’t involve their partners then it is crucial health professionals are aware of these risk factors when talking to women in their care.”

The study was supported by the Maternal and Child Health Equity Project (MACHEquity), funded by the Canadian Institutes of Health Research.

Publication:

Maxwell L, Devries K, Zionts D, Alhusen JL, Campbell J, Estimating the Effect of Intimate Partner Violence on Women’s Use of Contraception: A Systematic Review and Meta-Analysis, PLOS ONE. (2015) PLOS ONE 10(2): e0118234. doi:10.1371/journal.pone.0118234 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0118234

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