The mediation effect of contraceptive use and women’s autonomy on the relationship between intimate partner violence and unintended pregnancy in Ethiopia

Abstract

Background Intimate partner violence (IPV) affects one in every three women globally. Previous studies have revealed that women’s experiences of different forms of IPV are significantly associated with a higher rate of unintended pregnancy, reduced uptake of contraception, and reduced ability to make decisions regarding their fertility. The aim of this study was to investigate whether previously observed relationships between IPV and unintended pregnancy in Ethiopia are mediated by contraceptive use and women’s autonomy. Methods This study was performed using nationally representative data from the 2016 Ethiopian Demographic and Health Survey (EDHS). A subsample of married women of reproductive age reporting a pregnancy within the 5 years preceding 2016 and who participated in the domestic violence sub-study of the survey were included in analyses. Logistic regression models, together with the product of coefficients method, were used to estimate direct and mediated effects. Results Twenty six percent of participants reported an unintended pregnancy in the 5 years preceding the survey. Sixty-four percent reported having ever experienced IPV (a composite measure of physical, sexual, emotional abuse, and partner controlling behaviour). After adjusting for potential confounding factors, unintended pregnancy was significantly positively associated with reporting sexual IPV, emotional IPV, IPV (a composite measure of physical, sexual, or emotional abuse), and multiple partner controlling behaviour. However, IPV (as a composite of all four forms), physical IPV, and partner control (single act) were not significantly associated with unintended pregnancy. Women’s autonomy, but not contraception use, had a significant partial mediation effect in the relationships between some forms of IPV and unintended pregnancy. Women’s autonomy mediated about 35, 35, and 43% of the total effect of emotional IPV, IPV (physical, sexual, and/or emotional), and multiple partner control on unintended pregnancy respectively. Conclusion Women’s autonomy appears to play a significant role in mediating the effect of IPV on unintended pregnancy in Ethiopia. Maternal health service interventions in Ethiopia could incorporate measures to improve women’s decision-making power to reduce the negative reproductive health effects of IPV.

Magnitude and determinants of intimate partner violence against women in East Africa: multilevel analysis of recent demographic and health survey

“…Consistent with the previous studies [ 26 – 28 ], unintended pregnancy was found to have a significant association with IPV. This could be explained by women who experienced IPV and unintended pregnancy mostly living together in situations without a good relationship.…”

Association between sexual violence and unintended pregnancy among married women in Zambia

“…According to the current paper's findings, married women in Zambian had a high rate of unintended pregnancies (36%).This figure is much higher than what was found in a study of the 2016 Ethiopia DHS, where 26% of women had unintended pregnancies [25]. The prevalence of unintended pregnancies in Zambia, on the other hand, is lower than that of Uganda, where 38% of the women in a study of the 2016 DHS had an unintended pregnancy [26].…”

“…Further, in order to for us to evaluate the adjusted associations between the predictor variable (Sexual Violence), mediating factors (Ever use of contraception and RHDMC), and the outcome variable (unintended pregnancies), we constructed three model path ways based on the Generalised Structural Equation Modelling (GSEM) Stata 'gsem' command. All variables, predictor, mediating and outcome variables were coded as binary variables and as such, all path models (a, b, c and d) were modelled as logistic models [25]. As such, mediation existed in our modelling when the predicted variable was simultaneously regressed onto the predicting variable and the mediator.…”

Maternal exposure to intimate partner violence and uptake of maternal healthcare services in Ethiopia: Evidence from a national survey

“…Literature regarding the effects of IPV on women’s health in Ethiopia found associations between IPV and adverse birth outcomes [ 16 ], unintended pregnancy [ 17 ], pregnancy loss [ 18 ], unmet need for family planning [ 19 ], depression [ 20 , 21 ], Human Immuno-deficiency Virus (HIV) status [ 22 ], and antiretroviral therapy adherences [ 23 ]. Mediation effect of contraceptive use and women’s autonomy on the relationship between IPV and unintended pregnancy has also been documented [ 24 ].…”