Association of intimate partner violence with unintended pregnancy and termination of pregnancy among a nationally representative sample of ever married women of reproductive age in Pakistan

Background: Pakistan is among the countries with high rates of unintended pregnancies (i.e., unwanted and/or mistimed), most of them are terminated in induced abortions. Among the other factors, intimate partner violence against wives is one of the factors associated with unplanned pregnancies and termination of pregnancies. Understandably, the women who experience violence by their husbands, experience reproductive coercion, lack reproductive autonomy and fertility control over their bodies. It is relatively highest in developing countries including Pakistan where gender inequality index is high particularly in reproductive health, where have relatively low socio-economic status and lack of access to resources and opportunities. In Pakistan, there is lack of representative data on intimate partner violence that can give evidence on the association of IPV and unplanned pregnancies and termination of pregnancies. This paper investigates the association of intimate partner violence with unplanned pregnancies and termination of pregnancy among a nationally representative sample of ever-married women of reproductive age.

Methods: We used data from the Pakistan Demographic and Heath Survey (PDHS) 2012 – 13, a nationally representative sample of ever married women aged 15 – 49 years (N= 13,558). A domestic violence module was implemented only in a subsample of households. One ever-married woman per household was selected and 3,687 women were successfully interviewed for the violence module. Our analysis was limited to currently married women who had participated in the domestic violence module (N= 3,545; weighted N= 3,518). Association between intimate partner violence against wives and unintended pregnancies and termination of pregnancies were assessed by calculating adjusted odds ratios (AORs) using logistic regression models after controlling for respondents age, level of education, region, place of residence, wealth index, contraceptive use, husband's desire for more children, and unmet need for family planning. Whether women ever had an „unintended pregnancy” was assessed by a question if a woman wanted the child at birth, wanted the child later, or did not want any more child. Participants were categorized as having an unintended pregnancy, if they reported a pregnancy within which they wanted the child later or did not want any more child. We assessed „pregnancy termination” by a question if a participant's pregnancy had ever resulted in miscarriage, abortion, or stillbirth. The vvariables were included in the adjusted models that were significant in the bivariate analysis at p < 0.20.

Findings: The analysis of data showed that 19.5% of married women aged 15 – 49 years in Pakistan reported at least one unplanned pregnancy and 36% women had at least one termination of pregnancy. More than one-third (37.9%) of married women reported ever experiencing any violence (physical or emotional), 26% physical, 31.6% emotional and 19.8% both emotional and physical violence during their marital lifetime. We found that women who reported ever experiencing any form of physical or emotional violence (AOR 1.44, 95% Confidence Interval [CI] 1.10 – 1.87), emotional violence only (AOR 1.66, 95% CI 1.26 – 2.18), and both emotional and physical violence (AOR 1.51, 95% CI 1.11 – 2.03) were significantly associated with unintended pregnancies after controlling for women's age, education, region, place of residence wealth index, contraceptive use, and unmet need for family planning. Similarly, women who reported ever experiencing any form of physical or emotional violence (AOR 1.31, 95% CI 1.13 – 1.52), physical violence only (AOR 1.56, 95% CI 1.32 – 1.84), emotional violence only (AOR 1.28, 95% CI 1.10 – 1.49), and both emotional and physical violence (AOR 1.62, 95% CI 1.35 – 1.93) were significantly associated with termination of pregnancy after controlling for women's age, education, ethnicity and use of contraception.

Conclusions: We found that women who experienced intimate partner violence were more likely to have unintended and termination of pregnancies. These findings have important public health implications because of the significant health burden associated with unplanned pregnancies and termination of pregnancies, especially those carried out in unsafe and dangerous conditions as abortion is a serious crime in Pakistan. The results may be useful for policymakers to develop efficient strategies to reduce IPV and its associated health burden for poor women in Pakistan.