Study Examines Impact of Intimate Partner Violence on Reproductive Decision-Making

Women who are victims of intimate partnership violence are significantly less likely to use contraception after their most recent delivery, according to an AHRQ-funded study. The study said this is particularly true with Hispanic women who did not receive prenatal birth control counseling. Investigators used a population-based surveillance system to analyze data on more than 193,000 women in the United States with live births between 2004 and 2008. Study analyses revealed that approximately 6.2 percent of women reported intimate partner violence and 15.5 percent reported no postpartum contraceptive use. Researchers advised health providers to educate women on effective contraceptive options. In addition, the researchers recommended that providers talk with women, within the context of abusive relationships, about long-acting reversible contraceptives that do not depend on the cooperation of their partners. The study and abstract, “Intimate Partner Violence and Postpartum Contraceptive Use: The Role of Race/Ethnicity and Prenatal Birth Control Counseling,” were published in the April 29 issue of the journalContraception.

2015 Apr 29. pii: S0010-7824(15)00172-9. doi: 10.1016/j.contraception.2015.04.009. [Epub ahead of print]

Intimate partner violence and postpartum contraceptive use: the role of race/ethnicity and prenatal birth control counseling.

Cha S1, Chapman DA2, Wan W3, Burton CW4, Masho SW2.

Author information

Abstract

OBJECTIVES:

Intimate partner violence (IPV) is a major problem that could affect reproductive decision making. The aim of this study is to examine the association between IPV and contraceptive use and assess whether the association varies by receipt of prenatal birth control counseling and race/ethnicity.

STUDY DESIGN:

This study analyzed the 2004-2008 national Pregnancy Risk Assessment Monitoring System (PRAMS) that included 193,310 women with live births in the United States. IPV was determined by questions that asked about physical abuse by a current or former partner in the 12 months before or during pregnancy. The outcome was postpartum contraceptive use (yes vs. no). Multiple logistic regression analyses were conducted to assess the influence of experiencing IPV at different periods (preconception IPV, prenatal IPV, both preconception and prenatal IPV, preconception and/or prenatal IPV). Data were stratified to assess differential effects by race/ethnicity and receipt of birth control counseling.

RESULTS:

Approximately 6.2% of women reported IPV, and 15.5% reported no postpartum contraceptive use. Regardless of the timing of abuse, IPV-exposed women were significantly less likely to report contraceptive use after delivery. This was particularly true for Hispanic women who reported no prenatal birth control counseling and women of all other racial/ethnic groups who received prenatal birth control counseling.

CONCLUSIONS:

IPV victimization adversely affects the use of contraceptive methods following delivery in women with live births. Birth control counseling by health providers may mitigate these effects; however, the quality of counseling needs further investigation. Better integration of violence prevention services and family planning programs is greatly needed.

IMPLICATIONS:

Consistent with national recommendations by the U.S. Preventive Service Task Force, clinicians and public health workers are strongly encouraged to screen for IPV. Health providers should educate women on effective contraceptive options and discuss long-acting reversible contraceptives that are not partner dependent within the context of abusive relationships.