The impact of intimate partner violence on women's contraceptive use: Evidence from the Rakai Community Cohort Study in Rakai, Uganda

Lauren Maxwell, Heena Brahmbhatt, Anthony Ndyanabo, Jennifer Wagman, Gertrude Nakigozi, Jay S. Kaufman, Fred Nalugoda, David Serwadda, Arijit Nandi

Research output: Contribution to journalArticle

Abstract

A systematic review of longitudinal studies suggests that intimate partner violence (IPV) is associated with reduced contraceptive use, but most included studies were limited to two time points. We used seven waves of data from the Rakai Community Cohort Study in Rakai, Uganda to estimate the effect of prior year IPV at one visit on women's current contraceptive use at the following visit. We used inverse probability of treatment-weighted marginal structural models (MSMs) to estimate the relative risk of current contraceptive use comparing women who were exposed to emotional, physical, and/or sexual IPV during the year prior to interview to those who were not. We accounted for time-fixed and time-varying confounders and prior IPV and adjusted standard errors for repeated measures within individuals. The analysis included 7923 women interviewed between 2001 and 2013. In the weighted MSMs, women who experienced any form of prior year IPV were 20% less likely to use condoms at last sex than women who had not (95% CI: 0.12, 0.26). We did not find evidence that IPV affects current use of modern contraception (RR: 0.99; 95% CI: 0.95, 1.03); however, current use of a partner-dependent method was 27% lower among women who reported any form of prior-year IPV compared to women who had not (95% CI: 0.20, 0.33). Women who experienced prior-year IPV were less likely to use condoms and other forms of contraception that required negotiation with their male partners and more likely to use contraception that they could hide from their male partners. Longitudinal studies in Rakai and elsewhere have found that women who experience IPV have a higher rate of HIV than women who do not. Our finding that women who experience IPV are less likely to use condoms may help explain the relation between IPV and HIV.

Original languageEnglish (US)
Pages (from-to)25-32
Number of pages8
JournalSocial Science and Medicine
Volume209
DOIs
StatePublished - Jul 1 2018

Fingerprint

Uganda
Contraceptive Agents
contraceptive
Cohort Studies
violence
community
evidence
Condoms
contraception
Contraception
Structural Models
structural model
Longitudinal Studies
longitudinal study
Intimate Partner Violence
Cohort
HIV
Sexual Partners
Negotiating
experience

Keywords

  • Causal inference
  • Cohort
  • Condoms
  • Intimate partner violence
  • Long-acting and permanent methods
  • Marginal structural models
  • Reproductive coercion

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

Cite this

The impact of intimate partner violence on women's contraceptive use : Evidence from the Rakai Community Cohort Study in Rakai, Uganda. / Maxwell, Lauren; Brahmbhatt, Heena; Ndyanabo, Anthony; Wagman, Jennifer; Nakigozi, Gertrude; Kaufman, Jay S.; Nalugoda, Fred; Serwadda, David; Nandi, Arijit.

In: Social Science and Medicine, Vol. 209, 01.07.2018, p. 25-32.

Research output: Contribution to journalArticle

Maxwell, L, Brahmbhatt, H, Ndyanabo, A, Wagman, J, Nakigozi, G, Kaufman, JS, Nalugoda, F, Serwadda, D & Nandi, A 2018, 'The impact of intimate partner violence on women's contraceptive use: Evidence from the Rakai Community Cohort Study in Rakai, Uganda', Social Science and Medicine, vol. 209, pp. 25-32. https://doi.org/10.1016/j.socscimed.2018.04.050
Maxwell, Lauren ; Brahmbhatt, Heena ; Ndyanabo, Anthony ; Wagman, Jennifer ; Nakigozi, Gertrude ; Kaufman, Jay S. ; Nalugoda, Fred ; Serwadda, David ; Nandi, Arijit. / The impact of intimate partner violence on women's contraceptive use : Evidence from the Rakai Community Cohort Study in Rakai, Uganda. In: Social Science and Medicine. 2018 ; Vol. 209. pp. 25-32.
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