Advertisement

Intimate Partner Violence and Contraception among Adolescent Girls and Young Women: A Longitudinal Analysis of the Girl Power-Malawi Cohort

      Abstract

      Purpose

      In sub-Saharan Africa, sexually active adolescent girls and young women (AGYW) experience high rates of intimate partner violence (IPV) and low levels of contraceptive use, but the effect of IPV on contraceptive use is not well understood.

      Methods

      In the Girl Power-Malawi study, AGYW aged 15-24 were recruited from 4 health centers in Lilongwe, Malawi, and followed for 1 year. At baseline, AGYW were assessed for IPV using the modified Conflict Tactics Scale. AGYW reported contraceptive method use at 6 and 12 months, characterized as barrier, non-barrier, or any modern method. Modified Poisson regression was implemented to estimate risk ratios (RRs) and 95% confidence intervals (CIs) to examine the effect of IPV on contraceptive use.

      Results

      One thousand AGYW were enrolled, and 954 non-pregnant participants were included. Baseline prevalence of IPV with the most recent partner was 35.5% (physical), 46.2% (sexual), and 76.9% (emotional). Baseline IPV did not affect contraceptive use at 6 months (aRR [95% CI]: physical 0.98 [0.91-1.05]; sexual 1.00 [0.94-1.07]; emotional 1.03 [0.94-1.12]) or 12 months (physical 0.95 [0.89-1.02]; sexual 0.96 [0.90-1.02]; emotional 0.98 [0.91-1.05]). None of the 3 IPV categories affected contraceptive use when the outcome was restricted to either barrier or non-barrier methods.

      Conclusions

      In this cohort, IPV was not a key driver of contraceptive use in longitudinal analyses. Interventions are needed to address the alarming rates of IPV in this population, but addressing IPV alone might be insufficient to address low contraceptive use, and multifaceted youth-friendly health services might be necessary.

      Keywords

      Abbreviations:

      AGYW (adolescent girls and young women), IPV (intimate partner violence), HIV (human immunodeficiency virus), IUD (intrauterine device), OC (oral contraceptive), DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), PEPFAR (the United States President's emergency plan for AIDS relief), YFHS (youth-friendly health services), RR (risk ratio), aRR (adjusted risk ratio), CI (confidence interval)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Ahinkorah BO
        • Dickson KS
        • Seidu AA
        Women decision-making capacity and intimate partner violence among women in sub-Saharan Africa.
        Arch Public Health. 2018; 76: 5
        • Ahinkorah BO
        Intimate partner violence against adolescent girls and young women and its association with miscarriages, stillbirths and induced abortions in sub-Saharan Africa: evidence from demographic and health surveys.
        SSM Popul Health. 2021; 13100730
        • Kidman R
        • Kohler HP
        Emerging partner violence among young adolescents in a low-income country: perpetration, victimization and adversity.
        PLoS ONE. 2020; 15e0230085
      1. Global Database on Violence against Women: Malawi. United Nations Women: Available: https://evaw-global-database.unwomen.org/fr/countries/africa/malawi?typeofmeasure=60305524975b40e6b0ede2ae54aa5c0e, 1/26/22.

        • World Health Organization
        Global and regional estimates of violence against women.
        2013 (Available) (Accessed July 28, 2021)
        • Jewkes RK
        • Dunkle K
        • Nduna M
        • et al.
        Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: a cohort study.
        Lancet. 2010; 376: 41-48
        • Silverman JG
        • Gupta J
        • Decker MR
        • et al.
        Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women.
        Br J Obstet Gynaecol. 2007; 114: 1246-1252
        • Chaves K
        • Eastwood J
        • Ogbo FA
        • et al.
        Intimate partner violence identified through routine antenatal screening and maternal and perinatal health outcomes.
        BMC Pregnancy Childbirth. 2019; 19: 357
        • Yaya S
        • Gunawardena N
        • Bishwajit G
        Association between intimate partner violence and utilization of facility delivery services in Nigeria: a propensity score matching analysis.
        BMC Public Health. 2019; 19: 1131
        • Sabri B
        • Huerta J
        • Alexander KA
        • et al.
        Multiple intimate partner violence experiences: knowledge, access, utilization and barriers to utilization of resources by women of the African diaspora.
        J Health Care Poor Underserved. 2015; 26: 1286-1303
        • Maxwell L
        • Devries K
        • Zionts D
        • et al.
        Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis.
        PLoS ONE. 2015; 10e0118234
        • McCauley HL
        • Silverman J
        • Decker MR
        Contraceptive use, pregnancy testing and intimate partner violence among adolescent and young adult women ages 16-24.
        J Pediatr Adolesc Gynecol. 2013; 26: e57
        • Northridge JL
        • Silver EJ
        • Talib HJ
        • et al.
        Reproductive coercion in high school-aged girls: associations with reproductive health risk and intimate partner violence.
        J Pediatr Adolesc Gynecol. 2017; 30: 603-608
        • Alio A
        • Daley E
        • Nana P
        • et al.
        Intimate partner violence and contraception use among women in Sub-Saharan Africa.
        Int J Gynecol Obstet. 2009; 107: 35-38
        • Okenwa L
        • Lawoko S
        • Jansson B
        Contraception, reproductive health and pregnancy outcomes among women exposed to intimate partner violence in Nigeria.
        Eur J Contracept Reprod Health Care. 2011; 16: 18-25
        • Emenike E
        • Lawoko S
        • Dalal K
        Intimate partner violence and reproductive health of women in Kenya.
        Int Nurs Rev. 2008; 55: 97-102
        • Wusu O
        Predictors and implications of intimate partner violence against married female youths in Nigeria.
        J Fam Violence. 2015; 30: 63-74
        • Adjiwanou V
        • N'Bouke A
        Exploring the paradox of intimate partner violence and increased contraceptive use in sub-Saharan Africa.
        Stud Fam Plann. 2015; 46: 127-142
        • Kabir R
        • Kordowicz M
        Exploring the relationship between intimate partner violence and contraception use by Tanzanian women.
        Health Care Women Int. 2020; 42: 1220-1233
        • Wandera SO
        • Kwagala B
        • Odimegwu C
        Intimate partner violence and current modern contraceptive use among married women in Uganda: a cross-sectional study.
        Pan Afr Med J. 2018; 30: 85
        • Yusuf RA
        • Dongarwar D
        • Yusuf ZI
        • et al.
        Association between intimate partner violence, knowledge and use of contraception in Africa: comparative analysis across five African regions.
        Int J Matern Child Health AIDS. 2020; 9: 42-52
        • Antai D
        • Adaji S
        Community-level influences on women's experience of intimate partner violence and terminated pregnancy in Nigeria: a multilevel analysis.
        BMC Pregnancy Childbirth. 2012; 12: 128
        • Diop-Sidibé N
        • Campbell JC
        • Becker S
        Domestic violence against women in Egypt—wife beating and health outcomes.
        Soc Sci Med. 2006; 62: 1260-1277
        • Kidayi PL
        • Msuya S
        • Todd J
        • et al.
        Determinants of modern contraceptive use among women of reproductive age in Tanzania: evidence from Tanzania demographic and health survey data.
        Adv Sex Med. 2015; 5: 43-52
        • Kidman R
        • Palermo T
        • Bertrand J
        Intimate partner violence, modern contraceptive use and conflict in the Democratic Republic of the Congo.
        Soc Sci Med. 2015; 133: 2-10
        • Oluwaseyi SD
        • Latifat I
        Intimate partner violence and contraceptive behavior: evidence from Malawi and Zambia.
        South Afr J Demogr. 2015; 16: 123-150
        • Oyedokun AO
        Domestic violence and constrained contraceptive choices in selected areas of Osun State, Nigeria.
        Sex Relation Ther. 2008; 23: 305-323
        • Kacanek D
        • Bostrom A
        • Montgomery ET
        • et al.
        Intimate partner violence and condom and diaphragm nonadherence among women in an HIV prevention trial in southern Africa.
        J Acquir Immune Defic Syndr. 2013; 64: 400-408
        • Kupoluyi JA
        Intimate partner violence as a factor in contraceptive discontinuation among sexually active married women in Nigeria.
        BMC Womens Health. 2020; 20: 128
        • Kriel Y
        • Milford C
        • Cordero J
        • et al.
        Male partner influence on family planning and contraceptive use: perspectives from community members and healthcare providers in KwaZulu-Natal, South Africa.
        Reprod Health. 2019; 16: 89
        • OlaOlorun F
        • Seme A
        • Otupiri E
        • et al.
        Women's fertility desires and contraceptive behavior in three peri-urban communities in sub-Saharan Africa.
        Reprod Health. 2016; 13: 12
        • Saul J
        • Bachman G
        • Allen S
        • et al.
        The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women.
        PLoS ONE. 2018; 13e0208167
        • Rosenberg NE
        • Pettifor AE
        • Myers L
        • et al.
        Comparing four service delivery models for adolescent girls and young women through the ‘Girl Power’ study: protocol for a multisite quasi-experimental cohort study.
        BMJ Open. 2017; 7e018480
        • Rosenberg NE
        • Bhushan NL
        • Vansia D
        • et al.
        Comparing youth-friendly health services to the standard of care through “Girl Power-Malawi”: a quasi-experimental cohort study.
        J Acquir Immune Defic Syndr. 2018; 79: 458-466
        • Kishor S
        Domestic Violence Measurements in the Demographic and Health Surveys: The History and the Challenges.
        UN Division for the Advancement of Women, Geneva2005 (Retrieved from Expert paper forAvailable) (Accessed July 28, 2021)
        • Bazargan-Hejazi S
        • Medeiros S
        • Mohammadi R
        • et al.
        Patterns of intimate partner violence: a study of female victims in Malawi.
        J Injury Violence Res. 2013; 5: 38-50https://doi.org/10.5249/jivr.v5i1.139
        • Zou G
        A modified Poisson regression approach to prospective studies with binary data.
        Am J Epidemiol. 2004; 159: 702-706
      2. World Health Organization: Violence Against Women Fact Sheet. 2017. Available: https://www.who.int/news-room/fact-sheets/detail/violence-against-women. Accessed July 28, 2021

      3. Population Pyramid: 2021. Available: https://www.populationpyramid.net/sub-saharan-africa/2021/. Accessed July 28, 2021

        • ICAP
        • Ministry of Health, Malawi
        Malawi population-based HIV impact assessment (MPHIA) 2015-2016: final report. Lilongwe, Ministry of Health. October 2018. Link to PDF: https://phia.icap.columbia.edu/wp-content/uploads/2019/08/MPHIA-Final-Report_web.pdf.
        Columbia University Health MSoP, 2016
        • Maxwell L
        • Brahmbhatt H
        • Ndyanabo A
        • et al.
        The impact of intimate partner violence on women's contraceptive use: evidence from the Rakai Community Cohort Study in Rakai, Uganda.
        Soc Sci Med. 2018; 209: 25-32
        • Hartmann M
        • Palanee-Phillips T
        • O'Rourke S
        • et al.
        The relationship between vaginal ring use and intimate partner violence and social harms: formative research outcomes from CHARISMA study in Johannesburg, South Africa.
        AIDS Care. 2019; 31: 660-666