Sexual violence as a predictor of unintended pregnancy among married women of India: evidence from the fourth round of the National Family Health Survey (2015-16)

Investigating the relationship between spousal violence against women and total fertility rate in Afghanistan

BACKGROUND

spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one of the highest rates of SVAW in the world, and its impact on reproductive health and fertility is not well understood. This study aims to investigate the extent to which SVAW influences the total fertility rate (TFR) of Afghan women.

METHODS

In this study, a regression model of discrete-time survival models was used to calculate the total fertility rate (TFR), parity progression ratio (PPRs), and average closed birth intervals (CBI) between two children. The method used in this study has its roots in the works of Griffin Finney (1983) and was further developed by Redford et al. (2010). The study population utilized the 2015 Afghanistan Demographic and Health Survey, and sample weights were used to ensure accurate estimates for the population of Afghanistan as a whole.

RESULTS

The study found that women in Afghanistan who have experienced SV are more likely to progress to the next parity, start childbearing faster, and continue to do so. Women who have not experienced SV tend to progress to higher parities at a slower pace during their initial reproductive years. The study also suggests that women with spousal violence (SV) experience may have slightly higher fertility rates and shorter birth intervals for certain birth orders, although the differences between the two groups are generally small. Specifically, the total fertility rate (TFR) for women who experienced SV was 6.9, while the TFR for women who did not experience SV was 6.2.

CONCLUSIONS

These results provide valuable information for policymakers and public health professionals in developing effective policies and programs to address SVAW and improve maternal and child health outcomes in Afghanistan.

Understanding trimester-specific miscarriage risk in Indian women: insights from the calendar data of National Family Health Survey (NFHS-5) 2019-21

BACKGROUND

The primary public health issue, especially in low- and middle-income countries, is early pregnancy loss driven by miscarriage. Understanding early pregnancy losses and the characteristics of mothers who have miscarriages is essential to creating effective reproductive health strategies. Thus, this study's primary goal is to delve into the factors which impact miscarriages that take place prior to and following the first 12 weeks of gestation.

METHODS

The bivariate analysis was employed to determine the frequency of miscarriages. The factors associated with miscarriages in the first (≤12 weeks) and second & above (> 12 weeks) trimesters of pregnancy were then examined using a generalised linear regression model, with 95% confidence intervals. Finally, we use ArcGIS to illustrate the prevalence of miscarriage in the districts of India.

RESULTS

Our result shows that miscarriages occur often in India (4.9%), with 23% of cases occurring in the first trimester (≤12 weeks). In our bivariate analysis, we identified several factors associated with a higher prevalence of miscarriages in India. It was found that mothers aged thirty years or older, residing in urban areas, with less than ten years of education, belonging to the richest wealth quantile, expressing a desire for more children, having no demand for contraception, and possessing no parity experienced a higher prevalence of miscarriage in total pregnancies in India. On the other hand, the generalised linear model's findings show that mothers who are thirty years of age or older, practise other religions, live in urban areas, are members of other castes, want more children, marry before the age of eighteen, and meet their contraceptive needs are more likely to have miscarriages in total pregnancy. However, there is a larger likelihood of miscarriage in the first trimester (≤12 weeks) for mothers who follow other religions, live in urban areas, are from Other Backward Class (OBC), get married before the age of eighteen, and fall into the middle and upper wealth quantiles. A mother is more likely to miscarriage in the second & above (> 12 weeks) trimesters if she is older than thirty, from other castes, wants more children, has moderate media exposure, marries before turning eighteen, meets her contraceptive needs, and does not feel the need for contraception. After accounting for socioeconomic characteristics, all results were statistically significant.

CONCLUSIONS

Given the substantial number of miscarriages in India, police need to improve planning and guidance in order to lower pregnancy loss due to miscarriage. Miscarriage rates may be significantly decreased by enhancing the availability and quality of reproductive health care infrastructure, particularly in rural areas.

Changes in Socioeconomic Inequalities in Unintended Pregnancies Among Currently Married Women in India

Background

Despite the consistent prevalence of unintended pregnancies in India and its adverse impact on maternal and neonatal mortality, the literature discussing socioeconomic inequality remains scarce. This study aims to assess the change in wealth-related inequalities in unintended pregnancy in India from 2005-2006 to 2019-20 and to quantify the contribution of various factors towards inequality.

Methods

The present study analyzed cross-sectional data from the third and fifth rounds of the National Family Health Survey (NFHS). The information on fertility preferences and pregnancy intention of most recent live birth during the five years preceding the survey was collected from eligible women. The concentration index and Wagstaff decomposition were used to analyze wealth-related inequality and the contributing factors.

Results

Our results show that the prevalence of unintended pregnancy has declined in 2019-20 to 8% from 22% in 2005-2006. With the increase in education and wealth status, unintended pregnancy decreases significantly. The results of the concentration index depict that unintended pregnancy is more concentrated among the poor than the rich in India, and the individual's wealth status has the highest contribution to unintended pregnancy inequality. Other factors like mothers' BMI, place of residence and education also contribute majorly to the inequality.

Conclusions

The study results are critical and increase the need for strategies and policies. Disadvantaged women need education and family planning information, plus access to reproductive health resources. Governments should improve accessibility and quality of care in family planning methods to prevent unsafe abortions, unwanted births, and miscarriages. Further research is needed to investigate the impact of social and economic status on unintended pregnancies.

Association between unintended pregnancy and maternal antenatal care services use in Ethiopia: analysis of Ethiopian demographic and health survey 2016

Introduction

Unintended pregnancy disproportionately affects women in low and middle-income countries including Ethiopia. Previous studies identified the magnitude and negative health outcomes of unintended pregnancy. However, studies that examined the relationship between antenatal care (ANC) utilization and unintended pregnancy are scarce.

Objective

This study aimed to examine the relationship between unintended pregnancy and ANC utilization in Ethiopia.

Methods

This is a cross-sectional study conducted using the fourth and most recent Ethiopian Demographic Health Survey (EDHS) data. The study comprised a weighted sample of 7,271 women with last alive birth and responded to questions on unintended pregnancy and ANC use. The association between unintended pregnancy and ANC uptake was determined using multilevel logistic regression models adjusted for possible confounders. Finally p < 5% was considered significant.

Results

Unintended pregnancy accounted for nearly a quarter of all pregnancies (26.5%). After adjusting for confounders, a 33% (AOR: 0.67; 95% CI, 0.57-0.79) lower odds of at least one ANC uptake and a 17% (AOR: 0.83; 95% CI, 0.70-0.99) lower odds of early ANC booking were found among women who had unintended pregnancy compared to women with intended pregnancy. However, this study founds no association (AOR: 0.88; 95% CI, 0.74, 1.04) between unintended pregnancy and four or more ANC visits.

Conclusion

Our study found that having unintended pregnancy was associated with a 17 and 33% reduction in early initiation and use of ANC services, respectively. Policies and programs designed to intervene against barriers to early initiation and use of ANC should consider unintended pregnancy.

Does sexual Intimate Partner Violence (IPV) increase risk of multiple high-risk fertility behaviours in India: evidence from National Family Health Survey 2015–16

Background

One in three women from lower and middle-income countries are subjected to physical and/or sexual intimate partner violence (IPV) in their life span. Prior studies have highlighted a range of adverse health impacts of sexual IPV. However, less is known about the link between multiple high-risk fertility behaviours and sexual intimate partner violence. The present study examines the statistical association between multiple high-risk fertility behaviours and sexual intimate partner violence among women in India.

Methods

The present study used a nationally representative dataset, the National Family Health Survey (NFHS-4) 2015–16. A total of 23,597 women were included in the study; a subsample of married women of reproductive age who have had at least one child 5 years prior to the survey and who had valid information about sexual IPV. Logistic regression models were employed alongside descriptive statistics.

Results

Approximately 7% of women who are or had been married face sexual IPV. The prevalence of sexual violence was higher among women who had short birth intervals and women who had given birth more than three times (12%). Around 11% of women who had experienced any high-risk fertility behaviours also experienced sexual violence. The unadjusted association suggested that multiple high-risk fertility behaviours were 32% (UORs = 1.32, 95% CI: 1.16–1.50) higher for those women who experienced sexual violence. After adjusting for other sociodemographic variables, except for women’s education and wealth quantile, the odds of multiple high-risk fertility behaviours were 16% (AOR = 1.16; 95% CI: 1.02–1.34) higher among women who faced sexual violence. The inclusion of women’s educational attainment and wealth status in the model made the association between sexual IPV and high-risk fertility behaviours insignificant.

Conclusion

Sexual intimate partner violence is statistically associated with high-risk fertility behaviours among women in India. Programs and strategies designed to improve women’s reproductive health should investigate the different dimensions of sexual IPV in India.