Childhood Sexual Violence and Consistent, Effective Contraception Use among Young, Sexually Active Urban Women

Associations between adverse childhood experiences and contraceptive use among young adults in Honduras

OBJECTIVE

Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men.

METHODS

We used data from 810 women and 753 men aged 18-24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use.

FINDINGS

Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22).

CONCLUSION

The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.

Adverse childhood experiences and intimate partner violence during pregnancy and their association to postpartum depression

BACKGROUND

Adverse childhood experiences (ACEs) and intimate partner violence (IPV) are recognized global health problems. Both ACEs and IPV have been linked to adverse physical and mental health problems for both mothers and infants. The aim of this study was to determine the prevalence of physical and/or sexual ACEs and IPV and their association to symptoms of postpartum depression among postpartum women in sub-Saharan Africa.

METHODS

A cross-sectional survey was conducted in three health centers in the three districts of Dar es Salaam, comprising Ilala, Kinondoni and Temeke. A total of 500 women were interviewed by two trained midwife nurses during their routine postnatal care. The women were asked about their experiences of adverse childhood experiences, intimate partner violence and symptoms of postpartum depression.

RESULTS

Of the 500 women who were interviewed, 39.4% (n = 197) reported to have experienced physical and/or sexual ACE and 18.8% (n = 94) experienced physical and/or sexual IPV during their index pregnancy. Physical ACE (AOR 2.6, 95% CI: 1.50-4.57), sexual ACE (AOR 2.7, 95% CI: 1.35-5.41), physical IPV (AOR 5.8, 95% CI: 2.98-11.43) and Sexual IPV (AOR 5.5, 95%CI: 2.51, 12.09) were significantly associated with symptoms of postpartum depression.

CONCLUSION

Four out of ten women reported to have experienced ACEs and two out of ten women reported IPV in the index pregnancy which was significantly associated with symptoms of postpartum depression. These results are alarming and call upon the attention of health workers and the community at large in prevention, screening and early intervention of ACEs, IPV and symptoms of postpartum depression.

Sex Differences in Contraception Non-Use Among Urban Adolescents: Risk Factors for Unintended Pregnancy

BACKGROUND

Contraception non-use among sexually active adolescents is a major cause of unintended pregnancy (UP).

METHODS

In this cross-sectional study we sought to identify overall and sex-specific correlates of contraception non-use using the 2015 Philadelphia Youth Risk Behavior Survey (YRBS) (N = 9540). Multivariate regression models were used to examine mental health, sexual activity, substance use, and violence indicators on reported contraception non-use among sexually active youth.

RESULTS

Marijuana use among boys and girls was a statistically significant risk factor for contraception non-use. Availability of illegal drugs on school property in the past year was also significantly related to contraception non-use among boys.

CONCLUSIONS

These results may inform overall and sex-specific adolescent programs to promote consistent contraception use among urban youth within school-based communities.

Preventing Unintended Pregnancy Among Young Sexually Active Women: Recognizing the Role of Violence, Self-Esteem, and Depressive Symptoms on Use of Contraception

OBJECTIVES

Ineffective contraceptive use among young sexually active women is extremely prevalent and poses a significant risk for unintended pregnancy (UP). Ineffective contraception involves the use of the withdrawal method or the inconsistent use of other types of contraception (i.e., condoms and birth control pills). This investigation examined violence exposure and psychological factors related to ineffective contraceptive use among young sexually active women.

MATERIALS AND METHODS

Young, nonpregnant sexually active women (n = 315) were recruited from an urban family planning clinic in 2013 to participate in a longitudinal study. Tablet-based surveys measured childhood violence, community-level violence, intimate partner violence, depressive symptoms, and self-esteem. Follow-up surveys measured type and consistency of contraception used 9 months later. Multivariate logistic regression models assessed violence and psychological risk factors as main effects and moderators related to ineffective compared with effective use of contraception.

RESULTS

The multivariate logistic regression model showed that childhood sexual violence and low self-esteem were significantly related to ineffective use of contraception (adjusted odds ratio [aOR] = 2.69, confidence interval [95% CI]: 1.18-6.17, and aOR = 0.51, 95% CI: 0.28-0.93; respectively), although self-esteem did not moderate the relationship between childhood sexual violence and ineffective use of contraception (aOR = 0.38, 95% CI: 0.08-1.84). Depressive symptoms were not related to ineffective use of contraception in the multivariate model.

CONCLUSIONS

Interventions to reduce UP should recognize the long-term effects of childhood sexual violence and address the role of low self-esteem on the ability of young sexually active women to effectively and consistently use contraception to prevent UP.