Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women

Abstract

Partner-perpetrated pregnancy coercion inhibits women’s reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women’s health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15–49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53–0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41–0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.

Prevalence and correlates of reproductive coercion across ten sites: commonalities and divergence

“…Future research should oversample adolescents, who are at a critical stage in their life course trajectory, and may be prone to RC [25,26]; comparison with adult populations can help disentangle possible risk associated with delayed childbearing. Similarly, duration of marriage and child sex preference should be explored at potential drivers of RC.…”

A qualitative exploration of reproductive coercion experiences and perceptions in four geo-culturally diverse sub-Saharan African settings

“…To date, the majority of RC studies conducted in SSA are quantitative and have elucidated RC's potential health impact given observed associations with IPV ( Falb, Annan, Kpebo, & Gupta, 2014 ), post-traumatic stress disorder ( McCauley, Falb, Streich-Tilles, Kpebo, & Gupta, 2014 ), and covert contraceptive use ( Dozier et al, 2022 ; Silverman, Challa, Boyce, Averbach, & Raj, 2020 ; Wood et al, 2020 ; Wood et al, 2022 , Wood et al, 2022 , Wood et al, 2022 ). The limited qualitative studies on RC in SSA highlight themes such as direct and indirect contraceptive interference, IPV in response to contraceptive use, and partner-perpetrated RC based on preferred family size ( Boyce et al, 2020 ; Wood et al, 2020 ; Wood et al, 2022 , Wood et al, 2022 , Wood et al, 2022 ). Qualitative studies, however, have only been conducted in Kenya ( Boyce et al, 2020 ; Wood et al, 2020 ; Wood et al, 2022 , Wood et al, 2022 , Wood et al, 2022 ).…”

“…The limited qualitative studies on RC in SSA highlight themes such as direct and indirect contraceptive interference, IPV in response to contraceptive use, and partner-perpetrated RC based on preferred family size ( Boyce et al, 2020 ; Wood et al, 2020 ; Wood et al, 2022 , Wood et al, 2022 , Wood et al, 2022 ). Qualitative studies, however, have only been conducted in Kenya ( Boyce et al, 2020 ; Wood et al, 2020 ; Wood et al, 2022 , Wood et al, 2022 , Wood et al, 2022 ). Further, all studies exploring RC in SSA have focused exclusively on women ( Dozier et al, 2022 ; Falb et al, 2014 ; McCauley et al, 2014 ; Wood, Dozier, et al, 2022 ; Wood et al, 2023 , Wood et al, 2023 ) or sub-populations of women, such as adolescent girls/young women ( Decker et al, 2021 ; DeLong et al, 2020 ; Silverman et al, 2020 ) or women who are IPV survivors ( Wood et al, 2020 ; Wood, Kennedy, Akumu, Tallam, Asira, Hameeduddin, et al, 2022 ).…”

Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women’s contraceptive use in Burkina Faso, Côte d’Ivoire and Kenya

“…Current evidence examining the reproductive health impact of these leading forms of violence has been concentrated within high-income contexts, namely, the USA6 7 and Australia 9. Recent literature, however, highlights that RC is also common in sub-Saharan Africa, though behaviours, intentions and motivations may differ in comparison to high-income contexts 10–13. Specifically, partners may enact a broader range of RC behaviours with the means of asserting power over reproductive decision-making, including seeking to prevent pregnancy against a woman’s wishes via behaviours such as forced contraceptive use 10…”

“…Studies have reported increased contraceptive and covert use among IPV survivors,12 whereas others have indicated decreased contraceptive use 18. Moreover, such studies have largely failed to disentangle the impact of RC and emotional abuse (ie, manipulation, intimidation, verbal abuse) on women’s reproductive health outcomes, though women may be pressured or shamed when seeking to delay or limit childbearing; as such, these forms of violence may significantly impact contraceptive use and continuation 11 13 17…”