Women's attitude towards intimate partner violence and utilization of contraceptive methods and maternal health care services: an analysis of nationally representative cross-sectional surveys from four South Asian countries

Abstract

Background Intimate partner violence (IPV) adversely affects women’s reproductive health outcomes but to what extent women’s justification of IPV affects maternal health care service utilization is unexplored. Methods The secondary cross-sectional datasets from multiple indicator cluster surveys of Afghanistan, Bhutan, Nepal and Pakistan conducted between 2010 and 2015 were used. We used a generalized linear mixed model with random effects, at both cluster- and country-level, to determine the odds ratio of maternal health service utilization at the regional level and a multivariable logistic regression model adjusting for complex survey design at the country level. Interaction between women’s justification of IPV and residential location, and linear trend in the utilization of maternal health care services associated with increasing levels of women's justification of IPV, were examined using the Likelihood Ratio Test (LRT). Results A total of 26,029 women aged 15–49 years, living with their partners and had a pregnancy outcome 2 years prior to the survey were included. Women justifying IPV were less likely to utilize contraceptive methods (aOR) = 0.86, 95% CI 0.84, 0.88), at-least one Antenatal Care (ANC) visit (aOR = 0.80, 95% CI 0.72, 0.88), four or more ANC services (aOR = 0.81, 95% CI 0.76, 0.86), institutional delivery (aOR = 0.87, 95% CI 0.80, 0.94) and Post-natal Care (aOR = 0.76, 95% CI 0.62, 0.95) services. A decreasing linear trend was observed for four or more ANC visits (LRT P = 0.96) and institutional delivery (LRT P = 0.80) with increasing levels of IPV justification. Women justifying IPV were less likely to have at least one ANC visit in urban (aOR 0.67, 95% CI 0.60, 0.75) compared to rural areas (aOR 0.83, 95% CI 0.73, 0.94). Conclusions Women’s justification of IPV was associated with decreased odds of utilizing a wide range of maternal health care services at the regional level. Although further research that may help establish a causal link is important before formulating public health interventions, our study indicates interventions targeting women’s condoning attitude toward IPV, delivered sooner rather than later, could potentially help to improve women’s utilization of essential maternal health care services in the South Asian region that comprises Afghanistan, Bhutan, Nepal, and Pakistan.

Women’s socioeconomic status and attitudes toward intimate partner violence in Eswatini: A multilevel analysis

“…Further, it should be noted that the levels of acceptability of intimate partner violence in both the 2010 and 2014 surveys are lower than the average of 41% found in a study of 49 low- and middle-income countries [ 16 ]. Additionally in South Asia, the levels of acceptance ranged from 44% to 94% in Pakistan Punjab, and Afghanistan, respectively [ 4 ].…”

“…Women’s attitudes toward intimate partner violence may be influenced by norms, values, and practices that are sustained by systems that subjugate women in legal, social, and political institutions [ 27 , 31 ]. In patriarchal societies [ 4 ], as is the case in Eswatini [ 30 ] weak civil rights for women, limited opportunities for women, and gender inequality are potential risk factors for justification of intimate partner violence. Accordingly, sustained economic empowerment of women is required through the implementation of various political, social, and legal measures, including the provision of formal and informal employment in line with the SDGs.…”

“…The study findings were based on MICS surveys, which are nationally representative cross-sectional surveys. Since the MICS surveys are based on a robust survey sampling design and methodology, results are comparable and generalizable [ 4 ]. The study used two time points to ensure the comparison of variables across time.…”

“…According to a study of South Asian nations, there are varying degrees of women’s acceptance of intimate partner violence. Examples include when a woman leaves her husband without telling him, which ranges from 28% in Nepal to 82% in Afghanistan; neglects her children, which ranges from 30% in Pakistan Punjab to 65% Afghanistan; argues with her husband, which ranges from 19% Nepal to 80% Afghanistan; refuses to have sex with her husband, which ranges from 3% in Nepal to 54% Afghanistan; and burns food, which ranges from 5% Nepal to 35% in Afghanistan and Pakistan Sindh [ 4 ].…”

“…Violence against women has continued to draw global attention to women's population, health, and rights issues [1][2][3][4][5]. The Sustainable Development Goals (SDGs) of the United Nations and other international development initiatives have also given prominence to violence against women.…”