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Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis.

Maxwell L, Devries K, Zionts D, Alhusen JL, Campbell J - PLoS ONE (2015)

Bottom Line: While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH.Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate.In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montréal, Québec, Canada.

ABSTRACT

Background: Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception.

Methods: We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception.

Results: Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).

Conclusions: IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV.

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Related in: MedlinePlus

Meta-analysis of the association between IPV and contraceptive use, by duration of exposure.Estimated effect measures from the Fantasia and Kacanek studies have been inverted to present estimates of contraceptive use rather than non-use.
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pone.0118234.g005: Meta-analysis of the association between IPV and contraceptive use, by duration of exposure.Estimated effect measures from the Fantasia and Kacanek studies have been inverted to present estimates of contraceptive use rather than non-use.

Mentions: There are different ways of conceptualizing the severity of violence. Some classifications use the type of violence; others examine the frequency of violent acts. Three of the longitudinal studies in this review conceptualized violence severity using the duration of reported violence [38,43,46]. For studies that included several measures of violence duration, we used the measure that most closely matched the duration of violence reported in other studies in the violence severity meta-analysis. In Table 3, we report the effect estimates for the three studies that included measures of the duration of violence. Categorizing violence as either moderate or severe by using the type of violence has been used previously to predict the severity of adverse health outcomes [51,52]. Using the classification of violence severity from the Kacanek article [46], these three studies’ classification of each participant’s experience of IPV as persistent, measured at both time points; incident, only measured at the most recent time; or remitting, not measured at the most recent time, but measured previously, provide an opportunity to explore how the duration of IPV can differentially affect contraceptive use. Fig. 5 presents a forest plot of these duration measures.


Estimating the effect of intimate partner violence on women's use of contraception: a systematic review and meta-analysis.

Maxwell L, Devries K, Zionts D, Alhusen JL, Campbell J - PLoS ONE (2015)

Meta-analysis of the association between IPV and contraceptive use, by duration of exposure.Estimated effect measures from the Fantasia and Kacanek studies have been inverted to present estimates of contraceptive use rather than non-use.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4334227&req=5

pone.0118234.g005: Meta-analysis of the association between IPV and contraceptive use, by duration of exposure.Estimated effect measures from the Fantasia and Kacanek studies have been inverted to present estimates of contraceptive use rather than non-use.
Mentions: There are different ways of conceptualizing the severity of violence. Some classifications use the type of violence; others examine the frequency of violent acts. Three of the longitudinal studies in this review conceptualized violence severity using the duration of reported violence [38,43,46]. For studies that included several measures of violence duration, we used the measure that most closely matched the duration of violence reported in other studies in the violence severity meta-analysis. In Table 3, we report the effect estimates for the three studies that included measures of the duration of violence. Categorizing violence as either moderate or severe by using the type of violence has been used previously to predict the severity of adverse health outcomes [51,52]. Using the classification of violence severity from the Kacanek article [46], these three studies’ classification of each participant’s experience of IPV as persistent, measured at both time points; incident, only measured at the most recent time; or remitting, not measured at the most recent time, but measured previously, provide an opportunity to explore how the duration of IPV can differentially affect contraceptive use. Fig. 5 presents a forest plot of these duration measures.

Bottom Line: While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH.Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate.In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).

View Article: PubMed Central - PubMed

Affiliation: Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montréal, Québec, Canada.

ABSTRACT

Background: Intimate partner violence (IPV) is an important global public health problem. While there is a growing literature on the association between IPV and women's reproductive health (RH) outcomes, most studies are cross-sectional-which weakens inference about the causal effect of IPV on women's RH. This systematic review synthesizes existing evidence from the strongest study designs to estimate the impact of IPV on women's use of contraception.

Methods: We searched 11 electronic databases from January of 1980 to 3 December 2013 and reviewed reference lists from systematic reviews for studies examining IPV and contraceptive use. To be able to infer causality, we limited our review to studies that had longitudinal measures of either IPV or women's use of contraception.

Results: Of the 1,574 articles identified by the search, we included 179 articles in the full text review and extracted data from 12 studies that met our inclusion criteria. We limited the meta-analysis to seven studies that could be classified as subject to low or moderate levels of bias. Women's experience of IPV was associated with a significant reduction in the odds of using contraception (n = 14,866; OR: 0.47; 95% CI: 0.25, 0.85; I2 = 92%; 95% CII2: 87%, 96%). Restricting to studies that measured the effect of IPV on women's use of partner dependent contraceptive methods was associated with a reduction in the heterogeneity of the overall estimate. In the three studies that examined women's likelihood of using male condoms with their partners, experience of IPV was associated with a significant decrease in condom use (OR: 0.48; 95% CIOR: 0.32, 0.72; I2 = 51%; 95% CII2: 0%, 86%).

Conclusions: IPV is associated with a reduction in women's use of contraception; women who experience IPV are less likely to report using condoms with their male partners. Family planning and HIV prevention programs should consider women's experiences of IPV.

Show MeSH
Related in: MedlinePlus