Review articleHow does intimate partner violence affect condom and oral contraceptive Use in the United States?: A systematic review of the literature☆
Introduction
Intimate partner violence (IPV) affects millions of women each year and has been recognized as a leading cause for poor health, disability and death among women of reproductive age [1]. Population-based surveys found 13–61% of women throughout the world reported being physically assaulted by an intimate male partner during their lives [1] and 6–59% of women up to 49 years of age had experienced sexual assault by a partner at some point in their lives [2]. Specifically within the United States, 25% of adult women have been victims of severe IPV [3].
Further, in the United States, it is reported that only 62% of women aged 15–44 use contraception, equating to 23.2 million women who do not [4]. It is also estimated that 37% of births are unintended at the time of conception [5]. Moreover, as identified by Coker, IPV is known to impact a woman’s ability to use contraception and to result in unplanned pregnancies in a variety of ways (e.g., through physical violence and the ability to use barrier methods of contraception and through reduced self-esteem limiting the ability to negotiate condom use) [6]. Given this, the prevalence of IPV in the United States, and its linkages with contraceptive use and unintended pregnancy, it can be estimated that 2.1 million unintended pregnancies have resulted from this synergy [4], [5], [6]. We should also point out that IPV can interfere with a woman’s desire to be pregnant (and can lead to pregnancy loss from trauma) as well as limit her ability to protect herself from STIs [6]. We also acknowledge that men too, can be victims of IPV, with women as the perpetrators. For the purpose of this article, however, we will only focus on the perspective of pregnancy avoidance and women as victims.
Given the large number of unplanned pregnancies in the United States, it is imperative to better understand how the decision and ability to use condoms and oral contraceptives, specifically as both require daily action or action for each sexual encounter and therefore can be subject to partner interference, factor into relationships where IPV is present. The rationale for linking these issues is articulated in the review by Coker on the effect of IPV on women’s sexual health [6]. Specifically, Coker presents a mechanism linking IPV to unplanned pregnancy via multiple factors including contraceptive use [6]. Although linkages between IPV and unplanned pregnancy have been established in the literature, understanding intermediate variables (e.g., contraceptive use negotiation, sexual relationship power dynamics, reproductive coercion) that contribute to lack of condom and oral contraceptive use is necessary to develop more targeted interventions to improve more proximal (i.e., reductions in IPV victimization and perpetration, increased condom and oral contraceptive use) and distal outcomes (e.g., unplanned pregnancy, STIs) for women. Because of this, we conducted a systematic review to assess this pathway and to explore intermediate variables between IPV and condom and oral contraceptive use (hereafter referred to as contraceptive use). We undertook this review to explore this pathway at two pre-selected levels, that of the victim and that of the perpetrator. The first focuses on the female victim’s perspective on barriers to contraceptive use, in conjunction with experiencing IPV. The second level highlights the male perpetrator’s perspective regarding contraceptive use. Within these two foci, we then sought to investigate the clustered themes that emerged. The goal of this review is to attempt to identify and better understand the many factors affecting contraceptive use in relationships with IPV, with the intent of helping to inform intervention development in clinical settings.
Section snippets
Methods
A systematic approach was used to identify all original research addressing the association between IPV and contraceptive use among women in the United States. We define IPV as physical and/or sexual violence of a female by a current or former male intimate partner and contraceptive use as the use of condoms or oral contraceptives. We developed our conceptual framework based off of Coker’s mechanism [6], highlighting two themes that emerged from IPV and led to reduced contraceptive use: condom
Results
A total of 42 articles were identified as eligible for inclusion in this review. We identified 37 articles for Aim 1 (female victim’s perspective on barriers to contraceptive use, in conjunction with IPV) and grouped these into three themes that emerged across the studies: violence resulting in reduced contraceptive use; condom use negotiation, subcategorized as IPV due to contraceptive request, perceived violence (or fear) of IPV resulting in decreased contraceptive use, and sexual
Discussion
We reviewed the literature to determine the extent of research that exists linking IPV and contraceptive use. From the studies, it was apparent that there were several IPV-related factors that greatly influenced a woman’s ability to use contraception. Specifically, the use of violence against her eliminated the opportunity to choose to use contraception; experiencing violence due to a contraceptive request made women less likely to request the use of contraception at a later date; the fear of
Acknowledgements
This work was supported by the National Institutes of Health (K01DA031593, R01HD077891, and L60MD003701). The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health.
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Competing Interests: None.