Intimate Partner Violence and Unwanted Pregnancy, Miscarriage, Induced Abortion and Stillbirth among a National Sample of Bangladeshi Women
Intimate partner violence (IPV) against women is a pervasive global public health concern, with 15–71% of women experiencing such abuse worldwide.1 Among the numerous negative sexual and reproductive health outcomes associated with IPV (see Campbell2 and Heise et al.3 for review), unwanted/unintended pregnancy,4–10 induced abortion,11–13miscarriage,14, 15 and fetal death11, 16, 17 are of particular concern among Bangladeshi women. Bangladeshi women experience 24 stillbirths and 36 neonatal deaths per 1000 deliveries,18 and an estimated 40–70% of married Bangladeshi women experience IPV.19–21These rates are notably higher than those for IPV and stillbirth in the UK and in the USA, where approximately 5–7 deaths occur per 1000 deliveries,22, 23 and an estimated 20% of women experience IPV victimisation.24, 25
Studies of Indian samples indicate associations of IPV and unwanted pregnancy9, 10 as well as fetal death.17, 26 However, as well as lack of distinction between stillbirth and neonatal death,26 as well as among other forms of adverse pregnancy outcomes (i.e. grouped assessment of abortion and miscarriage17), limits clarification of the impact of IPV within this context. The only Bangladeshi investigation of the relations of IPV to induced abortion and miscarriage identified an association of IPV and induced abortion among an urban sample but not among rural women; no associations were observed between IPV and miscarriage.27 Neither this nor other studies have assessed the relation of IPV to stillbirth/fetal death among a Bangladeshi sample, and no previous research on violence from male partners, regardless of national context, has included assessments of induced abortion, miscarriage, and stillbirth.
The present study builds upon previous research by using a nationally representative sample of women at relatively high risk for both IPV and reproductive health concerns (married Bangladeshi women) to assess relations of IPV to unwanted pregnancy and multiple forms of pregnancy termination. Investigation of such patterns is critical to advancing our understanding of mechanisms by which violence from partners may impact specific forms of reproductive outcomes (e.g. induced abortion due to male partner coercion versus miscarriage or stillbirth due to injury, malnutrition, or other morbidity potentially associated with violence from a male partner). Specifically, the present analyses provide (1) estimates of lifetime physical and sexual IPV victimisation among married Bangladeshi women based on husband reports of such violence, (2) the relative likelihood of unwanted pregnancy based on experiences of IPV, and (3) the relative likelihood of induced abortion, miscarriage, and fetal death/stillbirth based on this victimisation.