Exploring the relationship between spousal violence during pregnancy and subsequent postpartum spacing contraception among first-time mothers in India

BACKGROUND: There is a growing body of research exploring how intimate partner violence affects contraceptive decision-making, recognizing that these decisions are reflective not only of access and acceptability, but also spousal power imbalances. Unfortunately, there is a dearth of knowledge regarding contraceptive choices following gender-based violence during pregnancy. There are an estimated 7·8 million in India affected by violence during pregnancy, and an ongoing, heavy reliance on female sterilization as the dominant form of contraception. This study examines the relationship between abuse during pregnancy and subsequent postpartum spacing contraception in India. METHODS: This analysis used cross-sectional, nationally representative data from first-time mothers of children aged 6–48 months in India. Multinomial regression models assessed relationships between spousal physical violence during pregnancy and postpartum spacing contraception (none, female-controlled, male-controlled). FINDINGS: Two percent of first-time mothers (2·4%) reported spousal physical violence while pregnant. Women who reported abuse during pregnancy were less likely to subsequently use male-controlled contraception than no contraception (adjusted relative risk ratio [aRRR]=0·3, 95% CI 0·1–0·8; p = 0·02) and more likely to use female-controlled vs. male-controlled spacing contraception (aRRR=7·5, 95% CI 2·1–25·4, p<0·01). INTERPRETATION: Women who experience spousal abuse during pregnancy have different postpartum contraceptive use patterns. The unique needs of this population should be incorporated into antenatal and postpartum contraceptive counseling. Efforts to increase spacing contraception use in India must consider experiences of gender-based violence and coercion. FUNDING: This work was supported by the 10.13039/100000865Bill & Melinda Gates Foundation [OPP1179208, PI: Raj]. Funders had no role in the design, analysis or interpretation of this research.