Intimate Partner Violence and Women's Reproductive Health Risks: Evidence From Azerbaijan, Moldova, and Ukraine

Objectives: Intimate partner violence (IPV) is a global social issue that infringes on a woman's rights, endangers her safety, and affects her overall wellbeing. In countries with relatively low levels of awareness about IPV, such as post-Soviet states, the consequences of violence are perceived to be limited to the woman's death or severe bodily harm (Fox, 2007). In addition to injuries as a direct result of violence, IPV can have long-lasting effects on a woman's health, impairing her fertility, sexual health, and childbearing functions (Coker, 2007; Jordan, 2007). IPV and power differentials between men and women pose direct and indirect risks for women's health by creating significant disparities in access to and utilization of health information, services, and technologies (Blanc, 2001). The majority of evidence presented in existing research, however, comes from studies conducted in western industrialized or developing countries. Studying health risks of IPV among women in transitional and middle-income countries of the former Soviet Union/fSU countries is critical to understanding the patterns of the problem in different social, political, and cultural contexts. Using population-based samples from three fSU countries, this study examined the relationships between lifetime exposure to various types of IPV (physical, sexual, psychological, controlling behaviors, and injurious IPV) and three groups of reproductive health outcomes: family planning, fertility preferences, and pregnancy loss.

Methods: The study utilized nationally representative data from the USAID-funded Demographic and Health Surveys conducted in Moldova (2005), Azerbaijan (2006), and Ukraine (2007). The sample included ever-married or cohabitating women of reproductive age (N=4,420 in Azerbaijan, N=4,485 in Moldova, and N=2,437 in Ukraine). Respondents were randomly selected using stratified multi-stage cluster sampling based on regional clusters. Given the nested structure of DHS dataset, the analysis was conducted using multilevel regression accounting for intra-cluster similarities and controlling for a number of covariates (Raudenbush, 2004).

Results: The higher odds of unmet need for family planning—failure to use contraception while being exposed to pregnancy and not planning to have children—were observed among currently married women with a history of severe physical IPV (adjusted odds ratios were significant for all three countries and ranged from 2.09 to 3.17). The odds of unintended last pregnancy were significantly higher even among women who reported lifetime exposure to psychological IPV and controlling behaviors (aOR=1.49-7.32). Physical IPV was associated with increased odds of having more than average number of abortions throughout life. The adjusted odds ratios were lowest in Azerbaijan (aOR=1.53, 95% CI=1.01, 2.33, p<0.05) and highest in Ukraine (aOR=2.38, 95% CI=1.36 – 4.14, p<0.01), where the relationship between IPV and abortions was the strongest. Conclusions: Evidence about long-lasting health risks of IPV (e.g., abortions) illustrate the seriousness of the problem and could be used as a tool to influence governments' readiness and commitment to address the problem of IPV. The findings stress the need for violence prevention programs in the fSU region that minimize the impact of IPV on women's health and call for modified health programs for women, who are currently unable to leave abusive relationships.