Intimate partner violence and unintended pregnancy: prevalence and associated factors Violência pelo parceiro íntimo e gravidez não pretendida: prevalência e fatores associados La violencia de género y los embarazos no deseados: prevalencia y factores asociados

This study investigated the association between unintended pregnancy and intimate partner violence before pregnancy. A cross-sectional study was carried out with 1,054 women, aged 18 to 49, in Recife, Northeastern Brazil, from July 2005 to March 2006. Non-conditional logistic regression analysis was performed with a hierarchical strategy for entering variables into the model, according to the conceptual framework defined. Unintended pregnancy was reported by 60.3% (636) women. Intimate partner violence prior to the pregnancy was associated with unintended pregnancy (ORadj = 1.57; 95%CI: 1.17-2.11), even when adjusted for the women’s sociodemographic characteristics, the partner's behaviour, and the relationship dynamic. When the association was adjusted for the use of contraception and the partner’s refusal to use contraception, the association was no longer significant, suggesting that the effect of partner violence on unintended pregnancy may be mediated by these variables. The findings point to the need of screening for intimate partner violence in reproductive health services. Violence Against Women; Spouse Abuse; Unplanned Pregnancy; Reproductive Health Resumo Este estudo investigou a associação entre gravidez não pretendida e violência por parceiro íntimo antes da gravidez atual. Estudo transversal foi realizado com 1.054 mulheres, com idade entre 18 e 49, residentes no Recife, Nordeste do Brasil, entre julho de 2005 e março de 2006. Utilizou-se análise de regressão logística com estratégia hierarquizada para a inserção de variáveis no modelo, de acordo com o quadro conceitual definido. Gravidez não pretendida foi relatada por 60,3% (636) das mulheres. Violência por parceiro íntimo antes da gravidez foi associada com gravidez não pretendida (ORajustado = 1,57; IC95%: 1,17-2,11), mesmo quando ajustada para as características demográficas e socioeconômicas das mulheres, pelo comportamento do parceiro e dinâmica da relação. Quando a associação foi ajustada pelo uso de contracepção e recusa do parceiro ao uso de contracepção, houve perda da significância estatística. Isso sugere que o efeito da violência por parceiro íntimo sobre gravidez não pretendida pode ser mediado por tais variáveis. Os achados apontam a necessidade de rastreamento da violência por parceiro íntimo nos serviços de saúde reprodutiva. Violência Contra a Mulher; Maus-Tratos Conjugais; Gravidez Não Planejada; Saúde Reprodutiva http://dx.doi.org/10.1590/0102-311X00161111 INTIMATE PARTNER VIOLENCE AND UNINTENDED PREGNANCY 2395 Cad. Saúde Pública, Rio de Janeiro, 29(12):2394-2404, dez, 2013 Introduction Unintended pregnancy has been incorporated into the reproductive health research agenda due to its adverse outcomes for women and child’s health 1. This is a difficult area of reproductive health to study, especially because the terms “unwanted”, “unplanned” and “unintended” have different meanings for the women and for researchers 2,3. In some studies 4, the intention to get pregnant is investigated retrospectively, when women are already pregnant, and is based on what they report about their reproductive intentions prior to becoming pregnant. In other studies 2,3, this term has overlapped with “planned pregnancies”, using different criteria to classify a pregnancy as intended or otherwise. While the use of contraceptives in Brazil is widespread, there is also a high proportion of unintended pregnancies. The National Survey of Demographic and Health 2006 (PNDS 2006) estimated that, of all births occurred in Brazil between 2001 and 2006, 46% were unplanned, 28% of which being mistimed and 18% unwanted 5. Few studies have directly addressed the association between intimate partner violence and unintended pregnancy 6,7,8,9,10,11. In Latin America, studies carried out in Colombia 8 and Peru 10 revealed a higher risk of unintended pregnancy among women who had suffered physical or sexual violence by an intimate partner. Violence by an intimate partner is highly prevalent in Brazil. The World Health Organization’s (WHO) multi-country study on violence against women 12 revealed that, in the city of São Paulo, 41.8% of women reported having suffered psychological violence at least once in their lifetimes, 27.2% physical, and 10.1% sexual. In a rural area of Pernambuco, 48.9% of the violence reported was psychological, 33.7% physical, and 14.3% sexual. Violence by an intimate partner is also frequent during pregnancy 13. A cross-sectional study 14 carried out to estimate the prevalence of this kind of violence among a sample of 2,156 women, aged 15 to 49 years, users of the Family Health Program (FHP), the Brazilian primary health care program, between 2005 and 2006, showed that 52.2% of women reported at least one form of intimate partner violence (physical, sexual, or psychological) in the course of their lives. When investigated in relation to the most recent or current partner in the previous year, this prevalence increased to 70.1% for any kind of violence. The aim of this study was to investigate the prevalence of unintended pregnancy and its association with intimate partner violence prior to the current pregnancy among women whose pregnancy progressed to a birth. The study was also designed to estimate the prevalence of intimate partner violence in the relationship with the current or most recent partner, prior to the current pregnancy. The theoretical framework included gender issues, which encourage men to behave violently towards their partners and undermine the social, sexual, and reproductive autonomy of women. This can reduce women’s power to negotiate contraceptive use with their partners and lead to a lack of control over reproductive intentions 15,16,17,18.