Gender norms, contraceptive use, and intimate partner violence: A six-country analysis

• Published in: Sexual & reproductive healthcare 2023-03, Vol.35, p.100815-100815, Article 100815
• Main Authors: Underwood, Carol R., Casella, Albert, Hendrickson, Zoé Mistrale
• Format: Article
• Language: English
• Subjects: Contraceptive Agents; Couple concordance; Cross-country studies; Domestic Violence; Family planning; Family Planning Services; Female; Gender Identity; Gender norms; Humans; Intimate Partner Violence; Risk Factors
• ISSN: 1877-5756; 1877-5764
• DOI: 10.1016/j.srhc.2023.100815

•Connell’s theory of gender and power is operationalized with global health data.•Shared power is associated with contraceptive use and reduced gender-based violence.•Positive emotional attachment is associated with reduced gender-based violence.•Health programs should address gender and power dynamics to increase gender equity. While considerable research has explored associations between gender norms and various sexual and reproductive health behaviors (SRH) with the aim of informing programs, no studies have examined whether couple concordance on specific gender norms is associated with both contraceptive use and reduced intimate partner violence (IPV) experience. This study relies on analysis of Demographic and Health Survey (DHS) couples’ datasets from Mali, Nigeria, Nepal, Pakistan, Tanzania, and Zambia that were collected in/after 2015 and include the DHS Domestic Violence Module for female respondents. To examine the associations between couple concordance regarding household decision-making or justification of violence (wife beating) and women’s use of modern contraceptives or experience of violence, bivariate and multivariate logistic regression models were fit using Stata15. Joint decision-making about large household purchases was significantly positively associated with modern contraceptive use in all study countries as well as with reduced odds of IPV experience in adjusted models in Tanzania and Zambia. In Nigeria, women’s justification for violence was negatively associated with contraceptive use. Across settings, women in couples where both justified violence had significantly increased odds of reporting IPV experience. The evidence suggests that family planning programs should support joint decision-making as it was positively associated with contraceptive use across the six countries and is a proxy for shared economic power within the household. IPV reduction and prevention programs should also consider encouraging joint decision-making given the correlations found in two settings. Programs should enable participants to interrogate attitudes regarding justifying violence against female partners and propose approaches to avoid IPV. Finally, husbands’ alcohol consumption, a strong predictor of IPV experience, has too long been overlooked.