This study examined the effect of IPV on unintended pregnancy among young women aged 15–24 years in Ethiopia using 2016 Demographic and Health Survey data. We found that 21.1% of participants reported ethier their current pregnancies or recent births were an unintended; which is nearly close to the national rate of unintended pregnancy among women of reproductive age (25%) (18) indicating that uintended pregnancy is common among younger population. In the same age group (15–24), relatively consistent findings were reported in Nepal (22.7%) (21), Bangladesh (23%) and India (18%) (22). Higher rate of unintended pregnancies among women of reproductive age was reported in sub-Saharan Africa countries (25.9%) (23), and among adolescent and young women in South Africa (41.9%) (24). Underuse of contraceptives could be attributed to these high rate of unintended pregnancy (25), and the involvement of only unmarried adolescent girls and young women in a study conducted in South Africa may not result a generalizable finding (24).
Most literature considers IPV as a composite measure of physical, sexual and emotional violence only, and exclude marital control. However, considering the influence of partner controlling behaviour on women’s decision-making power, health service utilization (26), and fertility control (27, 28); we have adopted the WHO definition of IPV (29) p89 and included marital control as one form of IPV in our study. We found that 64.2% of women aged 15–24 experince at least one form of IPV (physical, sexual, emotional or marital control). It was similar with the national overall prevalence of any form of IPV (64%) among women of reproductive age (30), suggesting that adolescent and young women aged 15–24 year takes the greater proportion of overall IPV. On the other hand, the overall prevalence of IPV in this study was much greater than sub-Saharan Africa women (44%) (31), which could be related to study participants age difference and the later study investigated any form of IPV as a composite measure of physical, sexual, and emotional violence only. When we compare with a similar age group (15–24 year), the overall prevalence of IPV in this study was higher than IPV (physical or sexual) reported in India (38%), Bangladesh (52%) and Nepal (28%) (22), keeping a difference in estimating the overall prevalence of IPV.
In the present study the most prevalent form of IPV was marital control (59.5%) and the least prevalent was sexual IPV (8.8%). It was consistent with a study conducted using similar data among women of reproductive age that reported marital control (56.4%) as the most prevalent and sexual IVP (11.9%) as the least prevalent form IPV (30), which implies the occurence of similar form of IPV across different age groups. On the other side, a systematic review and meta-analysis of cross-sectional studies in sub-Saharan Africa indicated emotional IPV as the most prevalent and sexual IPV as least prevaent form of IPV (31). The lower incidence of sexual IPV might be related to underporting by victimized women due to fear of discrimination and feeling shame.
The current study investigated unintended pregnancy in relation to different forms of IPV in Ethiopia. We found that physical violence, marital control and emotional violence by intimate partner have a significant effect on unintended pregnancy. After adjusting for potential confounding factors, unintended pregnancy was significantly associated with reporting physical IPV. Other studies have shown a similar association (22, 32). This could be because women who were physically mistreated by their husbands were less likely to use contraceptives (33), their husbands refused to use condoms or tried to stop them from using a contraceptive (34), or discontinued the use of spacing methods because of fear.
In this study those who ever experienced marital control behaviour had increased odds of unintended pregnancy, after adjusting for possible confounders. Similar finding was reported by a study done among Nicaraguan women (35) which could be due to a reason that controlling behavior by a partner can interfere with women’s reproductive freedom through hindering contraceptive use by limiting their autonomy, access to health care, or by facilitating contraceptive failure (36). In Ethiopia, where patriarchal views are common, the decision to seek care is usually made by male partners and they are the chief providers which often determining women’s access to economic resources (37).
After adjusting for possible confounders, women who ever experienced emotional violence had increased odds of unintended pregnancy. It was consistent with a study conducted using similar data among women of reproductive age in Ethiopia (30) and population-based study in southern Spain (38). Experincing emotional intimate violence could be related with a limited autonomy in controlling their fertility and are most likely to be discouraged for using contraceptive methods by their husband/partners. Therefore, it sugesst the need to involve male partners and efforts should be made to improve awareness of the male partner’s on fertility control through community based health education.
Furthermore, in this study any form of IPV and sexual IPV had no significant effect on unintended pregnancy. The lack of significant association between any form of IPV with unintended pregnancy was supported by a similar study conducted among women of reproductive age in Ethiopia (30) but contradicts with other study findings (39, 40). Contrary to the general argument, the association between sexual IPV and unintended pregnancy was not significant. Although a study conducted in Nepal (22) indicated no significant effect of sexual IPV on unintended regnancy, the reasons for this is uncertain. We assume that this could have been due to small sample size that may affect the results. Moreover, further investigation is needed to explore the nature of these associations.
Previous studies have focused mostly on women of reproductive age group (15–49), whereas this study presents the relationship between IPV and unintended pregnancy among adolescents and young women. Our findings further add to the growing body of knowledge by showing a higher prevalence of unintended pregnancy and IPV among adolescent and young women, despite improved contracetive use among women of reproductive age group in Ethiopia. This study also reinforces the findings on the effect of different form of IPV on unintended pregnancy indicating physical violence, marital control and emotional violence has been linked to unintended pregnancies. The mechanisms for the occurrence of these relation merit further investigation.
The findings of this study need to be interpreted in the light of some limitations. It was difficult to determine direct relationship between IPV and unintended pregnancy due to cross-sectional nature of the data used for analysis. The sensitive nature of IPV and recall bias may lead to under-reporting while sharing experiences of IPV. Additionally, unintended births may have been under-reported after a child is born because of the joy associated with having a child.