UC San Diego

Background: Social practices around marital sex and family planning in Indian societies often result in gendered inequities within households, such as husbands’ elevated alcohol use, poor gender equity ideologies, and wives’ intimate partner violence (IPV) victimization from husbands. The resulting power imbalance women face may contribute to challenges in contraception use and exclude wives from pregnancy decision-making.

Objective: To explore gendered inequities in relation to reproductive health outcomes of modern spacing contraception, and unintended pregnancy in Maharashtra, India.

Methods: This analysis includes data from rural, non-sterilized, couples (N=1,081) (Chapters 2-3), and postpartum (≤6 months) wives in urban slums (N=1,047) (Chapter 4). Associations were tested between 1) husbands’ elevated alcohol use, and gender equity ideologies with wives’ IPV victimization via logistic regression (Chapter 2), 2) wives’ IPV victimization with use of modern spacing contraception via multinomial regression (Chapter 3), and 3) wives’ reports of externally-decided pregnancy and IPV victimization with unintended pregnancy, through multinomial logistic regression (Chapter 4).

Results: Chapter 2 findings indicate that wives were less likely to report IPV if husbands reported greater gender equity ideologies (AOR: 0.97, 95% CI: 0.95, 0.99); husband’s elevated alcohol use was associated with increased risk of IPV (AOR: 1.89, 95% CI: 1.01, 3.40). Results from Chapter 3 show that women reporting physical IPV were more likely to report condom use (AOR: 2.07, 95% CI: 1.01, 3.89), and women reporting sexual IPV were more likely to report other modern spacing contraception (AOR: 2.86, 95% CI: 1.14, 7.16). Chapter 4 demonstrates that women reporting externally-decided pregnancies were more likely to have mistimed pregnancies (AOR: 6.14, 95% CI: 3.60, 10.46), as were women reporting IPV (AOR: 2.12, 95% CI: 1.38, 3.25).

Conclusion: This dissertation supports the need for gender equity counseling for husbands, with potential utility of integration within existing alcohol intervention services for men (Chapter 2). Results from Chapter 3 indicate that wives contending with IPV are accessing family planning services, thus presenting opportunities for IPV intervention. Finally, results from Chapter 4 support the need to include questions on wives’ roles in pregnancy decision-making in both screening and intervention efforts within family planning services.