Worldwide, an estimated one in three women are physically assaulted, coerced into sex or otherwise abused at least once during their life, in most cases by an intimate partner. The December 2004 issue of International Family Planning Perspectives, which is devoted to an examination of the reproductive health consequences of gender-based violence, provides new evidence that these women not only sustain physical injuries, they are more likely than other women to have unintended pregnancies, report symptoms of reproductive tract infections and have multiple partners, and less likely to use condoms and other contraceptives.
In Rakai, Uganda, 14 percent of women aged 15–19 report having been forced into their first sexual experience, authors Michael A. Koenig of Johns Hopkins University et al. report in "Coerced First Intercourse and Reproductive Health Among Adolescent Women in Rakai, Uganda." These young women are less likely than other young women to use contraceptives and more likely to become pregnant before they wish to be.
Annabel S. Erulkar of the Population Council shows that in Nyeri, Kenya, more than one in five young women and more than one in 10 young men report having been coerced into having sex. For more than one-quarter of young women, the perpetrator was their husband. Young women who had been abused were more likely to have multiple partners and to report symptoms of reproductive tract infections. Young men who had been abused were more likely than others to have had sex for the first time with a partner who was five or more years older. "Reproductive health programs designed for young people need to address nonconsensual sex, including the special needs of males and married females," the author concludes in "The Experience of Sexual Coercion Among Young People in Kenya."
In nearby Tanzania, authors Heidi Lary of Johns Hopkins University et al. examine the relationship between HIV and sexual coercion. "Exploring the Association Between HIV and Violence: Young People’s Experiences with Infidelity, Violence And Forced Sex in Dar es Salaam, Tanzania," shows that men who hit, slap, punch or kick their partners are also likely to force their partners to have sex. In addition, men with more than one partner reported becoming violent when their partners questioned their fidelity—making it difficult for young women to confront their partners about behaviors that put them at risk of HIV infection.
In "The Relationship Between Intimate Partner Violence and Unintended Pregnancy: Analysis of a National Sample from Colombia,"Christina C. Pallitto of the University of Toronto and Patricia O’Campo of Johns Hopkins University find that Colombian women who have been physically and sexually abused are more likely than other women to experience unintended pregnancy. They call on reproductive health programs to incorporate screenings for intimate partner violence among patients.
In China, one in three women and one in five men has been hit during her or his current relationship, according to William Parish of the University of Chicago et al. In "Intimate Partner Violence in China: National Prevalence, Risk Factors and Associated Health Problems," which presents the country’s first national estimates of domestic violence, the authors find that sexual jealousy, alcohol consumption, low female contribution to the household income and low socioeconomic status are among a range of factors that make violence more likely.
In six villages in rural Bangladesh, two-thirds of women have ever experienced domestic violence, one-third in the past year. In "Socioeconomic Factors and Processes Associated with Domestic Violence in Rural Bangladesh," Lisa M. Bates of the Academy for Educational Development et al. find that education plays the most significant role in protecting a women from domestic violence.
Reproductive health providers should give women who have suffered violence the privacy, time and confidentiality they need to share their experiences, argue Charlotte Watts and Susannah Mayhew in their comment "Reproductive Health Services and Intimate Partner Violence: Shaping a Pragmatic Response in Sub-Saharan Africa." Such efforts to make women feel comfortable can make a real difference in the quality of health care they receive and can be implemented relatively simply.