Unintended Pregnancy and Domestic Violence Among Pregnant Women in Regions of India: Evidence from Large Scale Survey Data

Abstract

The study examined effect of domestic violence (DV) on pregnancy intendedness among pregnant women across geographical regions in India. Using fourth wave of National Family Health Survey data, the study is confined to experience of physical/sexual violence within 12 months preceding the survey. Close to 6% of the women were found pregnant with high in the central region. Among them, 12% were having unintended pregnancy (UIP), with highest in the central (17.4%) region. UIP found 7% higher among victims of DV compared to those who did not face it (11%). Significantly, regional variation is much persisting as the regions having high prevalence of DV are also at an increased risk of UIP which hampers the notion of dignified reproductive rights. This needs region-specific policy and programme. Study push for interventions on minimising DV and reducing burden of high UIP in regions of India.

Keywords

Domestic violence gender NFHS region unintended pregnancy

Introduction

Unintended pregnancy (UIP) and domestic violence (DV) have remained at the centre of women’s rights perspective for a long time. Worldwide, more than two-fifth of all the pregnancies are unintended. The UIP rate remains substantially higher in developing regions than in developed regions (Bearak et al., 2018; Bongaarts, 1997). During 2010–2014, UIP rate declined by 30% in developed regions (64 per 1,000 women aged 15–44 years during 1990–1994 to 45 per 1,000 during 2010–2014) compared with only 16% (77 per 1,000 women aged 15–44 years to 65 per 1,000 women in same time periods) in developing regions (Sedgh et al., 2014). Unintended pregnancy is widespread in India and around half of all pregnancies are unintended. In 2015, pregnancy rate among 15–49 years women was 144 per 1,000, of which 70 per 1,000 were unintended (Singh et al., 2018).

Recent studies from developing region have revealed that domestic violence, especially intimate partner violence among married couples is a significant risk factor of UIP (Bawah et al., 1999; Cripe et al., 2008; Miller et al., 2010; Pallitto & O’Campo, 2004). Unfortunately, very few studies have explored such association between intimate partner violence and UIP. Some studies have explored linkages of UIP with abortion and the associated risk factors (Evins & Chescheir, 1996; Kaye, 2001). Some studies have explored the differences in pregnancy wantedness on women abuse during pregnancy (Goodwin et al., 2000; Hillard, 1985). Others have explored the association between intimate partner violence and pregnancy intentions using either quantitative data (Goodwin et al., 2000; Pallitto & O’Campo, 2004) or qualitative data (Campbell et al., 1995). Most of those studies are from developed countries Pallitto & O’ Campo, 2005), and their findings need not necessarily be generalised in case of developing countries.

In India, intimate partner violence is widespread phenomena and varies across regions (Jejeebhoy et al., 2013; Kimuna et al., 2012; Koenig et al., 2006) as do a range of indicators of women’s autonomy and empowerment (Dyson & Moore, 1983; Koenig et al., 2006; Pallitto & O’Campo, 2005). For example, the recent National Family Health Survey (NFHS-4) found that 30% of women had experienced physical (PV) or sexual violence (SV) within marriage, and it ranged from 45% in Tamil Nadu, Telangana and Manipur to 9% in Himachal Pradesh (IIPS & ICF, 2017). At the same time, many women reported UIP and there was a considerable unmet need for contraception (13% during 2015/16) and it varies across the region.

However, there are no studies which have explored the association between experience of spousal violence and its effect on pregnancy among pregnant women across regions as there are regional variations in the magnitude of domestic/spousal violence. So, this study examined differential effect of domestic (physical and/or sexual) violence on pregnancy intendedness in different regions in India. The research article is broadly having four sections. Introduction elaborated with setting background, context, evidence and issues of concern. The second section discusses about data and methods in detail. The next section is on results of the study focused on evidencing the effect of domestic violence on pregnancy intendedness and regional level differentials. Finally, fourth section on discussion and conclusion narrated the emerging evidence at regional level, documenting and supporting findings of the study and possible programmatic and policy interventions to minimise the threat of domestic violence and burden of UIP across regions in India.

Data and Methods

Data Source

Data are drawn from the fourth wave of National Family Health Survey (NFHS-4), conducted in 2015–2016. NFHS is a nationally representative, cross-sectional household survey, covering women in the reproductive age group of 15–49 years, selected through a multi-stage sampling approach. It provides reliable information on pregnancy-related behaviour, fertility and fertility intentions, contraception and other aspects of reproductive health, as well as on marital violence, women’s empowerment and socio-economic characteristics (IIPS & ICF, 2017). NFHS-4 collected data from 699,686 women aged 15–49 years, residing in all twenty-nine states, NCT of Delhi and six Union Territories. Among them, 499,627 (weighted = 511,377) women were currently married. Out of all currently married women, 32,428 (weighted = 31,118) were found pregnant at the time of the interview.

Selection of the Study Population

This study focuses on the experience of women who were pregnant at the time of interview. As many as 32,428 women (weighted = 31,118) were pregnant at the time of survey. Of them, 3,842 women (weighted = 3,526) had experienced spousal violence—either physical or sexual or both, anytime in 12 months preceding the interview. Here, it is very clear that the analysis is restricted to only those women who were pregnant at the time of survey in 2015/2016 to ensure temporality as far as possible, to ensure experience of violence preceded the pregnancy.

Moreover, by focusing on those pregnant women at the time of interview, pregnancy intentions may be captured more precisely than when captured later, as often, unwanted pregnancy ends in abortion or women modify their perceptions about unintendedness once birth has taken place. Furthermore, including a woman’s experience of spousal violence in the preceding 12 months may have a more direct impact on conception, as the experience of violence may exacerbate the risk of UIP (Black et al., 2010; Campbell, 2002).

Selection of Variables

Unintended Pregnancy

Pregnant women were asked to recall whether at the time of conception, they had intended to become pregnant; and if not, whether they had wanted to become pregnant later or not at all. A woman who reported she ‘wanted [the pregnancy] then’ is defined as having an ‘intended’ pregnancy. A woman who reported that her pregnancy was ‘wanted later’ and/or ‘not wanted at all’ is defined as having a ‘mistimed’ and ‘unwanted’ pregnancy, respectively. Mistimed and unwanted pregnancies are considered to be unintended pregnancies (Santelli et al., 2003). Unintended pregnancy for this study is, therefore, a dichotomous variable, set to equal 0 if the pregnancy was intended, and 1 if not, namely if the woman reported wanting the pregnancy later or not at all.

Domestic Violence

NFHS classified a woman as having experienced ‘physical violence (PV)’, if she answered affirmatively on at least one of the following forms of violence—her husband had pushed/shook/thrown something at her; slapped her; hit her with something harmful; twisted her arm or pulled her hair; kicked/dragged her, tried to strangulate her or burnt her; threatened her with knife/gun/other weapons. A woman was classified as having experienced ‘sexual violence (SV)’ if she answered affirmatively on at least any of the following—her partner forced into unwanted sex, unwanted sexual acts or physically forced her to perform sexual acts she did not want. Using both forms of violence, domestic violence is defined as the experience of either PV or SV within marriage. We limit the reference period of 12 months before the interview to have a better understanding of how the threat of domestic violence may have affected the unintended current pregnancy.

To note that by considering only those women who experienced violence in last 12 months, the study omits experience of other women who might have experienced violence throughout their married life. However, this restriction is also strength of this study. As it allows ensuring, as far as possible, that the experience of domestic violence preceded the pregnancy whose intendedness is the focus of this study.

Regional and Socio-Demographic Characteristics

In the study, the surveyed states/UTs have been categorised into six regions, following NFHS criteria of clubbing states/UTs in regions. Those are North Region: Chandigarh, Delhi, Haryana, Himachal Pradesh, Jammu and Kashmir, Punjab, Rajasthan and Uttarakhand; Central Region: Chhattisgarh, Madhya Pradesh and Uttar Pradesh; East Region: Bihar, Jharkhand, Odisha and West Bengal; Northeast (NE) Region: Arunachal Pradesh, Assam, Manipur, Meghalaya, Mizoram, Nagaland, Sikkim and Tripura; West Region: Dadra and Nagar Haveli, Daman and Diu, Goa, Gujarat and Maharashtra; South Region: Andaman and Nicobar Islands, Andhra Pradesh, Karnataka, Kerala, Lakshadweep, Puducherry, Tamil Nadu and Telangana. There are evidences of state level variation in domestic violence and UIP but the sample size limits to go further. Hence, it is also one of the limitations of the study.

On the socio-demographic characteristics mainly the woman’s age, number of children surviving, level of educational attainment, household economic status, social group (caste/tribe), religion, and place of residence is considered.

Statistical Analysis

Descriptive statistics are presented to depict status on the magnitude of UIP, domestic violence, and their respective regional pattern. Binary logit regression is conducted to delineate the factors; including socio-demographic factors and domestic violence, associated with the experience of UIP. Regression results are presented using odds ratios (Exp β). Model fitness is examined through –2 log likelihood values and R square statistics. Test of significance and robustness for each model were checked through chi-square values.

Co-variates were regressed first on all India at aggregate level considering domestic violence into account along with selected demographic and socio-economic characteristics of women. Selected demographic (women’s age and the number of children) and socio-economic characteristics (women’s education, household economic status, social group and place of residence) were also considered in the regression model.

Further, logit regression was conducted for each region separately controlling above-mentioned demographic and socio-economic characteristics. Logit regression provides odds ratio on occurrence of UIP. In the study, logit regression modelled relationship between a binary response variable (P: intended/non-intended) and a set of explanatory/predictor variables (X). The domestic violence is independent variable and socio-demographic and economic variables are co-variates used in the model. It can be written as

Logit (P) = Log {P/(1 – P)} = α + βX, where x is explanatory or predictor variable of P.

or, Logit (P) = b₀ + b₁x₁ + b₂x₂ + … + b_kx_k

or, Log (P/1 – P) = b₀ + b₁x₁ + b₂x₂ + … + b_kx_k.

where x₁, x₂, …, x_k are predictor variables and (P/1 – P) is the odds.

Hence, the final model is like

Log (unintended/intended) = α + β (DV, socio-demographic)

Odds ratio is used to compare the odds of intended and unintended, in the same way that the relative risk is used to compare risks as it is widely used in the studies and it can be understood as

Odd ratio = \frac{p / (1 - p)}{q / (1 - q)}

where p and (1 – p) is the probability of occurring and not occurring for the first group, and q and (1 – q) is the probability of occurring and not occurring for the second group.

The analysis was conducted using STATA version 14.0.

Results of the Study

Characteristics of Pregnant Women in India

Table 1 presents the demographic, economic and social characteristics of pregnant women in 2015–2016. The mean age of pregnant women was 24.7 years, mean age at delivery of first baby was around 21 years, and on average, women started to live with their husbands at the age of 19.5 years. Around 14% of pregnant women had reported for terminated their earlier at any time during their reproductive life. However, it would be clear here that reporting of terminated pregnancy cannot be understood as abortion rate. Further, about one-third (32%) of the pregnant women had ever used any means of family planning for averting a pregnancy.

Table 1.

Selected Characteristics of Currently Pregnant (15–49 Years) Women in India: 2015–2016.

Characteristics	Statistics
Mean age of pregnant women (years)	24.7
Mean age of women at first birth (years)	20.9
Mean age at first cohabitation (years)	19.4
Women have terminated pregnancy (%)	14.1
Women having no living male children (%)	65.1
Women having no living female children (%)	60.7
Women having no living children (%)	41.1
Mean number of members per household	5.9
Women ever used any contraception (%)	32.0
Women having no formal education (%)	25.1
Women’s education beyond higher secondary (%)	12.1
Mean years of women’s education	7.1
Women from rural areas (%)	71.5
Women from the poorest wealth index (%)	23.7
Women from the richest wealth index quintile (%)	15.3
Pregnant women (weighted N)	32,428 (31,118)

In addition, 41% of women did not had any living children at the time of survey. As much as 65% and 60% of the pregnant women did not have a son or daughter, respectively. Most pregnant women had about seven years of schooling, while one fourth of pregnant women did not had any formal education and only 12% were educated beyond higher secondary education. The majority of pregnant women were from rural areas. Economically, one-fourth came from the poorest wealth quintile and only 13% were from the richest quintile. The average number of members per household was found six.

Experience of Domestic Violence Among Pregnant Women

Among the married women, 6.1% were pregnant at the time of interview in 2015–2016. The largest proportion were in the central (7.6%) and the smallest (4.1%) was in the south region (Table 2). More than one-fifth (21%) of pregnant women had faced domestic violence in the country, including 19% who had experienced physical violence and 6% who had faced sexual violence. At regional level, the experience of domestic violence ranged from a high of 25% in central region to a low of around 13% in northern region. Physical violence was most likely to have been reported in the east (28%) and central (22%) regions and least likely in the north (12%) region. Sexual violence ranged from a high of 10% in eastern region to much lower levels in north (3.4%), south (3.7%) and west (3.9%) regions.

Table 2.

Pregnancy and Experience of Domestic Violence within 12 Months Among 15–49 Years Women in India: 2015–2016 (%).

Regions	Pregnant Women as Percentage of All Women	% of Pregnant Women Who Had Experienced Domestic Violence in 12 Months Preceding the Interview
Regions	Pregnant Women as Percentage of All Women	Physical Violence	Sexual Violence	Domestic Violence
North	6.3	11.9	3.4	12.7
Central	7.6	22.5	6.5	25.0
East	6.6	28.1	10.4	31.2
NE	5.8	18.9	6.5	21.6
West	5.1	13.4	3.9	13.4
South	4.1	15.9	3.7	17.7
India	6.1	19.3	6.0	21.4

In 2015–2016, around 12% of pregnant women reported that their pregnancy was unintended, as may be observed in Figure 1. The proportion of pregnant women who reported their pregnancy as unintended varied from 14 to 17% in the central and eastern regions to only 4% in the southern region.

Figure 1.

Source: National Family Health Survey (NFHS-4): 2015–2016.

Experiencing Domestic Violence and Unintended Pregnancy

This section explores the association of UIP with experience of physical, sexual and domestic violence by the women in last 12 months. Table 3 depicts pregnant women who had experienced some form of domestic violence in previous 12 months were more likely to have an UIP, in India, and in each region also, however, the magnitude differs. At the country level, 18% of pregnant women who had experienced domestic violence reported UIP as against 11% of those who had not experienced it. A similar pattern is observed when associations with physical and sexual violence were explored separately, with high of 6–11 percentage points more among women who faced it, across the regions.

Table 3.

Level of Unintended Pregnancy by Experience of Physical, Sexual or Domestic Violence Within 12 Months by Pregnant Women in India: 2015/2016 (%).

	Violence	Physical		Sexual		Domestic
		UIP	SL^a	UIP	SL^a	UIP	SL^a
North	No	10.4	*	11.2	NS	10.3	*
	Yes	17.5		15.4		17.7
Central	No	15.5	**	16.6	NS	15.4	**
	Yes	22.2		23.3		22.1
East	No	14.5	NS	14.9	NS	15.4	NS
	Yes	17.8		20.3		22.1
NE	No	7.9		7.8	****	7.1	**
	Yes	13.3		28.6		15.3
West	No	3.0	**	3.6	**	3.0	**
	Yes	10.9		20.0		10.9
South	No	6.9	NS	5.9	***	6.5	NS
	Yes	6.8		29.4^b		8.5
India	No	11.1	***	11.7	***	10.8	***
	Yes	17.1		22.4		17.5

Source: National Family Health Survey (NFHS-4): 2015–2016; ^aBased on chi-squared test; ^bHigh percentage due to small sample within cell.

Notes: UIP: unintended pregnancy, SL: significance level: ***≤0.001, **≤0.01, *≤0.05, NS: not significant.

The differential magnitudes are also calculated separately on PV, SV and DV for each region (Table 3). In each region, women who had experienced any form were more likely than those who had not to report UIP. Concerning experience of DV, differences were in the range of 7–8 percentage points across regions except for southern, with minimal difference of only 2%. Disparities found wider on sexual than physical violence in all of the regions. For example; in the central region, physical violence ranged from 22% among those whose pregnancy was unintended to 16% among those whose pregnancy was intended. Corresponding percentages in the northern region were 18% and 10%. On sexual violence, differences were in the range of 4–6 percentage points in northern, central and eastern regions, but far wider of 10–23 percentage points in NE, West and South regions.

Regressing Effect of Domestic Violence and Unintended Pregnancy

The effect of domestic violence as well as physical and sexual violence, on UIP among pregnant women, is modelled using Logit regression. The dependent variable is UIP among pregnant women and the main independent variable is experience of violence in 12 months preceding the interview. The model controlled on demographic, social and economic variables and results are presented in Table 5. For each region and the country as a whole, model is controlled on selected demographic, social and economic variables shown in Table 1. The association between UIP and violence is presented through odds ratios (OR) discussed in the methodology section in details. The model fitness and significance for predicting the effect of violence on UIP is presented in Table 4. The model fit is found significant on all three form of domestic—physical, sexual and spousal violence.

Table 4.

Model Specification on Predicting Risk of Unintended Pregnancy 15–49 Years Aged Pregnant Women in India

	–2 Log Likelihood	Pseudo R Square	Chi-Square Value	Significance Level	N
Domestic violence	–1217.9	0.0978	264.14	p < .001	3,671
Physical violence	–1216.1	0.0963	259.29	p < .001	3,654
Sexual violence	–1215.1	0.0971	261.39	p < .001	3,654

Table 5.

Effect of Domestic Violence (DV) Experience in Past 12 Months on Unintended Pregnancy (DV = No vs. Yes) in Regions and India, 2015–2016.

		Odds Ratio	Sig. Level	LL	UL
North	Yes (r = no)	1.763	0.075	0.945	3.290
Central	Yes (r = no)	1.610	0.014	1.099	2.358
East	Yes (r = no)	1.200	0.446	0.752	1.914
NE	Yes (r = no)	3.072	0.004	1.426	6.615
West	Yes (r = no)	4.458	0.043	1.049	18.954
South	Yes (r = no)	1.233	0.694	0.435	3.499
India	Yes (r = no)	1.574	0.000	1.245	1.990

Source: National Family Health Survey (NFHS-4): 2015–2016.

Note: Controlled on women’s age, number of children, women’s education, wealth index, caste, place of residence and regions for India. Each region has controlled on all the selected variables other than region variable.

LL: lower limit, UL: upper limit.

Table 5 shows effects of domestic violence on UIP whereas Table 6 shows effects of physical and sexual violence independently on UIP. Table 5 shows that for India as a whole, even after controlling for confounding factors including region, women who had experienced domestic violence in the last 12 months were found to be 1.57 times more likely (p < .001) to have an UIP than women who had not experienced it in the previous 12 months. Region-wise findings reveal that associations were strongest among women in western (OR, 4.5) and north-eastern (OR, 3.1) regions. However, domestic violence was not significantly associated with UIP in the eastern and southern regions of the country.

Table 6.

Effect of Physical/Sexual Violence (PV/SV) in the Past 12 Months on Unintended Pregnancy (PV/SV = No vs. Yes) in Regions and India, 2015–2016.

		Odds Ratio	Sig. Level	LL	UL
Physical violence
North	Yes (n = o)	1.585	0.162	0.831	3.023
Central	Yes (r=no)	1.679	0.010	1.134	2.487
East	Yes (r = no)	1.158	0.549	0.717	1.871
NE	Yes (r = no)	1.158	0.549	0.717	1.871
West	Yes (r = no)	4.458	0.043	1.049	18.954
South	Yes (n = o)	0.674	0.524	0.201	2.267
India	Yes (r = no)	1.470	0.002	1.154	1.871
Sexual violence
North	Yes (r = no)	1.676	0.406	0.495	5.669
Central	Yes (r = no)	1.675	0.114	0.884	3.177
East	Yes (r = no)	1.309	0.419	0.682	2.516
NE	Yes (r = no)	8.153	0.000	2.847	23.351
West	Yes (r = no)	14.659	0.023	1.451	148.064
South	Yes (r = no)	8.759	0.002	2.239	34.260
India	Yes (r = no)	1.993	0.000	1.395	2.847

Source: National Family Health Survey (NFHS-4): 2015–2016.

Note: Controlled on women’s age, number of children, women’s education, wealth index, caste, place of residence and regions. Each region is controlled on all the mentioned variables other than region variable.

LL: Lower limit, UL: Upper limit.

Table 6 presents effect of physical and sexual violence, separately, on UIP, after controlling for confounding factors, both having significant effect. At national level, UIP reported by women who had experienced physical violence was around 1.47 times higher than those who had not experienced it, and twice as high among women who had experienced sexual violence compared to those who had not. Effects were generally significant across all the regions for both physical and sexual violence, with two exceptions (physical violence in the southern region, and both sexual and physical violence in the eastern region).

Discussion and Conclusion

Domestic violence is a well-recognised global challenge with many adverse consequences for women’s life. One adverse outcome is UIP, which may end in abortion or an unintended birth (Watts & Zimmerman, 2002; WHO, 2013). Several recent studies have revealed that intimate partner violence is a significant risk factor for UIP (Bawah et al., 1999; Cripe et al., 2008; Miller et al., 2010; Pallitto & O’Campo, 2004). This study has examined the effect of domestic violence on UIP in the Indian context, and, to address the issue of temporality, as far as possible the experience of violence has preceded the pregnancy, by focusing on pregnancy intendedness among pregnant women. Given the wide sociocultural disparities across the region, this study has further explored the relationship in each region other than the country level. Possibly, this is the first study examined and studies effect of spousal violence for each of the region on same set of independent and covariates.

This study found that a woman who had experienced domestic violence in the 12 months before the interview have faced a 1.6 times greater risk of UIP compared to women who had not faced it. Those who had experienced physical violence were 1.5 times as likely, and those who had experienced sexual violence were 2.1 times as likely to have an UIP against women who had not experienced such forms of marital violence. Findings of the study are consistent with the findings of other studies that have observed ignited effect of physical violence (Cripe et al., 2008; Gao et al., 2008; Miller et al., 2010; Pallitto & O’Campo, 2004; Stephenson et al., 2008) and sexual violence (Begum et al., 2010; Pallitto et al., 2013; Shabnam & Mukherjee, 2013) on conception and pregnancy coerciveness.

These associations were observed consistently over four of six regions in the country, even after socio-demographic confounding factors were controlled. The associations are emerged significant for most regions on both sexual and physical violence. Importantly, India has a huge regional difference on local cultural context and socio-economic development of women, impacts attitudes towards violence against women (Kabeer, 1999; Kimuna et al., 2012; Koenig et al., 2006; Pallitto & O’Campo, 2005).

Several studies have shed light on the likely pathways through which experienced of physical and/or sexual violence may affect conception behaviour or other reproductive health outcomes. Women who experienced violence is likely to dominate by their husbands in many ways that may result into UIP and resort to induced abortion. Several authors have highlighted the dominant role played by husband in decision on women’s control over fertility, as well as their access to and use of contraceptives (Bawah et al., 1999; Gomez, 2011; Silverman et al., 2011; Stephenson et al., 2008). Some have drawn attention to, for example, men’s refusal to use condoms, and women’s fear of negotiation about the use of condoms (Gomez, 2011; Miller et al., 2010; Raj & McDougal, 2015; Silverman et al., 2011). Further, dominating husbands may also be less likely to cooperate when methods such as condoms, withdrawal or the rhythm method can be used and may engage in forced and unprotected sexual relations with their wife; UIP and abortion may result of it many times. However, outcome of pregnancy is not part of this study and can be understood as limitations.

This study has considerably advanced what is known about the relationship between spousal violence and the experience of UIP. It has, for one, shown the consistency of this association in India, even when confounding factors are controlled (Klerman, 2000), and has shown this association not only at the national level but in four of the six regions also. Second, study is free from the post-birth rationalisation of pregnancy (Moos et al., 1997); since data permitted us to explore the association among pregnant women only. While others have argued that a prospective measure of pregnancy intendedness eliminates biases caused by post-birth rationalisation (Koenig et al, 2006; Stephenson et al., 2008). By restricting the sample to pregnant women, study has minimised effect using cross-sectional data. Third, the study was also able to minimise problems of temporality by restricting the independent variable to the experience of domestic violence within the 12 months preceding the interview (Stephenson et al., 2008).

Limitations of the study must also be acknowledged. Some of the limitations have been discussed in data and method section. Moreover, restrictions imposed to ensure temporality also mean that the study sample may not be representative of Indian women in general, notably, those who had experienced spousal violence at some point but not in the year preceding the interview. Overall, this study concludes that domestic violence, and especially sexual violence, may pose a major threat to exacerbating UIP, and may be one factor explaining why completed family size exceeds desired family size in the country. Reducing threat of domestic violence will not only reduce the burden of high UIP in India but will also ensure those women’s rights is respected (Silverman & Raj, 2014).

Footnotes

Acknowledgement

I am very thankful to Shireen J. Jejeebhoy and Rajiv Acharya for their mentorship to work on the study and for their constructive comments and suggestion at various stages in improving the quality of the article. I am also highly obelised to Population Council, India for proving me opportunity to conduct the study. I am also thankful to International Union for the Scientific Study of Population (IUSSP) for selecting this study to present findings in Seminar on ‘Unintended Pregnancy and Key Outcomes—Abortion and Unplanned Births: Improvements in Measurement and New Evidence’ during 13–15 July 2022. Author is also thankful especially to Fatima Juarez, Ann Moore and Susheela Singh of the Guttmacher Institute, USA for discussions and inputs on the study.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding

This study received no specific grant from any funding agency, commercial entity or not-for-profit organisation. However, the study is conducted under the aegis of a ‘Scientific paper writing workshop on Reproductive, Maternal, Newborn and Child Health in India’ conducted by Population Council, Delhi, India.

Ethical Approval

The study uses the publically available Demographic Health Survey data of the Indian version. In the line, no ethical approval is needed.

ORCID iD

Rajesh Raushan

References

Bawah

, Akweongo

, Simmons

, & Phillips

(1999). Women’s fears and men’s anxieties: The impact of family planning on gender relations in northern Ghana. Studies in Family Planning , 30(1), 54–66. https://doi.org/10.1111/j.1728-4465.1999.00054.x

Bearak

, Popinchalk

, Alkema

, & Sedgh

(2018). Global, regional, and subregional trends in unintended pregnancy and its outcomes from 1990 to 2014: Estimates from a Bayesian hierarchical model. Lancet Global Health , 6(4), e380–e389. https://doi.org/10.1016/S2214-109X(18)30029-9

Begum

, Dwivedi

S. N.

, Pandey

, & Mittal

(2010). Association between domestic violence and unintended pregnancies in India: Findings from the National Family Health Survey-2 data. The National Medical Journal of India , 23(4), 198–200.

Black

K. I.

, Gupta

, Rassi

, & Kubba

(2010). Why do women experience untimed pregnancies? A review of contraceptive failure rates. Best Practice & Research. Clinical Obstetrics & Gynaecology , 24(4), 443–455. https://doi.org/10.1016/j.bpobgyn.2010.02.002

Bongaarts

(1997). Trends in unwanted childbearing in the developing world. Studies in Family Planning , 28(4), 267–277.

Campbell

J. C.

(2002). Health consequences of intimate partner violence. Lancet , 359(9314), 1331–1336. https://doi.org/10.1016/S0140-6736(02)08336-8

Campbell

J. C.

, Pugh

L. C.

, Campbell

, & Visscher

(1995). The influence of abuse on pregnancy intention. Women’s Health Issues , 5(4), 214–223. https://doi.org/10.1016/1049-3867(95)00058-5

Cripe

S. M.

, Sanchez

S. E.

, Perales

M. T.

, Lam

, Garcia

, & Williams

M. A.

(2008). Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru. International Journal of Gynaecology and Obstetrics , 100(2), 104–108. https://doi.org/10.1016/j.ijgo.2007.08.003

Dyson

, & Moore

(1983). On kinship structure, female autonomy and demographic behaviour in India. Population and Development Review , 9(1), 35–60. https://doi.org/10.2307/197289444

10.

Evins

, & Chescheir

(1996). Prevalence of domestic violence among women seeking abortion services. Women’s Health Issues , 6(4), 204–210. https://doi.org/10.1016/s0029-7844(98)00089-1

11.

Gao

, Paterson

, Carter

, & Iusitini

(2008). Intimate partner violence and unplanned pregnancy in the Pacific Islands Families Study. International Journal of Gynecology & Obstetrics , 100(2), 109–115. https://doi.org/10.1016/j.ijgo.2007.08.004

12.

Gomez

A. M.

(2011). Sexual violence as a predictor of unintended pregnancy, contraceptive use, and unmet need among female youth in Colombia. Journal of Women’s Health , 20(9), 1349–1356. https://doi.org/10.1089/jwh.2010.2518

13.

Goodwin

M. M.

, Gazmararian

J. A.

, Johnson

C. H.

, Gilbert

B. C.

, Saltzman

L. E.

, & PRAMS Working Group. (2000). Pregnancy intendedness and physical abuse around the time of pregnancy: Findings from the Pregnancy Risk Assessment Monitoring System, 1996–1997. Maternal and Child Health Journal , 4(2), 85–92. https://doi.org/10.1023/a:1009566103493

14.

Hillard

P. J. A.

(1985). Physical abuse in pregnancy. Obstetrics and Gynaecology , 66(2), 185–190.

15.

IIPS & ICF. (2017). National Family Health Survey (NFHS-4), 2015–2016 . International Institute for Population Sciences. https://dhsprogram.com/pubs/pdf/FR339/FR339.pdf

16.

Johnson

, & Sengupta

(2008). Do battered mothers have more foetal and infant deaths? Evidence from India (Report No. 08-634). University of Michigan. https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.689.1368&rep=rep1&type=pdf

17.

Kabeer

(1999). Resources, agency, achievements: Reflections on the measurement of women’s empowerment. Development and Change , 30(3), 435–464. https://doi.org/10.1111/1467-7660.00125

18.

Kaye

(2001). Domestic violence among women seeking post-abortion care. International Journal of Gynaecology and Obstetrics , 75(3), 323–325. https://doi.org/10.1016/s0020-7292(01)00484-2

19.

Kimuna

S. R.

, Djamba

Y. K.

, Ciciurkaite

, & Cherukuri

(2012). Domestic violence in India: Insights from the 2005–2006 National Family Health Survey. Journal of Interpersonal Violence , 20(10), 1–35. https://doi.org/10.1177/0886260512455867

20.

Klerman

L. V.

(2000). The intendedness of pregnancy: A concept in transition. Maternal and Child Health Journal , 4(3), 155–162. https://doi.org/10.1023/a:1009534612388

21.

Koenig

M. A.

, Acharya

, Singh

, & Roy

T. K.

(2006). Do current measurement approaches underestimate levels of unwanted childbearing? Evidence from rural India. Population Studies , 60(3), 243–256. https://doi.org/10.1080/00324720600895819

22.

Koenig

M. A.

, Stephenson

, Ahmed

, Jejeebhoy

S. J.

, & Campbell

(2006). Individual and contextual determinants of domestic violence in North India. American Journal of Public Health , 96(1), 132–138. https://doi.org/10.2105/AJPH.2004.050872

23.

Miller

, Decker

, McCauley

, Tancredi

, Levenson

, & Waldman

(2010). Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception , 81(4), 316–322. https://doi.org/10.1016/j.contraception.2009.12.004

24.

Moos

M. K.

, Petersen

, Meadows

, Melvin

C. L.

, & Spitz

A. M.

(1997). Pregnant women’s perspectives on intendedness of pregnancy. Women’s Health Issues , 7(6), 385–392. https://doi.org/10.1016/s1049-3867(97)00081-9

25.

Pallitto

, & O’Campo

(2004). The relationship between intimate partner violence and unintended pregnancy in Colombia: An analysis of a national sample. International Family Planning Perspectives , 30(4), 165–173. https://doi.org/10.1363/3016504

26.

Pallitto

C. C.

, & O’Campo

(2005). Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: Testing the feminist perspective. Social Science and Medicine , 60(10), 2205–2216. https://doi.org/10.1016/j.socscimed.2004.10.017

27.

Pallitto

C. C.

, García-Moreno

, Jansen

H. A. F. M.

, & Heise

(2013). Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi-Country Study on Women’s Health and Domestic Violence. International Journal of Gynaecology and Obstetrics , 120(1), 3–9. https://doi.org/10.1016/j.ijgo.2012.07.003

28.

Raj

, & McDougal

(2015). Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia. Contraception , 91(6), 456–463. https://doi.org/10.1016/j.contraception.2015.03.008

29.

Santelli

, Rochat

, Hatfield-Timajchy

, Gilbert

B. C.

, Curtis

, Cebral

, Hirsch

J. S.

, & Schieve

(2003). The measurement and meaning of unintended pregnancy. Perspective on Sexual and Reproductive Health , 35(2), 94–101. https://doi.org/https://doi.org/10.1363/3509403

30.

Sedgh

, Singh

, & Hussain

(2014). Intended and unintended pregnancies worldwide in 2012 and recent trends. Studies in Family Planning , 45(3), 301–314. https://doi.org/10.1111/j.1728-4465.2014.00393.x

31.

Shabnam

, & Mukherjee

(2013). Spousal violence and unintended pregnancy in India: Evidence from NFHS-3. Indian Journal of Research and Reports in Medical Sciences , 3(3), 1–8.

32.

Silverman

J. G.

, McCauley

H. L.

, Decker

M. R.

, Miller

, Reed

, & Raj

(2011). Coercive forms of sexual risk and associated violence perpetrated by male partners of female adolescents. Perspectives on Sexual and Reproductive Health , 43(1), 60–65. https://doi.org/10.1363/4306011

33.

Silverman

J. G.

, & Raj

(2014). Intimate partner violence and reproductive coercion: Global barriers to women’s reproductive control. PLoS Medicine , 11(9), e1001723. https://doi.org/10.1371/journal.pmed.1001723

34.

Singh

, Shekhar

, Acharya

, Moore

A. M.

, Stillman

, Pradhan

M. R.

, Frost

, Sahoo

, Alagarajan

, Hussain

, Sundaram

, Vlassoff

, Kalyanwala

, & Browne

(2018). The incidence of abortion and unintended pregnancy in India, 2015. Lancet Global Health , 6(1), e111–e120. https://doi.org/10.1016/S2214-109X(17)30453-9

35.

Stephenson

, Koenig

M. A.

, Acharya

, & Roy

T. K.

(2008). Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Studies in Family Planning , 39(3), 177–186. https://doi.org/10.1111/j.1728-4465.2008.165.x

36.

Watts

, & Zimmerman

(2002). Violence against women: Global scope and magnitude. The Lancet , 359, 1232–1237. https://doi.org/10.1016/S0140-6736(02)08221-1

37.

WHO. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner sexual violence . World Health Organisation. https://apps.who.int/iris/handle/10665/85239