Domestic Violence and Symptoms of Gynecologic Morbidity among Women in North India

Article excerpt

CONTEXT: Although there is increasing recognition of the global scope of domestic violence and the potential reproductive health consequences of violence, little is known about the relationship between physical and sexual domestic violence and gynecologic morbidity in developing country settings.

METHODS: A sample of 3,642 couples from northern India was created by matching husbands and wives who responded to the men's and women's surveys of the 1995-1996 PERFORM System of Indicators Survey. The association between men's reports of physical and sexual violence they had perpetrated against their wives and wives' reports of gynecologic symptoms was analyzed in bivariate and multivariate analyses.

RESULTS: Overall, 37% of men said they had committed one or more acts of physical or sexual violence against their wives in the past 12 months, with 12% reporting physical violence only, 17% sexual violence only and 9% both physical and sexual violence. Thirty-four percent of women reported at least one symptom of gynecologic morbidity. Compared with women whose husbands reported no violence, those who had experienced both physical and sexual violence and those who had experienced sexual violence only had elevated odds of reporting gynecologic symptoms (odds ratios, 1.7 and 1.4, respectively).

CONCLUSIONS: Plausible mechanisms through which domestic violence may influence gynecologic morbidity include physical trauma, psychological stress or transmission of STIs. Reproductive health care that incorporates domestic violence support services is needed to meet the special needs of abused women.

International Family Planning Perspectives, 2006,32(4):201-208

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Over the past decade, there has been a growing recognition of the scope of domestic violence globally and the implications of such violence for the health and well-being of women, children and families. (1) The World Health Organization's (WHO) definition of domestic violence extends beyond physical acts of violence toward one's partner to include sexual coercion, physical threats, psychological abuse and controlling actions such as physical isolation or restricting access to health care or financial resources. (2) Evidence from developing countries suggests that anywhere from 10% to 60% of married women of reproductive age report having ever experienced some form of domestic violence, (3) with some of the highest recorded levels coming from South Asia. (4) Domestic violence affects a range of health outcomes, both for the women who experience it and for their children. (5) For women, the consequences associated with domestic violence include physical injury, chronic pain and gastrointestinal symptoms, (6) and adverse mental health outcomes. (7) Negative reproductive health outcomes linked to violence include nonuse of contraception or condoms and unintended pregnancy. (8) For children, evidence shows an association between domestic violence and low birth weight and prematurity, (9) and elevated risks of perinatal and early childhood mortality. (10)

Domestic violence may also be associated with gynecologic morbidity. Empirical evidence on this issue, however, comes largely from clinic-based studies done in developed country settings; there is a dearth of evidence from population-based studies in developing countries. In this article, we use population-based data to examine the relationship between physical and sexual domestic violence and women's reports of gynecologic morbidity in Uttar Pradesh, a populous state in northern India.

BACKGROUND

Domestic Violence and Gynecologic Morbidity

There is substantial evidence from developed countries of a relationship between domestic violence and gynecologic morbidity. (11) Gynecologic problems are the most consistent physical health difference between women who have experienced domestic violence and those who have not, with the odds of experiencing a symptom of gynecologic morbidity generally three times as high among women who have experienced violence. …