Patriarchal traditions and a history of armed conflict in Timor-Leste provide a context that facilitates violence against women. More than a third of ever-married Timorese women report physical and/or sexual domestic violence (DV) perpetrated by their most recent partner. DV violates women’s rights and may threaten their reproductive health. Marital control may also limit women’s reproductive control and healthcare access. Our study investigated relationships between DV and marital control and subsequent family planning, maternal healthcare, and birth outcomes in Timor-Leste. Using logistic regression, we examined 2009–2010 Demographic and Health Survey data from a nationally representative sample of 2,951 women in Timor-Leste. We controlled for age, education, and wealth. We limited our analyses of pregnancy- and birth-related outcomes to those from the 6 months preceding the survey. Rural women with controlling husbands were less likely than other rural women to have an unmet need for family planning (Adj. OR 0.6; 95 % CI 0.4–0.9). Rural women who experienced DV were more likely than other rural women to have an unplanned pregnancy (Adj. OR 2.6; 95 % CI 1.4–4.8), fewer than four antenatal visits (Adj. OR 2.3; 95 % CI 1.1–4.9), or a baby born smaller than average (Adj. OR 3.1; 95 % CI 1.4–6.7). DV and marital control were not associated with the tested outcomes among urban women. Given high rates of DV internationally, our findings have important implications. Preventing DV may benefit both women and future generations. Furthermore, rural women who experience DV may benefit from targeted interventions that mediate associated risks of negative family planning, maternal healthcare, and birth outcomes.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
“Ever-married women” refers to women who have ever been married or lived with a man as if married. “Partner” refers to a man a respondent has married and to any man a respondent has lived with as if married.
Injuries include cuts, bruises, aches, eye injuries, sprains, dislocations, burns, deep wounds, broken bones, broken teeth, or any other serious injury.
Of the six controlling behaviors asked about in the Timor-Leste Demographic and Health Survey 2009-2010.
This is not a possibility for the outcome of unmet need for family planning, which was measured at the time of the survey.
“Skilled ANC provider” includes doctor, nurse, midwife, or assistant nurse.
“Skilled birth attendant” includes doctor, nurse, midwife, or assistant nurse.
Because birthweight was reported for only 26 % of births in the five years preceding the survey, we instead use mother’s estimate of the baby’s size at birth in our analysis. This estimate is considered a good proxy for birthweight when recorded birthweight is not available [14, p. 131].
To illustrate with an example, we tested whether DV could be a confounder in the relationship between marital control and unmet need for family planning by running Chi-square tests to determine if DV was significantly associated with marital control and with unmet need for family planning within the relevant sample.
Due to small sample size, the model that tested receiving no care from a skilled ANC provider did not control for wealth.
Garcia-Morena, C., Pallitto, C. C., Devries, K., Stockl, H., Watts, C., & Abrahams, N. (2013). Global and regional estimates of violence against women: Prevalence and health effects of intimate partner violence and non-partner violence. Geneva: World Health Organization.
Narciso, V., & Henriques, P. (2010). Women and land in Timor-Leste: Issues in gender and development. Indian Journal of Gender Studies, 17(1), 49–72.
Oxfam. (2012). Summary report on gender based violence study in Covalima and Oecusse. Oxfam.
Robertson, K. (2005). Gender-based violence in Timor-Leste: A case study. Bucharest: UNFPA Women, Peace and Security Technical Support Division.
Alves, M. D. F., Sequeira, I. M. M., Abrantes L. S., & Reis, F. (2009). Baseline study on sexual and gender-based violence in Bobonaro and Covalima. Dili, Timor-Leste: Asia Pacific Support Collective Timor-Leste. Supported by UNIFEM and funded by DFID-UK.
de Sousa, R. (2005). Women of Timor-Leste: Seeking freedom in a free nation. Development Bulletin, 68, 34–35.
Harris-Rimmer, S. (2009). After the guns fall silent: Sexual and gender-based violence in Timor-Leste. Issue brief. Timor-Leste Armed Violence Assessment (TLAVA). Issue Brief No.: 5.
(2003). Underlying causes of gender inequity in Covalima, Timor-Leste. Final report. Oxfam Australia. Funded by NZAID, Government of New Zealand.
Niner, S. (2011). Hakat Klot, Narrow steps. International Feminist Journal of Politics, 13(3), 413–435.
Silove, D., Liddell, B., Rees, S., Chey, T., Nickerson, A., Tam, N., et al. (2014). Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: A 6-year longitudinal study. The Lancet Global Health, 2(5), e293–e300.
Silove, D., Brooks, R., BatemanSteel, C. R., Steel, Z., Hewage, K., Rodger, J., & Soosay, I. (2009). Explosive anger as a response to human rights violations in post-conflict Timor-Leste. Social Science & Medicine, 69(5), 670–677.
Commission for Reception, Truth, and Reconciliation Timor-Leste (CAVR). (2005). Chega! The report of the Commission for Reception, Truth, and Reconciliation Timor-Leste—Executive Summary. Timor-Leste: Commission for Reception, Truth, and Reconciliation Timor-Leste (CAVR). http://www.etan.org/news/2006/cavr.htm
Hall, N. (2009). East Timorese women challenge domestic violence. Australian Journal of Political Science, 44(2), 309–325.
National Statistics Directorate (NSD) [Timor-Leste], Ministry of Finance [Timor-Leste], ICF Macro (2010). Timor-Leste Demographic and Health Survey 2009–2010. Dili, Timor-Leste: NSD [Timor-Leste] and ICF Macro. http://dhsprogram.com/pubs/pdf/FR235/FR235.pdf
Sarkar, N. N. (2008). The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. Journal of Obstetrics and Gynaecology, 28(3), 266–271.
Mezey, G. C., & Bewley, S. (1997). Domestic violence and pregnancy. An International Journal of Obstetrics & Gynaecology, 104, 528–531.
Pallitto, C. C., Garcia-Moreno, C., Jansen, H. A. F. M., Heise, L., Ellsberg, M., & Watts, C; On behalf of the WHO Multi-Country Study on Women’s Health and Domestic Violence. (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.
Cook, J., & Bewley, S. (2008). Acknowledging a persistent truth: Domestic violence in pregnancy. Journal of the Royal Society of Medicine, 101, 358–363.
Alio, A. P., Nana, P. N., & Salihu, H. M. (2009). Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: Cross-sectional study. Lancet, 373(9660), 318–324.
Bailey, B. A. (2010). Partner violence during pregnancy: Prevalence, effects, screening, and management. International Journal of Women’s Health, 2, 183–197.
Stephenson, R., Koenig, M. A., Acharya, R., & Roy, T. K. (2008). Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Studies in Family Planning, 39(3), 177–186.
Williams, C. M., Larsen, U., & McCloskey, L. A. (2008). Intimate partner violence and women’s contraceptive use. Violence Against Women, 14(12), 1382–1396.
Taft, A., & Watson, L. (2013). Violence against women in Timor-Leste: Secondary analysis of the 2009–2010 Demographic Health Survey. Final report. Mother and Child Health Research, La Trobe University. Funded by AusAID through the Timor-Leste Justice Sector Support Facility.
Deen, J., Matos, L. D. C., Temple, B., Su, J. Y., da Silva, J., Liberato, S., et al. (2013). Identifying national health research priorities in Timor-Leste through a scoping review of existing health data. Health Research Policy and Systems, 11(8). doi:10.1186/1478-4505-11-8.
World Health Organization, Department of Making Pregnancy Safer and Department of Reproductive Health and Research (2007). Provision of effective antenatal care. In Standards for Maternal and Neonatal Care. World Health Organization. http://www.who.int/reproductivehealth/publications/maternal_perinatal_health/a91272/en/
Devries, K. M., Kishor, S., Johnson, H., Stockl, H., Bacchus, L. J., Garcia-Moreno, C., & Watts, C. (2010). Intimate partner violence during pregnancy: Analysis of prevalence data from 19 countries. Reproductive Health Matters, 18(36), 158–170.
World Health Organization/London School of Hygiene and Tropical Medicine. (2010). Preventing intimate partner and sexual violence against women: Taking action and generating evidence. Geneva: World Health Organization.
Many, many thanks to Judy Meiksin and Ben Pelhan for their support and feedback throughout this project.
About this article
Cite this article
Meiksin, R., Meekers, D., Thompson, S. et al. Domestic Violence, Marital Control, and Family Planning, Maternal, and Birth Outcomes in Timor-Leste. Matern Child Health J 19, 1338–1347 (2015). https://doi.org/10.1007/s10995-014-1638-1
- Domestic violence
- Marital control
- Birth outcomes
- Family planning
- Maternal care