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Domestic Violence, Marital Control, and Family Planning, Maternal, and Birth Outcomes in Timor-Leste

Abstract

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.

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Notes

  1. 1.

    “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.

  2. 2.

    Injuries include cuts, bruises, aches, eye injuries, sprains, dislocations, burns, deep wounds, broken bones, broken teeth, or any other serious injury.

  3. 3.

    Of the six controlling behaviors asked about in the Timor-Leste Demographic and Health Survey 2009-2010.

  4. 4.

    This is not a possibility for the outcome of unmet need for family planning, which was measured at the time of the survey.

  5. 5.

    “Skilled ANC provider” includes doctor, nurse, midwife, or assistant nurse.

  6. 6.

    “Skilled birth attendant” includes doctor, nurse, midwife, or assistant nurse.

  7. 7.

    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].

  8. 8.

    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.

  9. 9.

    Due to small sample size, the model that tested receiving no care from a skilled ANC provider did not control for wealth.

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Acknowledgments

Many, many thanks to Judy Meiksin and Ben Pelhan for their support and feedback throughout this project.

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Correspondence to Rebecca Meiksin.

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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

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Keywords

  • Domestic violence
  • Marital control
  • Birth outcomes
  • Family planning
  • Maternal care