Association between spousal emotional abuse and reproductive outcomes of women in India: findings from cross-sectional analysis of the 2005-2006 National Family Health Survey.
PURPOSE
Spousal violence against women is a global public health problem. In India, approximately 40% of women report spousal violence. Like physical and sexual violence, emotional violence may be a determinant of women's health. This study explores the association between exposure to spousal emotional abuse and poor reproductive outcomes in Indian women.


METHODS
Data on 60,350 women, collected in the Third Indian National Family Health Survey were analysed to assess the impact of spousal emotional abuse on seven reproductive outcomes: age at first birth, number of children, terminated pregnancies, unwanted pregnancies, access to prenatal and skilled delivery care, and breastfeeding. Spousal emotional abuse was assessed using two overlapping constructs: emotional violence and controlling behaviour. Multivariable logistic regression was used for analysis.


RESULTS
Spousal emotional violence and controlling behaviour was reported by 16 and 38% of the women, respectively. In unadjusted analyses, spousal emotional violence was associated with all adverse reproductive outcomes, except breastfeeding. Controlling for socio-demographic risk factors attenuated the association, and further adjustment for other forms of violence removed all significant associations. Spousal controlling behaviour was significantly associated with all outcomes, except breastfeeding. The effects remained statistically significant in multivariable regression.


CONCLUSIONS
Women's experience of violence may be under-reported. When other forms of violence were adjusted for, emotional violence was not associated with adverse reproductive outcomes, whereas controlling behaviour remained associated with all but one adverse reproductive outcome. Therefore, spousal controlling behaviour requires further investigation as a determinant of reproductive health.
['Tiwari|Sucheta|S|http://orcid.org/0000-0002-7137-5315', 'Gray|Ron|R|', 'Jenkinson|Crispin|C|', 'Carson|Claire|C|']
D000028:Abortion, Induced D000328:Adult D003430:Cross-Sectional Studies D005191:Family Characteristics D005192:Family Health D005260:Female D006306:Health Surveys D006801:Humans D007194:India D016015:Logistic Models D008875:Middle Aged D010298:Parity D011247:Pregnancy D011275:Pregnancy, Unwanted D043762:Reproductive Behavior D012307:Risk Factors D013179:Spouse Abuse D014754:Violence
Emotional abuse India Reproductive health Intimate partner violence Women’s health