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protection of women from domestic violence act , 2005 ,  which states that  any act , conduct , omission and commission that harms or injures or has a potential to harm or injure will be considered as domestic violence by the law.(2 ) data from national health family survey suggest that approximately 37% of the married women experience physical or sexual violence in their lifetime.(3 ) health issues related to ipv include injuries , chronic pain syndrome , substance abuse , depression , suicidal attempts , sexually transmitted infections , adverse pregnancy outcomes , and less frequent contraception adoption .
studies have highlighted the association of ipv with reproductive health problems such as unwanted pregnancies , lesser adoption of contraception , fetal loss , abortions , and higher incidence of infertility .
existing data reveal that these associations co - occur with reproductive control , i.e. , male partners ' attempts to control a woman 's reproductive choices .
women in abused relationships have limited decision - making regarding contraceptive use and family planning .
women 's lack of control over her reproductive health is increasingly recognized as a critical mechanism underlying abused women 's elevated risk for unintended pregnancy.(45 ) much of the evidence for ipv and contraception use has been from studies conducted in developed countries ; very few studies have examined this relationship in the indian scenario .
stephenson et al . found lower contraceptive adoption among indian women experiencing physical domestic violence from their husbands.(6 ) in this study , we tried to evaluate the prevalence of ipv , response to it by the women , and the impact of partner violence on contraceptive adoption .
partner violence and population control are two big social problems the indian society is facing .
existing data suggest that women in abusive relationships exhibit fear and less decisive powers ; hence , we hypothesized that contraception adoption would be lesser among women with ipv compared to those without ipv .
thus , the present study was designed with the following objectives : 
 to find out the prevalence of various types of domestic violence.to identify associated risk factors for ipv.to find out the relation between ipv and contraceptive adoption among women who are victim of ipv . 
  to find out the prevalence of various types of domestic violence . to identify associated risk factors for ipv . to find out the relation between ipv and contraceptive adoption among women who are victim of ipv .
this questionnaire - based , cross - sectional study was conducted in the department of obstetrics and gynecology at a tertiary care hospital in delhi .
four hundred and one postpartum females were randomly selected over a period of 5 months from march 2014 to july , 2014 .
the women were questioned about their age , parity , educational status , occupation , husband 's education , and monthly family income .
questions pertaining to ipv and contraceptive adoption are mentioned in the questionnaire as in table 1 .
questions pertaining to ipv and contraceptive adoption ( self - made ) data were analyzed using statistical package for the social sciences ( spss ) software 22.0.0 ( spss - inc . ,
chi - square and fisher exact tests were used to assess differences in patient characteristics between women who experienced ipv and those who did not .
four hundred and one women were interviewed . out of them , 195 ( 48.63% ) women were victim of at least one form of violence and the remaining 206 ( 51.37% ) women denied any kind of violence . among 195 cases of ipv ,
12.8% were in the age group of 15 - 20 years , 52.3% were in the age group of 21 - 25 years , 27.7% were in the age group of 26 - 30 years , and 7.2% were in the age group of 31 - 45 years . around
28.2% such women were illiterate , but women with higher educational status ( graduate and above-7.2% ) also victim of ipv .
most of the cases ( 65% ) of ipv happened between 2 - 10 years of marriage . among such women ,
statistically significant association of ipv was seen with women 's and her partner 's education status and the family income [ table 2 ] .
sexual violence was seen in 38.4% of the cases , physical violence in 22.4% of the cases , and verbal abuse was seen in nearly 32.7% of the cases .
physical violence mainly consisted of pushing ( 9.4% ) , slapping ( 19.45% ) , being punched ( 9.4% ) , kicked ( 4.98% ) , beat with weapon ( 2.49% ) , and inflict burns ( 0.99% ) [ table 3 ] . in response to any of the three violence perpetrated , only 23 cases ( 11.79% ) reacted . in 4.61% cases ,
approximately , 88.2% of the women never complained and silently tolerated the torture thinking it to be her destiny [ table 4 ] .
demographic characteristics with respect to partner violence type of violence faced by women response to any of the violence approximately , 45.14% of the women could not use condoms just because it was their husbands ' decision . among the remaining women ,
15.71% were not aware of the use of condoms and 8.73% felt shy to ask their husbands to use it . in nearly 25.68% of the cases ,
approximately , 81.5% women who are victim of ipv were aware of contraception as compared to 86.89% who are not victim of ipv , and around 49.2% women with ipv had used contraception as compared to 47.1% cases without ipv . around 25% of women with history of ipv agreed to use postpartum cu - t / progestin only pill in immediate postpartum period , whereas 35.9% of those without history of ipv accepted them ( p value = 0.023 ) .
it is also noted that 7.69% of the husbands got violent in cases with ipv as compared to only 0.48% cases without ipv . on the other hand
, 17.39% of the husbands got angry in cases with ipv as compared to 3.39% cases without ipv .
only 2.05% husbands accepted wife 's request of contraception in ipv cases in contrast to 14% husbands of women without ipv [ table 6 ] .
reasons for not using condoms among the subjects contraception characteristics of women with or without ipv
partner violence in any household is a common problem . in spite of many initiatives set up by the government of india to decrease its occurrence ,
it is a universal phenomenon in some or other form in every household . in this study , at least 48.63% of the cases were victim of at least one form of the violence .
forced sex was seen in 38.4% , physical abuse in 22.4% , and verbal abuse in 32.7% of the cases .
jeyaseelan et al.(7 ) found the prevalence of physical violence as 26% , whereas shrivastava et al.(8 ) found it as 63.4% . in the present study ,
this could be due to the fact that these women were mainly dependent on their husband for basic needs , thereby kept on tolerating the violence .
approximately , 93% of the abused women were housewives . a statistically significant odds ratio of 2.24 [ 95% confidence interval ( ci ) : ( 1.14 - 4 - 37 ) ] was noted between the literacy status of less than 10th standard education and being abused by mishra et al.(9 ) kimuna et al . also noted it to be one of the key determinants for domestic violence in india.(10 ) husband 's literacy also carried significant impact on ipv in our study .
moreover , families with lower monthly income had higher ipv incidence ( 85% cases of ipv occurred in families with income < 10,000 ) .
this study showed that only a small proportion of suffering women reacted to the violence ( 11.79% ) . majority of the women silently tolerated the violence .
reason behind this could be her concern for her children or lack of an alternative economic support .
majority of the women in this study were housewives and economically dependent only on their husbands .
moreover , she felt that her love and care for her husband would change him and as such she never reacts aggressively .
her concern for her parents also prevented her from taking any drastic step against her husband .
ipv is one of the factors associated with women not being able to use or access contraceptives(1112 ) ( silverman et al .
, 2007 ; williams et al . , 2008 ) . in our male - dominated society , there is no reproductive autonomy that means , a woman is never allowed to make independent choices regarding family planning .
decisions regarding getting pregnant or to avoid pregnancy are mostly taken either by husband or mother - in - law .
this reproductive control by a man can exist in several forms  economic or monetary control ( depriving a women by not giving her money to buy contraceptives ) , emotional ( accusing her of not trusting him , telling her that due to work stress he forgot to buy contraception ) , and physical ( getting angry and violent on her contraceptive requests ) .
all these behaviors expose her to the risk of recurrent pregnancy and at times , recurrent induced abortion .
previous authors have postulated that contraceptive use may be more difficult for women experiencing violence , leading to a higher incidence of unintended pregnancy.(13 ) ipv is associated with a reduced likelihood of modern method adoption in india.(6 ) however , these associations are not always true as many other studies have found that partner violence has increased likelihood of ever using contraceptives and even subsequent contraceptive use.(141516 ) the present study revealed that women exposed to ipv were more likely to use contraception ( 49.2% ) as compared to those who did not report any violence ( 47.1% ) .
the reason behind increased contraception among ipv suffering women could be comparatively increased desire to avoid unwanted pregnancies in these women .
many studies have found that women who suffer from domestic violence are more likely to seek induced abortions .
moreover , the government 's initiatives to make contraceptive services freely available to all could be another reason for its increased use , despite the violent behavior of the husband . though this study showed that higher percentage of women without ipv accepted immediate postpartum contraception methods as compared to those with ipv ( 35.9% vs. 25% ) , still women with ipv had higher overall frequency of using contraceptive methods .
the present study revealed that women exposed to ipv were more likely to use contraception ( 49.2% ) as compared to those who did not report any violence . however , higher percentage of women without ipv accepted immediate postpartum contraception methods as compared to those with ipv .
health - care providers need to be more sensitive to the issue of ipv while offering and prescribing contraceptive advice as the acceptance and persual may be affected .
objective : to determine the prevalence of various types of domestic violence and to find out the impact of intimate partner violence ( ipv ) on adoption of contraceptive measures among the women who are victim to this.materials and methods : this questionnaire - based , cross - sectional study was conducted in the department of obstetrics and gynecology of a tertiary care hospital in delhi . 
 four hundred and one postpartum females were randomly selected over a period of 5 months and were questioned about their age , parity , educational status , occupation , husband 's education , monthly family income , and , if present , ipv in detail . 
 these study participants were enquired about their contraceptive knowledge and use.results:sexual violence was seen in 38.4% of the cases , physical violence in 22.4% of the cases , and verbal abuse was seen in nearly 32.7% of the cases . in response to any of the three violence faced , only 23 women ( 11.79% ) reacted by discussing with parents and friends . in 4.61% of the cases , the violence was so severe that she had to inform police . 
 this study showed that higher percentage of women without ipv accepted immediate postpartum contraception methods as compared to those with ipv ( 35.9% vs. 25% , p = 0.023 ) , but the overall frequency of using contraceptive methods was higher in those with ipv as compared to those without ipv ( 49% vs. 47% , p = 0.690).conclusion : ipv is associated with increased contraceptive adoption .