Purpose

In sub-Saharan Africa, sexually active adolescent girls and young women (AGYW) experience high rates of intimate partner violence (IPV) and low levels of contraceptive use, but the effect of IPV on contraceptive use is not well understood.

Methods

In the Girl Power-Malawi study, AGYW aged 15-24 were recruited from 4 health centers in Lilongwe, Malawi, and followed for 1 year. At baseline, AGYW were assessed for IPV using the modified Conflict Tactics Scale. AGYW reported contraceptive method use at 6 and 12 months, characterized as barrier, non-barrier, or any modern method. Modified Poisson regression was implemented to estimate risk ratios (RRs) and 95% confidence intervals (CIs) to examine the effect of IPV on contraceptive use.

Results

One thousand AGYW were enrolled, and 954 non-pregnant participants were included. Baseline prevalence of IPV with the most recent partner was 35.5% (physical), 46.2% (sexual), and 76.9% (emotional). Baseline IPV did not affect contraceptive use at 6 months (aRR [95% CI]: physical 0.98 [0.91-1.05]; sexual 1.00 [0.94-1.07]; emotional 1.03 [0.94-1.12]) or 12 months (physical 0.95 [0.89-1.02]; sexual 0.96 [0.90-1.02]; emotional 0.98 [0.91-1.05]). None of the 3 IPV categories affected contraceptive use when the outcome was restricted to either barrier or non-barrier methods.

Conclusions

In this cohort, IPV was not a key driver of contraceptive use in longitudinal analyses. Interventions are needed to address the alarming rates of IPV in this population, but addressing IPV alone might be insufficient to address low contraceptive use, and multifaceted youth-friendly health services might be necessary.

中文翻译：

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青春期女孩和年轻女性的亲密伴侣暴力和避孕：对马拉维女权队列的纵向分析

目的

在撒哈拉以南非洲，性活跃的青春期少女和年轻女性 (AGYW) 遭受亲密伴侣暴力 (IPV) 的比率很高，而避孕药具的使用率较低，但 IPV 对避孕药具使用的影响尚不清楚。

方法

在 Girl Power-Malawi 研究中，从马拉维利隆圭的 4 个健康中心招募了 15-24 岁的 AGYW，并进行了为期 1 年的随访。在基线时，使用修改后的冲突战术量表评估 AGYW 的 IPV。AGYW 报告了在 6 个月和 12 个月时使用的避孕方法，其特征为屏障、非屏障或任何现代方法。实施修正泊松回归来估计风险比 (RR) 和 95% 置信区间 (CI)，以检查 IPV 对避孕药具使用的影响。

结果

招募了 1000 名 AGYW，其中包括 954 名未怀孕的参与者。最近伴侣的 IPV 基线流行率为 35.5%（身体）、46.2%（性）和 76.9%（情感）。基线 IPV 不影响 6 个月时的避孕药具使用（aRR [95% CI]：身体 0.98 [0.91-1.05]；性 1.00 [0.94-1.07]；情绪 1.03 [0.94-1.12]）或 12 个月（身体 0.95 [0.89] -1.02]；性 0.96 [0.90-1.02]；情感 0.98 [0.91-1.05]）。当结果仅限于屏障或非屏障方法时，3 个 IPV 类别均不影响避孕药具的使用。

结论

在这个队列中，IPV 不是纵向分析中避孕药具使用的关键驱动因素。需要采取干预措施来解决这一人群中令人震惊的 IPV 感染率，但仅解决 IPV 问题可能不足以解决避孕药具使用率低的问题，可能需要多方面的青年友好型健康服务。