Psychological abuse: Hidden barrier to contraceptive use

Freedom from abuse and freedom to choose and use a contraceptive method are both social justice issues. While research has indicated that domestic violence (DV) affects women's ability to use contraception, little is known whether differences in contraceptive use exist between women experiencing physical versus psychological abuse. We use combined 3-years (2006-2008) California Women's Health Survey to explore the correlates of DV with contraceptive use as intervening variable. Six questions about physical violence (pushing, hitting, beating, throwing objects, forced sex, and threats with gun or knife) were categorized under physical abuse while three questions (fear, control and stalking) were classified as psychological abuse. Overall, 10% of women aged 18-49 reported DV experience in the last 12 months. More women experienced psychological than physical abuse (4% vs. 2%) and another 4% experienced both. The proportion of women experiencing DV in the past year was significantly higher among contraceptive non-users than users (13% vs. 8%; p<0.0001). The logistic regression models that controlled for women's socioeconomic and demographic characteristics indicated that women who experienced psychological abuse (OR=0.6; 95% CI=0.4-0.9) or both (OR=0.6; 95% CI=0.3-0.9) were significantly less likely to use contraception, but not for women reporting physical abuse (OR=0.9; 95% CI=0.4-2.0), as compared to women with no DV experience. These results suggest that differing experiences with DV may influence contraceptive use. Health care providers are in a critical position to screen women experiencing DV, especially psychological abuse, and facilitate provision of contraception tailored to the victims' needs.