The associations among partner violence, problems with birth control, and abortion number and timing
Awarded 2011
Large Research Grants
Gillian Dean, MD, MPH
Planned Parenthood of New York City

Background: More than two decades of research has shown associations among partner violence, reproductive control, and detrimental sexual and reproductive health outcomes including lower use of condoms and other contraceptives, higher rates of sexually transmitted infections, HIV, urinary tract infections, unintended and teen pregnancies, and poor birth outcomes as well as miscarriage due to physical assault. However, little is known about whether partner violence is related to abortion characteristics such as method, timing, number, and follow-up. Objective: To compare women who reported partner violence to those who did not for odds of birth control problems, single and repeat miscarriages and abortions, gestational age at abortion, medication vs. surgical method choice, and return for follow-up visit after abortion. Methods: A retrospective cohort study of randomly selected samples of medical charts of women reporting a history of partner violence (n=6,564) and no history of partner violence (n=6,564) at the time of a family planning or abortion appointment at one of three health care centers in New York City between 2010-2011. Measures were self-reports answers to questions on the medical history form, except gestational age, medical vs. surgical abortion, and return for follow-up visit which were recorded by health staff. Lifetime history of partner violence was analyzed for its association with lifetime history of abortion and miscarriage number, and birth control problems. To more closely match timing, an analysis of a subsample of women reporting current violence (n=2,186) vs. not at the time of an abortion appointment were analyzed for differences in gestational age, medical vs. surgical method choice, and return for follow-up visit. Logistic regression models adjust for age, years sexually active, parity, race, and payment method. Results: After adjusting for years at risk and demographic characteristics, multivariate logistic regressions showed that compared to women with no partner violence, women with a past history of partner violence were not more likely to have ever had one abortion, but they were more likely to have had problems with birth control (OR=1.61, Cl=1.47-1.76, p<.001), repeat abortions (OR=1.39, Cl=1.28-1.55, p<.000), and one (OR=1.65, Cl=1.46-1.85, p<.000) and more than one (OR=1.65, Cl=1.46-1.85, p<.000) miscarriage (OR=2.27, Cl=1.81-2.83, p<.000). Women with current partner violence, were more likely to be receiving an abortion at 19 to 24 weeks gestational age (OR=1.63, Cl=1.15-2.30, p<.01). No differences were found for return for abortion follow-up visit or choice of surgical vs. medication termination method. Conclusion: This study adds to growing literature about the relationship between reproductive control by a partner and reproductive outcomes. Findings support violence screening and counseling to safety plan for partner influences on reproductive health.