Violence, Autonomy and Reproductive Decision-Making

Reproductive-health decisions are frequently presented as individual choices: whether to use contraception, seek antenatal care, deliver in a facility or return for follow-up. But those choices do not always occur under conditions of complete freedom. Relationships, economic dependence, household decision-making, fear of violence, social expectations and control over mobility can change both the options available and the consequences of choosing them.

A multi-country DHS analysis across 45 low- and middle-income countries examined physical intimate-partner violence during pregnancy in relation to maternal and early postnatal behaviours. It showed both the scale of violence and the value of distinguishing when violence occurs rather than treating IPV as one lifetime exposure. Other population analyses of contraception and violence produce associations that can look counterintuitive: higher contraceptive use among women experiencing IPV should never be interpreted automatically as evidence that violence promotes autonomy. Contraception may reflect deliberate fertility control, covert use, efforts to avoid pregnancy in an unsafe relationship, differential service contact or confounding by social and relationship factors.

Qualitative evidence helps expose those mechanisms by showing how autonomy, finances, transport, confidentiality, infrastructure and partner dynamics interact. The central methodological lesson is that service utilization and reproductive autonomy are not the same outcome.