DEMOGRAPHIC

AND

HEALTH

RESEARCH

DHS WORKING PAPERS

2010 No. 79

Leyla Ismayilova

December 2010

This document was produced for review by the United States Agency for 

International Development.

Intimate Partner Violence

and Unintended Pregnancy 

in Azerbaijan, Moldova, and Ukraine
The DHS Working Papers series is a prepublication series of papers reporting on research in progress that 

is based on Demographic and Health Surveys (DHS) data. This research is carried out with support 

provided by the United States Agency for International Development (USAID) through the MEASURE 

DHS project (#GPO-C-00-08-00008-00). The views expressed are those of the authors and do not 

necessarily reflect the views of USAID or the United States Government. 

MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. Additional information about the MEASURE DHS project can 

be obtained by contacting MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, 

MD 20705 (telephone: 301-572-0200; fax: 301-572-0999; e-mail: reports@measuredhs.com; internet: 

www.measuredhs.com).
Intimate Partner Violence and Unintended Pregnancy 

in Azerbaijan, Moldova, and Ukraine 

Leyla Ismayilova 

ICF Macro 

Calverton, Maryland, USA

December 2010 

Corresponding author: Leyla Ismayilova. Columbia University, School of Social Work, 1255 Amsterdam Avenue 

Room 809, New York, NY 10027 USA; E-mail: li61@columbia.edu. 
ACKNOWLEDGMENTS 

The author is thankful to the staff at ICF Macro and particularly to Dr. Sunita Kishor and 

Sarah Bradley. Their suggestions and insightful feedback were instrumental in the writing of this 

paper. The study was supported by the United States Agency for International Development 

(USAID) through the DHS fellowship project at ICF Macro. Special thanks to the women who 

participated in the DHS surveys. 

Suggested citation: 

Ismayilova, Leyla. 2010. Intimate Partner Violence and Unintended Pregnancy in Azerbaijan, 

Moldova, and Ukraine. DHS Working Papers No. 79, Calverton, Maryland, USA: ICF Macro. 
ABSTRACT 

Objectives: The study examines the relationship between intimate partner violence and 

unintended pregnancy in three countries of the former Soviet Union, where abortions were safe, 

easily available to women, and often used as a form of birth control. 

Methods: The study uses data from the nationally representative Demographic and Health 

Surveys conducted in Moldova (2005), Azerbaijan (2006), and Ukraine (2007). The original 

sample size is restricted to ever-married (or cohabitating) women of reproductive age (N=1,620 

in Azerbaijan, N=1,377 in Moldova, and N=545 in Ukraine) who completed the survey‟s 

Domestic Violence Module and who had a pregnancy in the past five years. Using multinomial 

logistic regression, the study compares outcomes of last pregnancy (wanted birth, unintended 

birth, and abortion) by exposure to lifetime intimate partner violence committed by the most 

recent partner. 

Results: Women who ever experienced physical or sexual violence from their partners showed

consistently higher risks of unintended pregnancy across the three countries. After adjusting for 

socio-demographic characteristics, lifetime contraceptive use, and previous use of abortions, the 

study found that women with a history of intimate partner violence demonstrated higher risks of 

their last pregnancy ending in abortion (aRRR=2.1, 95% CI=1.4, 3.2 in Azerbaijan and 

aRRR=1.6, 95% CI=1.1, 2.3 in Moldova) or in unwanted live birth (aRRR=4.8, 95% CI=1.8, 

12.7 in Ukraine). 

Conclusions: Women exposed to physical or sexual violence from their partners demonstrated 

significantly higher risks of unintended pregnancy compared with women never exposed to 

intimate partner violence. The study emphasizes the need for developing programs that integrate 

reproductive health and intimate partner violence components to reduce the risk of unintended 

births and abortions among women living with abusive partners in countries of the former Soviet 

Union. 

1

INTRODUCTION 

Intimate partner violence (IPV)—defined as a “behavior within an intimate relationship 

that causes physical, sexual or psychological harm”1p.89—is a global social issue that infringes 

on women‟s rights, endangers their safety, and affects their overall wellbeing. In countries with 

relatively low levels of awareness about IPV, the consequences of violence are perceived to be 

limited to the woman‟s death or severe bodily harm2. Nonetheless, in addition to injuries as a 

direct result of violence, IPV can have long-lasting adverse effects on a woman‟s reproductive 

health3-5.

Empirical studies have demonstrated that IPV is negatively associated with unintended 

births6-8and abortions9. The majority of evidence presented in existing research, however, comes 

from studies conducted in western industrialized countries or developing countries of Africa, 

Latin America, and Asia8, 10-13. The relationships between IPV and unintended births and 

abortions remain unknown in the transitional countries of the former Soviet Union (FSU). The 

FSU region is historically known for liberal abortion laws and easy access to safe abortions. The 

research findings from other parts of the world may not be applicable to the countries where 

abortions are easily available and acceptable and women have a choice of terminating

unintended pregnancies through abortions. 

This paper aims to answer the following research question: Are women who have 

experienced IPV more likely to have an unintended pregnancy compared with women who have 

not experienced violence from their partners, in Azerbaijan, Moldova, and Ukraine? The results 

of the paper may provide an empirical foundation for violence prevention and reproductive 

health programs in some countries of the FSU region.
2

LITERATURE REVIEW 

Regional Context 

Politically, geographically, and socially, the FSU region represents a common area that 

deserves special consideration. As a part of the Soviet Union for 70 years, Azerbaijan, Moldova, 

and Ukraine shared similar systems of social and health care services14. After the collapse of 

Soviet Union in 1991, the countries gained independence and have been in the transition stage 

from socialist political systems to independent democratic states with market economies. The 

transition from a socialist to market economy, however, brought on the economic crisis of the 

1990s, resulting in growth in poverty and deterioration of services15. Nevertheless, over the last 

decade all three countries have experienced economic growth (to varying degrees), and

improving women‟s reproductive health has become a national priority16. Since the collapse of 

the Soviet Union, reproductive health programs in Azerbaijan, Ukraine, and Moldova have 

focused primarily on increasing the knowledge, availability, and use of modern contraception

and on improving the quality of family planning services17. 

The FSU region is not a homogenous entity. Due to differences in ethnicity and religion, 

family relationships, health behaviors and cultural norms vary across these three countries18. 

Ukraine and Moldova, with predominantly Christian populations, share relatively more 

egalitarian gender beliefs, while Azerbaijan, a secular Muslim nation, is characterized by more 

traditional values and conservative norms in respect to women19-22. Azerbaijan differs from 

countries with traditional Muslim cultures due to a long history of socialistic ideology and 

suppression of religion. Furthermore, while Azerbaijan and Ukraine exhibit significant economic 

growth, Moldova remains the poorest country in Eastern Europe. Therefore, an examination of 

cross-country similarities and differences in the relationships between IPV and unintended 

pregnancy in Azerbaijan, Moldova, and Ukraine may contribute to the understanding of IPV and 

reproductive health issues in a unique socio-cultural context. 
3

Theory 

The paper is guided by feminist theory and analyzes reproductive health problems 

through a gender perspective23-25. IPV and power differentials between men and women pose 

direct and indirect risks to women‟s health by creating significant disparities in access to and use

of health information, services, and technologies. In addition to the direct influence of IPV (e.g., 

unintended pregnancy as a result of forced unprotected sex), partner violence can indirectly 

affect women‟s health by diminishing their functioning and competencies. Living in a situation 

of chronic violence, intimidation, or fear can impair a woman‟s self-esteem, decision-making 

abilities, and motivation to care for herself3. 

More specifically, an abusive and controlling family environment precludes a woman 

from negotiating and taking control over her life and can limit her autonomy in making decisions

regarding her health, sexuality, and fertility26, 27. This can include decisions related to 

contraceptive use and fertility choices, often leading to unprotected sex and resulting in 

unplanned pregnancies and abortions28. Furthermore, living in an abusive environment can affect 

a woman‟s freedom of movement, which in turn can limit her access to health information and 

services, including family planning clinics. Lack of power in negotiating contraception and fear 

of a violent response are among the factors impeding behavioral change that health programs are 

trying to achieve29. Empirical studies have shown that women who live in abusive relationships 

are less likely to use modern contraceptive methods consistently30, 31, which in turn increases the 

likelihood of unintended pregnancies28. 

IPV and Unintended Pregnancy 

Studies in other countries have shown that after controlling for confounding factors 

women with a history of IPV report higher numbers of pregnancies that are either unwanted 

(„wanted no more children‟) or mistimed („wanted children later‟)28, 32. Having limited control 

over their bodies and decisions related to sexual activities, such as the time of sex and use of 

contraceptive protection, women are more likely to engage in unwanted and/or unprotected sex, 

which can lead to unintended pregnancies3, 28. Lifetime physical and/or sexual IPV was found to 

be associated with higher odds of unintended pregnancy in studies using DHS data from 
4

Colombia (aOR=1.4)8, India (aOR=1.3)

12, and Bangladesh (aOR=1.5)9

. The risks of unintended 

pregnancy were particularly higher when sexual abuse was combined with physical violence8, 32. 

A case-control study in Uganda identified a similarly strong relationship between IPV and 

unwanted pregnancy among women seeking post-abortion services, after adjusting for 

contraceptive use, pregnancy intentions, and other confounders33. 

Further, a study in rural India demonstrated that the relationship between IPV and 

unintended pregnancy is even stronger when prospective measures of unintended pregnancy are 

used12. The DHS uses a retrospective approach to measuring unintended pregnancy (women 

report the wantedness of a child after giving birth or becoming pregnant). Additionally, in the 

DHS, questions about unintended pregnancy are available only for pregnancies resulting in live 

births in the past five years and for current pregnancies. The question about unintended 

pregnancy may not solicit accurate information in countries where the culture of family planning 

is almost absent and women do not refer to unplanned pregnancies as unwanted or undesired, 

especially after the child is born. Hence, retrospective measures may underestimate the reports of 

unintended pregnancy.

According to the DHS, the percentage of unintended live births in the five years 

preceding the survey was 17% in Azerbaijan, 21% in Moldova, and 14% in Ukraine34-36.

However, the same surveys found that only about half of pregnancies end in a live birth in 

Azerbaijan (46%) and Moldova (55%), and about two-thirds in Ukraine (68%)34-36. An estimated 

49% of pregnancies in Azerbaijan, 34% in Moldova, and 25% in Ukraine are terminated through 

abortion. Thus, for these FSU countries, the fact that the unintended live birth measure in the 

DHS does not capture pregnancies that were terminated through abortions provides an 

incomplete measure of unintended pregnancies.

Abortions 

Women may use abortions in situations when a fetus endangers the woman‟s health. 

However, women may also deliberately terminate a pregnancy if it was unintended37. The FSU

countries have some of the world‟s most liberal abortion laws, and for decades abortion was safe 
5

and free and became a form of birth control18. A 2003 study found that about 57% of pregnancies 

in Azerbaijan were unintended and 87% of unintended pregnancies resulted in abortion38. 

In the late 1990s a woman in the FSU region would have, on average, at least one 

abortion during her lifetime—1.3 abortions per woman in Moldova, 1.6 in Ukraine and 3.2 

abortions per woman in Azerbaijan, one of the highest abortion rates in the world18, 39. During 

the Soviet period there were few legal restrictions to constrain a woman from having an abortion; 

abortions were provided free of charge at women‟s health clinics, while oral contraceptive 

methods without significant side effects were not easily available40. After the collapse of the 

Soviet Union, the practice of treating abortion as a main method of birth control began to change, 

starting with the introduction of family planning programs. 

The most significant reduction in abortion has been observed in Ukraine, where the 

abortion rate dropped to 0.4 abortions per woman in 200736. In Moldova, however, the abortion 

rate was dropping at first but after 2001 stagnated at the rate of 1.1 abortions per woman34. The 

abortion rate in Azerbaijan fell but remains high, at 2.3 abortions per woman35. Furthermore, a 

recent gap between the number of boys and girls in Azerbaijan demonstrates a preference for 

sons41 and suggests a tendency toward sex-selective abortions42.

A number of previous studies have used DHS data to examine associations between 

pregnancy loss and lifetime IPV7, 9, 11. Significant associations have been identified between 

lifetime exposure to IPV (physical and/or sexual) and a history of pregnancy loss in Bangladesh 

(aOR=1.5), Bolivia (aOR=1.6), Dominican Republic (aOR=1.8), Malawi (aOR=1.6), and 

Zimbabwe (aOR=1.7), as well as Moldova (aOR=1.7). These studies, however, used a binary 

measure of pregnancy loss that combined a history of stillbirth, miscarriage, or abortion. Another 

study in Bangladesh examined different types of pregnancy loss as separate outcomes and

confirmed significant relationships for abortions and miscarriages but not for stillbirths

9

. 

In this study, to examine the relationship between IPV and unintended pregnancy, a new 

measure of unintended pregnancy more suited to the FSU countries was created that included 

both unintended pregnancies that resulted in live births and pregnancies that were terminated 

through induced abortion. 
6

Hypothesis 

The paper examines the relationships between IPV and unintended pregnancy using 

population-based samples from three FSU countries—Azerbaijan, Moldova, and Ukraine. More 

specifically, the paper examines the associations between a history of physical or sexual partner 

violence from the most recent intimate partner and unintended pregnancy within the last five 

years, while controlling for socio-demographic characteristics (woman‟s age, urban/rural 

residence, years of education, wealth status) and important covariates (the number of living 

children, previous use of abortion, and lifetime use of contraceptives). 

Our hypothesis is that women who have ever experienced physical or sexual IPV will 

demonstrate higher likelihood of unintended last pregnancy compared with women who have 

never experienced physical or sexual IPV, after controlling for key covariates. 
7

METHODS 

Data Source 

This study is an analysis of secondary data collected through the Demographic and 

Health Surveys (DHS) in Azerbaijan (2006), Moldova (2005), and Ukraine (2007). The DHS, 

conducted in more than 80 developing countries, recently has included the FSU countries, and 

for the first time provided nationally representative data on socio-demographic, household, 

women‟s status, and health variables. The DHS employs a unified methodology that allows for 

cross-country comparisons. The standard DHS questionnaire was fielded in eight FSU countries.

a

However, only three—Azerbaijan, Moldova, Ukraine—included the optional Domestic Violence 

Module. Therefore, our analysis is limited to these three countries.

Sampling Scheme 

Demographic and Health Surveys are nationally representative household surveys that 

use a stratified multistage sampling strategy. Using the most recent national census, clusters (or 

PSUs, primary sampling units) are selected using a probability-proportionate-to-size sampling 

procedure within each strata, meaning that more populated clusters had a higher probability of 

being selected. Households are then randomly selected within each selected cluster. The 

Domestic Violence module is administered to one randomly-selected woman of reproductive age 

(15-49 years old) within each selected household.b

In the Moldova DHS, the clusters were drawn separately for urban and rural areas 

(strata). In Azerbaijan and Ukraine, the stratification was achieved by separating economic 

regions into rural and urban areas. Due to administrative difficulties and a blockade, no 

respondents were included from the following areas: Transnistria (a disputed region of 

Moldova), Nakhichevan (an autonomous republic in Azerbaijan), Kalbajar-Lachin region and the 

 

a

 The standard DHS questionnaire without the Domestic Violence Module was conducted in Armenia, Kazakhstan, 

Kyrgyz Republic, Turkmenistan and Uzbekistan. 

b

 In Ukraine, women were not eligible for the Domestic Violence Module in households in which men were 

administered the domestic violence module (one-half of all selected households). 
8

four districts of Yukhari Garabakh (occupied territories in Azerbaijan), and a region in Ukraine 

uninhabited since the Chernobyl nuclear disaster. 

The original samples (N=8,444 in Azerbaijan, N=7,440 in Moldova, and N=6,841 in 

Ukraine) were reduced to include ever-marriedc(or cohabiting) women of reproductive age 

(15-49) who were eligible and completed the Domestic Violence Module and who had a 

pregnancy in the last five years preceding the survey. Almost half of the respondents from the 

domestic violence sample in Azerbaijan had a pregnancy in the last five years compared with

one-third of respondents in Moldova and one-quarter in Ukraine. Eligible ever-married women 

who did not complete the Domestic Violence Module or who could not be interviewed because 

privacy could not be achieved during their interviews were excluded from the analysis. In 

addition, women whose last pregnancy resulted in a miscarriage or stillbirth (69 cases in 

Azerbaijan, 123 in Moldova, and 28 in Ukraine) were not included in the final analysis. To 

obtain nationally representative estimates, weights from the Domestic Violence Module were 

used as sampling weights. The final weighted samples included 1,620 women in Azerbaijan, 

1,377 women in Moldova, and 545 women in Ukraine.

Measures 

Predictor variable: Lifetime occurrence of physical or sexual IPV is a binary outcome 

defined as having occurred if a woman reported any abusive acts ever committed by her most 

recent husband or cohabitating partner. The scale included seven items measuring physical 

violence (husband/partner ever threw something at her, pushed, shoved; slapped the respondent; 

twisted her arm, or pulled her hair; ever punched with his fist or with something that could hurt 

her, kicked, or dragged; tried to strangle or burn; or threatened with a knife, gun, or other type of 

weapon) and three items measuring sexual violence (husband/partner ever physically forced 

respondent to have sexual intercourse; forced her to perform any other sexual acts; respondent 

reported forced first sexual intercourse with this partner). Almost all women who reported 

experiencing sexual IPV also reported ever experiencing physical IPV, and this measure was 

combined into lifetime occurrence of physical and/or sexual IPV.

 

c Hereafter married or cohabitating (living with a partner) will be used interchangeably.
9

Outcome variable: The DHS questionnaire collected information about the respondent‟s

pregnancy history. Women who had a live birth within the five years preceding the survey were

asked whether they had wanted the child then, later, or wanted no more children at the time of 

pregnancy. Thus, the measure of unintended pregnancy is available only for pregnancies 

resulting in live births. In the FSU region, where women historically had an option of 

terminating an unintended pregnancy through an abortion, this question may not capture a large 

portion of unintended pregnancies. Therefore, to measure unintended pregnancy, we constructed 

a new variable that captured unintended pregnancies that resulted in live births and pregnancies 

that were terminated through abortion. This new measure of unintended pregnancy was based on

outcome of last pregnancy within the last five years preceding the survey and included three 

categories (0: live birth wanted then; 1: live birth wanted later or not wanted at all; and 2:

abortion). 

Control variables: The analysis adjusted for socio-demographic covariates—rural 

residence, low levels of education, and poverty—often associated with poor reproductive health 

outcomes43. Residence was measured as a dichotomous variable (rural/urban areas). Age 

demonstrated a non-linear relationship with the outcome variables, and regression models

included two variables for age—age in years and age squared. To measure socio-economic 

status, the DHS uses a wealth index that is computed using principal component analysis and has 

been tested in many countries44. The wealth index includes five quintiles (from 1, lowest wealth,

to 5, highest) based on ownership of durable assets and selected living conditions. In this paper 

the wealth index was dichotomized into two categories; the lowest two quintiles were coded as 1 

to indicate poverty, and the middle and two highest quintiles were coded as 0. Education was

used as a continuous variable measuring total years of schooling. Further, the model included 

lifetime use of contraceptives as a reproductive health predictor of unintended pregnancy. 

Lifetime use of contraceptives included 3 categories (0: no method; 1: only ever used traditional 

methods such as rhythm, withdrawal, and folkloric methods; and 2: modern methods such as pill, 

condom, diaphragm, IUD, spermicides, and other modern methods). Finally, to estimate the 

association between a history of IPV and the decision regarding the most recent pregnancy, the 

study adjusted for reproductive health covariates commonly associated with pregnancy 

outcomes—number of living children prior to last pregnancy and number of abortions prior to 

last abortion.
10

Data Analysis 

The statistical analysis was performed in STATA 11. The statistical analysis was 

conducted individually for each country and the results were compared. To examine associations 

between IPV and outcomes of last pregnancy the multinomial survey logistic regression was 

performed adjusting for the stratified multistage sampling design and using sample weights from 

the Domestic Violence Module. Without specifying sampling design, the analysis may 

underestimate the standard errors and produce more statistically significant results, running the 

risk of Type I Error45. The raw and adjusted relative risk ratios with 95% confidence intervals are 

reported. Models were adjusted for key socio-demographic covariates (woman‟s age, marital 

status, urban/rural residence, education, and wealth) and reproductive health covariates (number 

of children, number of abortions, and lifetime use of contraceptives). The models were tested for 

multicollinearity and variance inflation factors (VIFs) did not exceed the cut-off value of 10,

indicating high colinearity46. 
11

RESULTS 

Socio-Demographic Characteristics 

Table 1 contains information about the socio-demographic characteristics, prevalence of 

IPV, and key reproductive health outcomes for ever-married (or cohabitating) women of 

reproductive age 15-49 who were eligible and completed the Domestic Violence Module and 

who had a pregnancy in the last five years. 

The mean age of participants was 29-30 years in all three countries. In Ukraine 

respondents predominantly lived in urban areas (63%), and in Moldova in rural areas (60%),

with Azerbaijan having a relatively equal proportion of respondents in urban and rural areas 

(54% vs. 46%, respectively). The mean number of years of education was higher in Ukraine (14 

years) than in Azerbaijan or Moldova (11 years). The percentage of formerly married women 

was lowest in Azerbaijan (4%), followed by Moldova (8%), and Ukraine (11%). 

Physical and Sexual IPV 

Table 1 shows that 22% of respondents in Moldova, 14% in Azerbaijan, and 11% in 

Ukraine reported ever experiencing acts of physical and/or sexual IPV from their most recent 

partners (being punched, kicked, strangled, burned, or threatened or attacked with a weapon; 

being physically forced to have sexual intercourse or perform other sexual acts against their will, 

or having forced first sexual intercourse). 

Unintended Pregnancy and Reproductive Health Covariates 

A number of substantial differences were observed among the three countries in regard to 

reproductive health outcomes. Last pregnancy within the last five years preceding the survey 

resulted in abortion for 47% of women in Azerbaijan, 35% of women in Moldova, and 28% of 

women in Ukraine. In Azerbaijan 27% of respondents have never used any method of 

contraception compared with 5% in Moldova and 16% in Ukraine. On average, women in 

Ukraine and Moldova reported having one living child prior to the last pregnancy compared with 

almost two children for women in Azerbaijan.
12

Table 1. Socio-demographic characteristics, prevalence of intimate partner violence, and key 

reproductive health covariates among ever-married women who completed the Domestic Violence 

Module (Domestic Violence Sample) and had a pregnancy in the past 5 years preceding the survey. 

Azerbaijan Moldova Ukraine

(N=1,620) (N=1,377) (N=545)

% [95% CI] % [95% CI] % [95% CI]

Socio-demographic characteristics

Age, mean 30.1 [29.6, 30.5] 28.9 [28.5, 29.3] 29.3 [28.6, 30.0]

Residence

Urban 54.4 [49.7, 59.0] 40.1 [37.4, 42.9] 63.4 [59.2, 67.5]

Rural 45.6 [41.0, 50.3] 59.9 [57.1, 62.7] 36.6 [32.5, 40.9]

Marital status

Currently married 96.4 [94.8, 97.6] 92.4 [90.7, 93.8] 88.9 [85.1, 91.7]

Formerly married 3.6 [2.4, 5.2] 7.6 [6.2, 9.3] 11.2 [8.3, 14.9]

Wealth status 

Middle and higher quintiles/ 60% 58.9 [54.2, 63.4] 65.5 [62.0, 68.8] 62.0 [56.7, 67.0]

Lowest two quintiles/ 40% 41.1 [36.6, 45.8] 34.6 [31.2, 38.1] 38.0 [33.0, 43.3]

Number of years of education, mean 10.8 [10.6, 11.0] 11.3 [11.1, 11.4] 13.6 [13.3, 13.9]

Lifetime IPV

Any physical IPV 13.0 [11.2, 15.2] 21.5 [19.2, 24.0] 10.3 [7.6, 13.8]

Any sexual IPV 2.9 [2.1, 4.1] 4.7 [3.5, 6.2] 4.2 [2.3, 7.5]

Any physical or sexual IPV 13.8 [11.9, 15.9] 22.4 [20.1, 25.0] 10.9 [8.0, 14.5]

Reproductive health outcomes

Ever used contraception

No method 27.0 [24.2, 30.0] 4.8 [3.6, 6.4] 15.8 [11.9, 20.8]

Traditional methods only 38.5 [35.0, 42.1] 8.9 [7.3, 10.8] 12.6 [9.9, 15.9]

Modern methods 34.5 [31.2, 38.0] 86.3 [84.0, 88.4] 71.6 [66.8, 75.8]

Number of children

(prior to last live birth) 1.6 [1.5, 1.6] 1.1 [1.0, 1.2] 0.9 [0.8, 1.0]

Number of abortions

(prior to last abortion) 0.4 [0.4, 0.5] 0.4 [0.3, 0.4] 0.3 [0.2, 0.3]

Last pregnancy outcome

Wanted live birth 43.0 [40.1, 45.9] 50.3 [46.9, 53.7] 61.5 [56.9, 66.0]

Unintended live birth 8.5 [7.0, 10.4] 14.3 [12.1, 16.8] 10.9 [8.2, 14.3]

Abortion 46.5 [45.8, 51.3] 35.4 [32.6, 38.4] 27.6 [23.6, 32.1]
13

IPV and Unintended Last Pregnancy 

In all three countries lifetime occurrence of physical or sexual IPV demonstrated strong 

associations with unintended pregnancy, after adjusting for key socio-demographic covariates, 

lifetime use of contraceptives, and previous use of abortions (see Table 2). In Azerbaijan and 

Moldova women who had ever experienced physical or sexual IPV demonstrated higher risks of 

the last pregnancy resulting in abortion (Azerbaijan, aRRR=2.1, 95% CI=1.4, 3.2; Moldova,

aRRR=1.6, 95% CI=1.1, 2.3) compared with women who had no history of physical or sexual 

IPV. Ever experiencing physical or sexual IPV did not demonstrate a significant relationship 

with abortion in Ukraine, where the average abortion rate is significantly lower than in

Azerbaijan and Moldova. However, in Ukraine ever experiencing physical or sexual IPV was 

associated with higher risk of unintended live birth (aRRR=4.8, 95% CI=1.8, 12.7). 

In all three countries formerly married status and number of living children prior to the 

last birth were positively associated with the last pregnancy resulting in abortion. Women of 

lower wealth status in Azerbaijan (aRRR=0.6, 95% CI=0.4, 1.0) and Moldova (aRRR=0.6, 95% 

CI=0.4, 0.9) and women from rural areas in Moldova (aRRR=0.6, 95% CI=0.4, 0.9) were less 

likely to terminate their last pregnancy through abortion. Unintended live birth was positively 

associated with rural residence in Ukraine (aRRR=2.7, 95% CI=1.2, 6.1) and with lower wealth 

status in Moldova (aRRR=1.6, 95% CI=1.0, 2.4).
Table 2. Relative risk ratios for lifetime exposure to IPV and outcomes of last pregnancy within the last 5 years preceding the survey among 

ever-married (or cohabiting) women in Azerbaijan, Moldova, and Ukraine.

Azerbaijan Moldova Ukraine

Outcome of last pregnancy within last 5 

years (N=1,620)

Outcome of last pregnancy within last 5 

years (N=1,377)

Outcome of last pregnancy within last 5 

years (N=544)

Wanted 

live 

birth

Unwanted live 

birth Abortion

Wanted 

live 

birth

Unwanted live 

birth Abortion

Wanted 

live 

birth

Unwanted live 

birth Abortion

RRR RRR [95% CI] RRR [95% CI] RRR RRR [95% CI] RRR [95% CI] RRR RRR [95% CI] RRR [95% CI]

Model 1(unadjusted)

Ever experienced any 

physical or sexual IPV

 No ref ref ref

 Yes 1.0 1.2 [0.6,2.2] 2.0*** [1.4,2.8] 1.0 2.0** [1.3,3.1] 2.3*** [1.7,3.1] 1.0 5.3*** [2.3,12.1] 3.5*** [1.7,7.1]

Model 2 (adjusted)

Ever experienced any 

physical or sexual IPV

 No ref ref ref

 Yes 1.0 1.2 [0.7,2.3] 2.1*** [1.4,3.2] 1.0 1.3 [0.8,2.1] 1.6* [1.1,2.3] 1.0 4.8** [1.8,12.7] 2.0 [0.8,4.8]

Age 1.0 0.9 [0.6,1.1] 0.7* [0.5,0.9] 1.0 0.6*** [0.5,0.8] 0.7** [0.6,0.9] 1.00 0.6** [0.4,0.9] 0.6** [0.4,0.9]

Age (squared) 1.0 1.0 [1.0,1.0] 1.0** [1.0,1.0] 1.0 1.0*** [1.0,1.0] 1.0** [1.0,1.0] 1.00 1.0* [1.0,1.0] 1.0** [1.0,1.0]

Residence 

 Urban ref ref ref

 Rural 1.0 0.8 [0.4,1.6] 0.7 [0.5,1.0] 1.0 0.7 [0.4,1.1] 0.6** [0.4,0.9] 1.00 2.7* [1.2,6.1] 0.6 [0.3,1.2]

Marital status 

 Currently married ref ref ref

 Formerly married 1.0 0.9 [0.2,3.3] 3.6* [1.2,10.5] 1.0 3.7*** [1.7,7.8] 4.9*** [2.6,9.4] 1.00 2.1 [0.6,7.0] 5.8*** [2.6,12.9]

Years of education 1.0 1.0 [0.9,1.1] 1.0 [0.9,1.1] 1.0 1.0 [1.0,1.1] 1.1 [1.0,1.2] 1.00 0.9 [0.8,1.0] 1.1 [0.9,1.2]

Wealth status

 Middle and higher 60% ref ref ref

 Lowest 40% 1.0 0.6 [0.3,1.3] 0.6* [0.4,1.0] 1.00 1.6* [1.0,2.4] 0.6* [0.4,0.9] 1.00 0.4* [0.2,0.8] 1.10 [0.5,2.3]

# Living children 1.0 2.3*** [1.6,3.2] 7.0*** [4.8,10.2] 1.0 3.6*** [2.6,4.9] 4.3*** [3.0,6.1] 1.0 1.6 [1.0,2.5] 2.6*** [1.7,4.0]

# Abortions 1.0 0.9 [0.7,1.2] 1.5*** [1.3,1.8] 1.0 1.0 [0.8,1.2] 1.1 [1.0,1.3] 1.0 1.0 [0.5,1.8] 2.1*** [1.5,2.9]

Ever used

contraceptives

 No methods (ref) ref ref ref

 Traditional only 1.0 0.8 [0.5,1.4] 1.6* [1.0,2.5] 1.0 1.0 [0.3,3.2] 0.9 [0.4,1.9] 1.0 4.4* [1.1,18.2] 1.8 [0.6,5.6]

 Modern methods 1.0 1.0 [0.6,1.7] 1.6* [1.0,2.3] 1.0 1.2 [0.4,3.3] 0.9 [0.5,1.7] 1.0 3.6* [1.1,11.7] 3.6** [1.6,8.5]

Note: Models are adjusted for age, rural/urban residence, marital status, education, and wealth status, number of children excluding last live birth, previous use of abortions, and lifetime use

of contraceptives.

*** p<0.001, ** p<0.01, * p<0.05, + p<0.10

14
15

DISCUSSION 

This paper has identified significant associations between IPV and unintended pregnancy

in three countries of the former Soviet Union. In all three countries women with a history of 

physical or sexual IPV demonstrated elevated probabilities of unintended pregnancies,

manifested either through higher probabilities of last pregnancy resulting in abortion in 

Azerbaijan and Moldova, or through unintended live births in Ukraine. The relationship between 

IPV and abortions was not significant in Ukraine, where the abortion rate among the general 

population is lower than in Azerbaijan and Moldova. 

The findings in this paper suggest that to further reduce the number of abortions, 

reproductive health programs in Azerbaijan and Moldova need to take into account the specific 

risks of women living in abusive relationships. In addition, in Moldova, women with lower 

economic status who may have limited means and access to abortion are more likely than women 

from higher economic status to keep an unplanned last pregnancy. In Ukraine, unplanned live 

births are more common in rural than urban areas. 

The study has a number of limitations. It used cross-sectional data to explore initial 

associations between IPV and reproductive health decisions, but cannot make causal inferences. 

Despite the strong associations found in this paper, the use of cross-sectional data cannot help 

sort out whether IPV serves as a risk factor or predictor of reproductive health outcomes, or both.

Further, the data collection procedure, an interviewer-administered survey, may pose constraints 

to the disclosure of sensitive information. The presence of an interviewer may create a situation 

for social desirability bias and decrease reporting of unwanted pregnancies, large numbers of 

abortions, and IPV, particularly sexual IPV. Despite certain limitations, interviewing is still 

considered a legitimate data collection method for studies on IPV and health outcomes, 

especially if interviewers are trained and administer a standardized instrument, as in the DHS. 

Another limitation is that the analysis relied on self-reported data about women‟s reproductive 

health and did not compare their reported health outcomes with health records. Less than 5% of 

respondents reported ever experiencing sexual IPV, which significantly limited the power to 

identify significant relationships between pregnancy outcomes and sexual IPV separately from 

physical IPV.
16

The paper lays the groundwork for future studies aiming to understand the complex 

relationship between IPV and unintended pregnancy. To identify causal relationships between 

IPV and family planning indicators, future studies accounting for temporal factors—the onset of 

IPV and decisions related to adoption or discontinuation of contraception—are indispensible. To 

be especially beneficial in program development, the studies should examine mechanisms 

linking unintended pregnancy and IPV. Moreover, studies using experimental designs are 

necessary to test the effects of factors mediating the relationship between pregnancy outcomes

and IPV and determining their role in preventing and reducing the negative consequences of 

IPV. Studies examining various mechanisms linking different types of IPV with contraceptive

use, unintended pregnancies, abortions, and miscarriages could be extremely informative in 

developing programs to reduce the effect of IPV on health outcomes among women who have 

ever experienced violence in intimate relationships. 

This analysis suggests that the relationship between IPV and women‟s health may go far 

beyond physical injuries and seriously undermine women‟s reproductive health outcomes. The 

results of this paper illustrate the need for reproductive health programs to address IPV as a 

potential obstacle to preventing unintended pregnancies and its counterpart, use of effective 

contraception. Likewise, women receiving or seeking services for IPV from women‟s crisis 

centers or shelters should also be assessed for their family planning needs and risks of 

unintended pregnancy. Furthermore, women‟s health clinics, family planning centers, and 

hospital units providing abortion services could be effective settings for screening women for 

IPV and providing necessary assistance, referrals, and health information. A harm-reduction 

approach could be applied to reproductive health programs to minimize the risk of unintended 

pregnancies among women who are currently unable or unwilling to leave their abusive partners.
17

CONCLUSION 

Power dynamics in relationships should be taken into account when understanding the 

reproductive health behaviors and decisions of women in the FSU region. Strong associations in 

the FSU region between women‟s abusive experiences and unintended pregnancy suggest the 

importance of designing new programs or adjusting current reproductive health programs to 

address the special circumstances and needs of women who have experienced violence from 

their partners. 

 
18

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