DHS ANALYTICAL 

STUDIES 57

Intimate Partner Violence 

and Interruption to 

Contraceptive Use

August 2016

This publication was produced for review by the United States Agency for International Development. It was prepared by 

Kerry L.D. MacQuarrie, Lindsay Mallick, and Sunita Kishor.

DHS Analytical Studies No. 57 

Intimate Partner Violence and Interruption to 

Contraceptive Use 

Kerry L.D. MacQuarrie1

Lindsay Mallick1 

Sunita Kishor2

ICF International 

Rockville, Maryland, USA 

August 2016 

1

 The DHS Program, Avenir Health 

2

 The DHS Program, ICF International 

Corresponding author: Kerry L.D. MacQuarrie, The DHS, ICF International, 530 Gaither Road, Suite 

500, Rockville, MD 20850, USA; phone: +1 301-572-0282; fax: +1 301-407-6501; email: 

Kerry.macquarrie@icfi.com 
Acknowledgments: The authors are grateful for the contributions to this study from multiple people. We 

extend our appreciation to: Rohini Pande for a thoughtful review of an earlier draft, Sara Head for input 

into the scope of the study, Lauren Maxwell who helped review the literature and provided comments on 

an earlier draft, Trevor Croft for compiling customized event data files, Cameron Taylor for suggestions 

on data visualization, and Imelda (Inday) Feranil who provided support with the Family Planning Effort 

Index data. 

Editor: Diane Stoy 

Document Production: Natalie La Roche 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through The DHS Program (#AID-OAA-C-13-00095). The views expressed are 

those of the authors and do not necessarily reflect the views of USAID or the United States Government. 

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

population, health, and nutrition programs. For additional information about The DHS Program, contact 

The DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; phone: 

301-407-6500; fax: 301-407-6501; email: reports@dhsprogram.com; Internet: www.dhsprogram.com. 

Recommended citation: 

MacQuarrie, Kerry L.D., Lindsay Mallick, and Sunita Kishor. 2016. Intimate Partner Violence and 

Interruption to Contraceptive Use. DHS Analytical Studies No. 57. Rockville, Maryland, USA: ICF 

International. 
iii 

Contents 

Tables ................................................................................................................................................................... v 

Figures ............................................................................................................................................................... vii

Preface ................................................................................................................................................................ ix

Abstract .............................................................................................................................................................. xi

Executive Summary ......................................................................................................................................... xiii

1. Background ............................................................................................................................................ 1

2. Methods and Data ................................................................................................................................. 5

2.1. Data Structure ............................................................................................................................ 6

2.2. Domestic Violence Module ....................................................................................................... 9

2.3. Analytic Strategy ..................................................................................................................... 11

2.4. Measures .................................................................................................................................. 14

3. Prevalence of Contraception and Intimate Partner Violence in Study Surveys ............................ 21

3.1. Contraception Profile of Study Surveys .................................................................................. 21

3.2. IPV Profile ............................................................................................................................... 28

4. Sample Profile ...................................................................................................................................... 31

5. Experience of Intimate Partner Violence .......................................................................................... 33

5.1. Contraceptive Use by Experience of IPV ................................................................................ 36

6. Discontinuation .................................................................................................................................... 39

7. Bivariate Association of IPV with Contraceptive Discontinuation ................................................. 41

7.1. Bivariate Associations Between IPV and Discontinuation While Still in Need ...................... 41

7.2. Bivariate Associations Between IPV and Discontinuation due to No Further Need ............... 43

7.3. Bivariate Associations Between IPV and Total Discontinuation ............................................ 46

8. Association of Socio-Demographic Factors with Discontinuation .................................................. 47

8.1. Discontinuation While Still in Need ........................................................................................ 47

8.2. Discontinuation due to No Further Need ................................................................................. 49

8.3. Total Discontinuation .............................................................................................................. 51

9. Multivariate Analysis of the Association Between IPV and Discontinuation While Still 

in Need .................................................................................................................................................. 53

9.1. Emotional Violence ................................................................................................................. 55

9.2. Physical Violence .................................................................................................................... 56

9.3. Sexual Violence ....................................................................................................................... 56

9.4. Any IPV ................................................................................................................................... 56

10. Discussion and Conclusions ................................................................................................................ 59

References .......................................................................................................................................................... 63 

Appendix Tables ............................................................................................................................................... 71 

Appendix Tables: Sensitivity Analysis ............................................................................................................ 87 

v 

Tables 

Table 1. Selected characteristics for surveys included in the analysis .............................................. 5

Table 2. Derivation of the analytic samples .................................................................................... 13

Table 3. Background characteristics of the analytic sample: Currently married women age 

15-49 using contraception 12 months prior to interview .................................................. 31

Table 4. Proportion of currently married women age 15-49 using contraception at the start 

of the 12-month observation period and distribution of method type by experience 

of intimate partner violence .............................................................................................. 37

Table 5. Unadjusted odds of emotional, physical, sexual, and any intimate partner violence 

predicting discontinuation while still in need, discontinuation due to no further need, 

and total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models ......................... 44

Table 6. Unadjusted odds of discontinuing while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic 

regression models ............................................................................................................. 48

Table 7. Unadjusted odds of discontinuing due to no further need in the 12 months prior to 

the survey among currently married women age 15-49: Odds ratios from logistic 

regression models ............................................................................................................. 50

Table 8. Unadjusted odds of total discontinuation in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models ......... 52

Table 9. Adjusted odds of emotional, physical, sexual, and any intimate partner violence 

predicting discontinuation while still in need, discontinuation due to no further need, 

and total discontinuation in the 12 months prior to the survey among currently married 

women age 15-49: Odds ratios from logistic regression models controlling for 

contraceptive method type and socio-demographic controls ............................................ 54

Appendix Table 1. Proportion of currently married women age 15-49 in the analytic sample using 

specific methods contraception 12 months prior to interview .......................................... 73

Appendix Table 2. Percent distribution of reason for discontinuation among currently married women 

age 15-49 who discontinued contraceptive use in the 12 months prior to the survey ....... 73

Appendix Table 3. Proportion of currently married women age 15-49 discontinuing while still in need 

in the 12 months prior to the survey, by type of contraception......................................... 74

Appendix Table 4. Adjusted odds of discontinuing while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic 

regression models with emotional violence and socio-demographic controls .................. 75

Appendix Table 5. Adjusted odds of discontinuing while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic 

regression models with physical violence and socio-demographic controls..................... 76

Appendix Table 6. Adjusted odds of discontinuing while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic 

regression models with sexual violence and socio-demographic controls ........................ 77

Appendix Table 7. Adjusted odds of discontinuing while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic 

regression models with any intimate partner violence and socio-demographic 

controls ............................................................................................................................. 78

Appendix Table 8. Adjusted odds of discontinuing due to no further need in the 12 months prior to 

the survey among currently married women age 15-49: Odds ratios from logistic 

regression models with emotional violence and socio-demographic controls .................. 79
vi 

Appendix Table 9. Adjusted odds of discontinuing due to no further need in the 12 months prior to 

the survey among currently married women age 15-49: Odds ratios from logistic 

regression models with physical violence and socio-demographic controls..................... 80

Appendix Table 10. Adjusted odds of discontinuing due to no further need in the 12 months prior to 

the survey among currently married women age 15-49: Odds ratios from logistic 

regression models with sexual violence and socio-demographic controls ........................ 81

Appendix Table 11. Adjusted odds of discontinuing due to no further need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic models 

with any intimate partner violence and socio-demographic controls ................................ 82

Appendix Table 12. Adjusted odds of total discontinuation in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models 

with emotional violence and socio-demographic controls ................................................ 83

Appendix Table 13. Adjusted odds of total discontinuation in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models 

with physical violence and socio-demographic controls .................................................. 84

Appendix Table 14. Adjusted odds of total discontinuation in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models with 

sexual violence and socio-demographic controls ............................................................. 85

Appendix Table 15. Adjusted odds of total discontinuation in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models 

with any intimate partner violence and socio-demographic controls ................................ 86

Appendix Table 16. Sensitivity analysis: Proportion of women using contraception at the start of the 

12-month observation period by timing of experience of intimate partner violence ........ 89

Appendix Table 17. Sensitivity analysis: Unadjusted odds of multiple forms of intimate partner violence 

predicting discontinuation while still in need, discontinuation due to no further need, 

and total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models ......................... 91

Appendix Table 18. Sensitivity Analysis: Unadjusted odds of the frequency of emotional, physical, 

sexual, and any intimate partner violence predicting discontinuation while still 

in need in the 12 months prior to the survey among currently married women age 

15-49: Odds ratios from logistic regression models ......................................................... 92

Appendix Table 19. Sensitivity Analysis: Unadjusted odds of emotional, physical, and sexual violence 

predicting discontinuation while still in need in the 12 months prior to the survey 

among currently married women age 15-49: Odds ratios from logistic regression 

models ............................................................................................................................... 94

Appendix Table 20. Sensitivity Analysis: Unadjusted odds of lifetime timing of emotional, physical, 

sexual, and any intimate partner violence predicting discontinuation while still in 

need in the 12 months prior to the survey among currently married women age 

15-49: Odds ratios from logistic regression models ......................................................... 95

Appendix Table 21. Sensitivity Analysis: Proportion of currently married women age 15-49 using 

contraception at 12 months prior to the survey who experienced interruption, by 

experience of intimate partner violence in the last 12 months .......................................... 97
vii 

Figures 

Figure 1. Sample DHS reproductive calendar .................................................................................... 8

Figure 2. Emotional, physical, and sexual violence items in the DHS Domestic Violence 

Module .............................................................................................................................. 10

Figure 3. Proportion of currently married women age 15-49 currently using contraception ........... 22

Figure 4. Dominant method and method mix among currently married women age 15-49 

using contraception ........................................................................................................... 24

Figure 5. Family Planning Effort Index scores ................................................................................ 26

Figure 6. Percentage of currently married women age 15-49 who experienced emotional, 

physical, sexual, and any intimate partner violence .......................................................... 27

Figure 7. Proportion of currently married women age 15-49 in the analytic sample 

experiencing each form of intimate partner violence in the 12 months prior 

to the survey ...................................................................................................................... 34

Figure 8. Proportion of currently married women age 15-49 using contraception 12 months 

prior to the survey who discontinue their contraceptive use in the past 12 months .......... 39

Figure 9. Unadjusted odds of emotional, physical, sexual, and any intimate partner violence 

predicting discontinuing while still in need: Odds ratios from logistic regression 

models ............................................................................................................................... 42
viii 
ix 

Preface 

The Demographic and Health Surveys (DHS) Program is one of the principal sources of international data 

on fertility, family planning, maternal and child health, nutrition, mortality, environmental health, 

HIV/AIDS, malaria, and provision of health services. 

One of the objectives of The DHS Program is to analyze DHS data and provide findings that will be 

useful to policymakers and program managers in low- and middle-income countries. DHS Analytical 

Studies serve this objective by providing in-depth research on a wide range of topics, typically including 

several countries and applying multivariate statistical tools and models. These reports are also intended to 

illustrate research methods and applications of DHS data that may build the capacity of other researchers. 

The topics in the DHS Analytical Studies series are selected by The DHS Program in consultation with 

the U.S. Agency for International Development. 

It is hoped that the DHS Analytical Studies will be useful to researchers, policymakers, and survey 

specialists, particularly those engaged in work in low- and middle-income countries. 

Sunita Kishor 

Director, The DHS Program 

xi 

Abstract 

This study explores the relationship between intimate partner violence (IPV) and contraceptive 

discontinuation using data from 11 Demographic and Health Surveys. The study uses detailed data in the 

reproductive calendars and the domestic violence module of the survey to co-locate contraceptive and 

IPV experience in the same 12-month observation period. The study examines the odds of discontinuation 

while still in need (DWSIN) among contraceptive users in relation to the experience of IPV and compares 

this to discontinuation due to no further need and total discontinuation. The study examines three forms of 

violence separately—emotional, physical, and sexual violence—and any IPV combined. It finds limited 

evidence of association between IPV and DWSIN. Where associations exist, they are often weakly 

significant, of small magnitude, or inconsistent in direction. Emotional violence is associated with greater 

odds of DWSIN in Egypt and nearly associated in Honduras and Kenya. In the Kyrgyz Republic, 

emotional violence is nearly significantly associated with lower odds of DWSIN. Findings also vary with 

the form of violence assessed. Associations between emotional violence and DWSIN are more commonly 

detected than other forms or any IPV. Sexual violence is positively associated with DWSIN in Jordan and 

negatively associated with DWSIN in Tajikistan. Positive associations between physical violence (Egypt) 

or any form of violence (Egypt and Honduras) are of borderline significance. The overall finding that 

associations are country-specific, rather than global in nature, suggests that the approach to incorporating 

IPV into family planning programs should likewise take a country-specific approach. 

xiii 

Executive Summary 

While there is a robust demographic literature examining contraceptive dynamics such as contraceptive 

discontinuation, this literature seldom addresses experience of intimate partner violence (IPV). Literature 

on gender-based violence, meanwhile, more frequently investigates the association of IPV with current 

use of contraception, rather than the adherence to contraceptive use over time. Prior studies suggest IPV is 

associated with less contraceptive use. Meanwhile, studies emerging from the literature on reproductive 

control and coercion indicate that women who experience IPV and a partner’s controlling behaviors face 

interference in their contraceptive practices and greater difficulty avoiding unintended pregnancy. Based 

on this extant literature, the authors of this study hypothesize that women who experience intimate partner 

violence would be more likely to experience interruptions in their contraceptive use, namely, that they 

would be more likely to experience discontinuation while still in need (of contraception). 

This study takes advantage of detailed data in the reproductive calendars and psychometrically tested 

measures of various forms of IPV found in The Demographic and Health Surveys Program surveys to test 

this hypothesis in 11 countries. We co-locate contraceptive and IPV experience in the same 12-month 

observation period. More specifically, we examine discontinuation in the 12 months preceding the survey 

among samples of contraceptive users in relation to the experience of IPV following the start of their 

contraceptive use. We examine the odds of discontinuation while still in need (DWSIN) and compare this 

to discontinuation due to no further need and total discontinuation. We examine the effects of three forms 

of violence separately—emotional violence, physical violence, and sexual violence—and the experience 

of any of these forms of violence on discontinuation in the preceding 12 months. 

The modern contraceptive prevalence rate is greater than 25% in all study countries. A range of 

contraceptive methods, some LARC and some non-LARC, dominates the method mix. The prevalence of 

IPV (any form) ranges from 24% (Tajikistan) to 59% (Uganda). There is no difference in the method type 

(LARC or non-LARC method) based on experience of violence, except in Kenya, where women who 

experience IPV are more likely to be using a LARC method compared to women with no experience of 

IPV in the preceding 12 months. In the other 10 countries, regardless of IPV experience, LARC use 

exceeds non-LARC use in Egypt, Jordan, the Kyrgyz Republic, and Tajikistan while non-LARC use 

exceeds LARC use in Cambodia, Honduras, Rwanda, Uganda, Zambia, and Zimbabwe. 

In contrast to our expectations, we find limited evidence of association between the experience of 

violence and discontinuation while still in need. Where associations are found, they are often weakly 

significant or of small magnitude. Additionally, they are inconsistent across countries in the direction of 

the association. For example, the experience of emotional violence in the previous 12 months is 

associated with a greater likelihood of discontinuation while still in need in the preceding 12 months in 

Egypt (where IUDs are the most common method). This same association is of borderline significance in 

Honduras and Kenya, where injections are the most common reversible method. In the Kyrgyz Republic, 

however, where IUDs are also common, the experience of emotional violence is nearly significantly 

associated with a lower likelihood of discontinuation while still in need. No association is detected with 

emotional violence in the remaining seven countries. 

Findings also vary with the form of violence assessed. Associations between emotional violence and 

discontinuation while still in need are more commonly detected than other forms or any IPV combined. 

Sexual violence in the preceding 12 months is positively associated with discontinuation while still in 

need in Jordan and negatively associated with discontinuation while still in need in Tajikistan (where 

IUDs dominate the method mix). Positive associations between physical violence (Egypt) or any form of 

violence (Egypt and Honduras) are of borderline significance. No other associations are observed in the 

other countries. 
xiv 

In contrast to the varying direction of association with IPV and discontinuation while still in need, 

associations with discontinuation due to no further need are consistently negative where they are detected. 

However, these associations are not frequently observed. Women who experience emotional violence 

have significantly lower odds of discontinuing due to no further need in Kenya and the Kyrgyz Republic 

(and nearly significantly lower odds in Honduras), as do women who experience physical violence in 

Kenya, sexual violence in Cambodia (where the pill is the most common method) and the Kyrgyz 

Republic, or any IPV in Honduras, Kenya, and Tajikistan. These associations are not observed elsewhere. 

For many countries, using a non-LARC method is independently and positively associated with both 

discontinuation while still in need and due to no further need, and the magnitude of the effect (where it 

exists) is generally larger than that of experience with IPV. No clear pattern emerges across countries 

with regard to other characteristics. For example, age, duration of contraceptive use prior to the 

observation period, and household wealth quintile are associated with discontinuation while still in need 

in some countries, but not in others. These findings would suggest that, like IPV, the factors influencing 

discontinuation while still in need (or due to no further need) are country-specific. 

This study attempts to fill a gap in the separate demographic literatures on contraceptive dynamics and on 

gender-based violence to explore the relationship between IPV and contraceptive discontinuation. Our 

primary finding is that these associations are generally modest and weak and are country-specific, rather 

than global in nature. This overall finding suggests that the approach to screening for IPV and tailoring 

family planning programs to meet the needs of clients who may be at risk of IPV should likewise take a 

country-specific approach. Furthermore, service providers should be mindful of the potential for other 

forms of abuse—marital control, emotional violence, and sexual violence—and not only physical 

violence, as our findings indicate that discontinuation may be associated with one form of violence and 

not all forms equivalently. 
1 

1. Background 

Intimate partner violence (IPV) and other forms of gender-based violence, in their own right, present 

significant public health concerns and gross violations of women’s human rights. Appropriately, a 

substantial and growing body of literature documents the prevalence and patterns of such violence 

(Djamba and Kimuna 2015; Garcia-Moreno et al. 2006; Hindin, Kishor, and Ansara 2008; Kishor and 

Bradley 2012; Krug et al. 2002; MacQuarrie, Winter, and Kishor 2014; Solotaroff and Pande 2014). 

Attention also has focused on the poor social and health outcomes associated with IPV. 

The experience of IPV against a woman threatens her physical and mental health (García-Moreno 2013). 

Physical IPV can be so severe that it can lead to death or cause debilitating injuries to muscles, bones, 

skin, or the reproductive system. Sexual violence may cause similar physical injury and damage to the 

reproductive system. The multiple, indirect pathways by which IPV harms a woman’s health are even 

more complicated. For example, these pathways often invoke risky behaviors associated with IPV or 

negative effects from chronic stress, which may impair immune system functioning or result in mental 

health or substance abuse problems (Campbell et al. 2008; García-Moreno 2013). 

In addition, IPV is also associated with a number of adverse sexual and reproductive health outcomes 

(Coker 2007; Hasstedt and Rowan 2016). These include sexual risk taking (Collins et al. 2005; Silverman 

et al. 2001); urinary tract infections, sexually transmitted infections, or HIV (Kishor 2012; MacQuarrie, 

Winter, and Kishor 2013; Singh, Singha, and Jain 2015); pregnancy loss, miscarriage, or abortion 

(Garcia-Moreno et al. 2006; Hasstedt and Rowan 2016; Kishor and Johnson 2006; Okenwa, Lawoko, and 

Jansson 2011; StÖCkl et al. 2012); pelvic pain (Campbell et al. 2002; Champion et al. 2004); and sexual 

dissatisfaction (Kovac et al. 2003; Parish et al. 2004). Additional research has identified a relationship 

between IPV and higher parity, unmet need for family planning (Gomez 2011; Kaneda and Smith 2015; 

Ogunjuyigbe, Akinlo, and Oni 2010), adolescent pregnancy (Baumgartner et al. 2009; Garcia-Moreno et 

al. 2006), unintended, mistimed, or unwanted pregnancy (Azevêdo et al. 2013; Cripe et al. 2008; Hasstedt 

and Rowan 2016; Rahman et al. 2012; Raj and McDougal 2015). These findings indicate that women 

who experience IPV may have greater difficulty controlling their reproduction in ways that align with 

their fertility aspirations. 

An association between IPV and a lack of self-efficacy is well established; IPV is an expression of power 

and attempt to exert control. Furthermore, IPV is experienced within a gendered context of social norms. 

Although conceptually distinct from women’s agency, IPV and the disempowerment of women have been 

found to covary, at both an individual and community level (MacQuarrie 2009). Women who experience 

IPV often are disempowered in other areas of their lives and face restricted life options and poor social 

outcomes as well as adverse reproductive outcomes. Their lack of self-efficacy may prevent them from 

being able to engage in health-promoting behaviors such as adopting contraception or sustaining 

contraceptive use effectively without interruption. Alternately, as an implement of social control, IPV 

may present as a response when expected gender norms are contested. Such challenges to gender norms 

may include contraceptive use directly or other behaviors, such as civic engagement, educational pursuits, 

or participation in work outside of the home, that may be correlated with contraceptive use. The former 

interpretation would suggest that women who experience IPV may be less motivated to use or able to 

access contraception while the latter interpretation would lead us to expect violence and contraceptive use 

to coincide. 

A substantial body of literature, related to that on unintended pregnancy, has investigated this association 

between IPV and contraceptive use. Although conventional wisdom suggests that women who experience 

IPV may be less likely to use contraception, the empirical evidence is inconclusive and suggests such a 

relationship is far more complex. Without accounting for temporality, numerous studies based on cross-
2 

sectional data finds that women who experienced IPV are more likely to use contraception (Alio et al. 

2009; Chan and Martin 2009; Dalal, Andrews, and Dawad 2012; Fanslow et al. 2008; Okenwa, Lawoko, 

and Jansson 2011; Raj and McDougal 2015), with some researchers positing that women who experience 

IPV may be more motivated to avoid pregnancy, particularly if they can access discreet methods of 

contraception that can be used covertly. Dalal (2012) and Okenwa (2011) find a positive association 

between contraceptive use and physical violence but not sexual violence in Bangladesh and Nigeria, 

respectively. In contrast, Raj and McDougal (2015) do find spousal sexual violence to be positively 

associated with modern contraceptive method use. Raj and colleagues (2015) also examined IPV by 

specific contraceptive methods in Bangladesh, India, and Nepal and found partner sexual violence to be a 

key predictor of increased use of a temporary method—in particular, oral contraceptive pills. 

On the other hand, other cross-sectional research finds that women who experienced IPV are less likely to 

use contraception (Fantasia et al. 2012; Kacanek et al. 2013; Laanpere et al. 2013; Scribano, Stevens, and 

Kaizar 2013). Yet other research finds no association with IPV and contraceptive use (Adjiwanou and 

N’Bouke 2015; Oluwaseyi and Latifat 2015; Williams, Larsen, and McCloskey 2008). A multi-country 

study using Demographic and Health Surveys (DHS) data finds that women who have ever in their 

lifetime experienced IPV are more likely to have ever used modern contraception at some point in their 

lives than those who have not reported IPV, but among women in most of the ten developing countries 

studied, there was no significant association between IPV and current contraceptive use (Kishor and 

Ansara 2009). Findings from several studies indicate that the length of time a woman experiences IPV, or 

the chronicity of IPV, affects a woman’s contraceptive choices (Fantasia et al. 2012; Kacanek et al. 2013; 

Salazar Torres 2011).

Mixed results are also seen even when studies attempt to isolate the timing of violence in relation to 

specific contraceptive behavior. Some research suggests that contraception can lead to violence if a 

woman is discovered using contraception without her partner’s consent (Wilson-Williams et al. 2008), 

although most research that includes components of temporality position measures of violence and 

contraception in the other sequence, with IPV preceding contraceptive behavior outcomes. The direction 

of the association is not consistent, or always significant in these studies. For example, a study by 

Fanslow (2008) that examined the association between IPV in the last twelve months and current 

contraceptive use found little to no significant association. Two studies in India found a negative 

association between IPV and initiation or adoption of contraception; women who have experienced 

spousal physical violence were less likely to start using contraception (Stephenson, Koenig, and Ahmed 

2006; Stephenson et al. 2008). Stephenson and colleagues (2008) add that IPV is also associated with a 

higher likelihood of having an unwanted pregnancy. A recent systematic review and meta-analysis 

conducted by Maxwell et al (2015) reviewed longitudinal studies in which IPV preceded contraceptive 

use. With the exception of one study by Salazar and colleagues (2012), the study found that use of 

contraception, particularly condom use, was negatively associated with IPV, although that association 

varied by whether the form of IPV was physical or sexual. 

The empirical literature on the relationship between IPV and contraception generally examines current or 

recent contraceptive use, with less focus on other aspects of contraception. Another emerging body of 

literature that investigates reproductive coercion and control provides possible insight into the potential 

pathways between IPV and reproductive outcomes. 

Reproductive coercion is male partners’ behavior, intended to maintain power and control in a 

relationship by controlling contraceptive and pregnancy outcomes of their female partners or otherwise 

enforcing their own reproductive intentions, whether in direct conflict with or without regard for the 

woman’s intentions and desires (Clark et al. 2014; Miller and McCauley 2013; Moore, Frohwirth, and 

Miller 2010; Obstetricians and Gynecologists 2013). Reproductive coercion is considered to be a form of 

IPV by some (Falb et al. 2014; Maxwell et al. 2015; Moore, Frohwirth, and Miller 2010; Park et al. 
3 

2016), while others conceptualize reproductive coercion as distinct from IPV, although possibly 

associated with or co-occurring with IPV (Gee et al. 2009; Hall et al. 2014). Reproductive coercion and 

control consists of contraception sabotage, pregnancy coercion, sexual and pregnancy pressure, and 

attempts to control the outcome of a pregnancy (Moore, Frohwirth, and Miller 2010; Park et al. 2016; 

Silverman and Raj 2014). Moore et al. (2010) propose that reproductive control reduces women’s 

reproductive empowerment and leads to decreased contraceptive use and unwanted pregnancy. In their 

review and meta-analysis, Maxwell et al (2015) suggest that women may circumvent contraceptive 

sabotage by discreetly using contraception. This literature suggests one pathway by which women who 

experience IPV may be less able to use contraception consistently in pursuit of their reproductive goals 

and to experience more interruptions in their contraceptive use. 

With the possible exception of reproductive coercion studies, the IPV literature has seldom delved further 

beyond contraceptive status into the nuances or the dynamics of contraceptive behavior, such as 

interruptions in use, abandonment, or discontinuation. One exception are studies linking IPV with 

inconsistent condom use (e.g., Kacanek et al. 2013; Van Horne et al. 2009), although this literature is 

often framed as one of sexually risky behaviors and disease prevention, rather than reproductive 

aspirations. Another exception is one U.S. study in which the experience of any IPV (emotional, physical, 

or sexual violence), either of short or long duration, was related to more changes in contraceptive method. 

The same study also found that women in the United States who experienced IPV over longer periods of 

time were more likely to use covert, long-acting methods such as injections, implants, IUDs, or 

sterilization (Fantasia et al. 2012). Another U.S. study found that women who experienced violence—

emotional, physical, or sexual— as an adult did not discontinue contraception at faster rates if they were 

using a long-acting, reversible (LARC) method; but such women who were using a shorter-term method 

were more likely to discontinue sooner than women who had not experienced violence (Allsworth et 

al. 2013). 

Although IPV research has not investigated the more nuanced aspects of contraceptive use more 

extensively, there is an established demographic literature on contraceptive dynamics such as methodswitching and discontinuation. This literature has focused on documenting contraceptive discontinuation 

rates, comparison of discontinuation among specific contraceptive methods, reasons for discontinuation, 

and determinants of discontinuation (e.g., Ali and Cleland 2010a; Ali, Cleland, and Shah 2012; Blanc et 

al. 2009; Bradley, Schwandt, and Khan 2009; Castle and Askew 2015; Haddad et al. 2013; Jain et al. 

2013; Staveteig, Mallick, and Winter 2015). This literature has found that side effects/health concerns, as 

well as cost and availability are reasons for discontinuation or method switching. Further, discontinuation 

rates vary consistently by method type (Ali and Cleland 1995; Ali, Cleland, and Shah 2012; Bradley, 

Schwandt, and Khan 2009; Maslyanskaya et al. 2016; Modey, Aryeetey, and Adanu 2014; Steele and 

Curtis 2003). Individual factors commonly associated with discontinuation include fertility desires, parity 

education, socio-economic status, and sometimes age. However, this demographic literature has seldom 

examined the experience of IPV as a possible predictor of contraceptive discontinuation. One study that 

attempted to do so in Bolivia was limited by small sample sizes and found that side effects, not IPV, 

influenced discontinuation behavior (McCarraher, Martin, and Bailey 2006). 

This study seeks to fill a void left by the intersection of the demographic and IPV literatures on women’s 

contraceptive behavior. The study is informed by the IPV and reproductive coercion literature that 

demonstrated that women experiencing IPV disproportionately experience unintended pregnancies, 

thereby suggesting greater difficulty in succeeding in their attempts to control their fertility. This study 

explores whether and to what degree women who experience IPV have greater difficulty using 

contraception consistently without interruption until a pregnancy is desired. Specifically, this study 

analyzes contraceptive discontinuation by experience of IPV in 11 countries with recent data from DHS 

surveys. We use time-bound measures of IPV experience and contraceptive behavior to collocate these 

experiences in the same 12-month window. We assess experience of multiple forms of violence 
4 

(emotional, physical, sexual, or any IPV) with contraceptive discontinuation behavior. We focus 

specifically on discontinuation while still in need of contraception (DWSIN) and compare this to 

discontinuation due to no further need and total discontinuation in study countries. We hypothesize that 

women who experience IPV will be more prone to discontinuation and, more specifically, discontinuation 

while still in need of contraception and that this effect will be most pronounced among women who use 

shorter-term, non-LARC methods of contraception. 
5 

2. Methods and Data 

This study uses data from 11 recent Demographic and Health Surveys with 5 from sub-Saharan Africa, 2 

from North Africa/West Asia, 2 from Central Asia, 1 from Southeast Asia, and 1 from Latin America and 

the Caribbean. For inclusion in the study, we required that surveys meet the following conditions: 

conducted since 2010; data publicly available by June 2016; survey has a two-column reproductive 

calendar; survey has a domestic violence module with a full complement of items assessing emotional, 

physical, and sexual violence; and, to ensure a sufficient number of cases for analysis, a minimum sample 

size of 2,000 women completing the domestic violence module and a modern contraceptive prevalence 

rate of at least 25%. The DHS surveys included in the analysis are: Cambodia 2014, Egypt 2014, 

Honduras 2011-12, Jordan 2012, Kenya 2014, Kyrgyz Republic 2012, Rwanda 2014-15, Tajikistan 2012, 

Uganda 2011, Zambia 2013-14, and Zimbabwe 2011-11. Sample parameters for the study’s surveys are 

found in Table 1. 

Table 1. Selected characteristics for surveys included in the analysis 

Country 

Year of 

survey 

Sample 

type 

# of women 

interviewed 

(unweighted)

Eligible 

woman 

response 

rate 

Sample 

design for 

violence 

module 

# of women 

interviewed 

with violence 

module (unweighted) 

Violence 

module 

response 

rate 

Cambodia 2014 All women 17,578 97.6 one-third of 

selected 

households 

4,307 99.3 

Egypt 2014 Ever-married 21,762 99.4 one-third of 

selected 

households 

6,693 97.4 

Honduras 2011-12 All women 22,757 93.2 all selected 

households 

15,833 99.9 

Jordan 2012 Ever-married 11,352 97.3 two-thirds of 

selected 

households 

7,027 92.1 

Kenya 2014 All women 31,079 96.6 two-thirds of 

selected 

households 

5,657 99.7 

Kyrgyz 

Republic 

2012 All women 8,208 99.1 all selected 

households 

6,022 99.4 

Rwanda 2014-15 All women 13,497 99.5 one-fourth of 

selected 

households 

2,679 99.4 

Tajikistan 2012 All women 9,656 98.6 all selected 

households 

5,547 99.6 

Uganda 2011 All women 8,674 93.8 two-thirds of 

selected 

households 

2,056 99.3 

Zambia 2013-14 All women 16,411 96.2 all selected 

households 

11,778 99.6 

Zimbabwe 2010-11 All women 9,171 93.3 all selected 

households 

6,694 98.0 

Notes: 

Only one eligible respondent per household is randomly selected for interview with the domestic violence module, 

regardless of the number of eligible respondents present in the household. 

Of the 31,079 women interviewed in Kenya, 14,741 were interviewed with the ‘full questionnaire’ that includes the 

reproductive calendar and 16,338 were administered the ‘short questionnaire’ that excluded the reproductive 

calendar. 
6 

Sample sizes for the domestic violence module range from 2,056 (Uganda) to 15,833 (Honduras). In most 

surveys, all eligible women are interviewed without regard to marital status. In two surveys, Egypt and 

Jordan, only ever-married women are interviewed. Nevertheless, data on the forms of IPV that we 

investigate are from ever-married women only. The violence module was administered in every selected 

household in approximately half of the surveys. The module was administered in two-thirds of selected 

households in 3 surveys; in one-third of selected households in two surveys, and in every fourth selected 

household in the Rwanda DHS survey. Response rates for both the violence module and the survey 

exceed 90% in all 11 surveys. 

DHS surveys are nationally representative, population-based household surveys that employ standardized 

questionnaires and modules for household, women’s, and men’s interviews (ICF International 2011). The 

surveys employ multistage, clustered area sampling techniques. In the first sampling stage, the country is 

stratified into major sub-national regions from which census-based enumeration areas are selected with 

probability proportional to size. The major regions may or may not coincide with administrative units (as 

in Uganda) and consist of provinces or groups of provinces (Cambodia, Zambia, and Zimbabwe), 

governorates (Egypt and Jordan), departments (Honduras), or oblasts (Kyrgyz Republic and Tajikistan). 

The Kenya 2014 and Rwanda 2014-15 surveys stratified districts in the first sampling stage. Urban areas 

and less populous areas are typically oversampled in the first sampling stage in order to produce reliable 

regional estimates and rural-urban comparisons of health indicators. A mapping and household listing 

exercise is then implemented in each selected enumeration area. In the second sampling stage, households 

are randomly selected from the household list within each enumeration area. 

Pre-calculated sampling weights included in the datasets are applied. These weights account for both 

sampling probability and non-response. In this study, we apply the weight that accounts for sample 

selection and non-response for the domestic violence module. In addition, we use the complex survey 

(svy) commands available within Stata 14.1 to account for the clustered sampling design and to estimate 

robust standard errors as the basis for the 95% confidence intervals reported in the following sections. 

2.1. Data Structure 

2.1.1. Reproductive calendar 

We base our analyses of discontinuation and other interruptions to contraceptive use on data obtained 

through the reproductive calendar1

. The reproductive calendar is an instrument in DHS surveys that 

records month-by-month, retrospective information on episodes of contraceptive use or non-use, live 

births, pregnancies, and terminations2

 for, typically, the five completed years preceding the survey3. The 

reproductive calendar has become the primary data source for estimating contraceptive discontinuation 

rates and the analysis of other contraceptive dynamics such as contraceptive failure, switching, and 

postpartum adoption of contraception (Ali, Cleland, and Shah 2012; Bradley et al. 2012; MacQuarrie et 

al. 2014; Staveteig, Mallick, and Winter 2015; Winfrey and Rakesh 2014). 

Occasionally, the reproductive calendar is reduced to its simplest form: a single column calendar that 

records only monthly data on reproductive events and contraceptive use. The core questionnaire for DHS-

 

1

 Because of its prominence to the study of contraceptive dynamics, the calendar is often referred to as the 

“contraceptive calendar” although it captures a broader range of reproductive events than contraceptive use and is, in 

actuality, a “reproductive calendar”. The terms are used interchangeably in this study. 

2

 Terminations may include induced abortions, miscarriages, and stillbirths. 

3

 The exact length of the reproductive calendar is determined by the duration of data collection and the month in 

which the respondent is interviewed. 
7 

7, the current phase of The DHS Program, stipulates a two-column calendar (ICF International 2015). 

This more common form of the reproductive calendar is comprised of monthly data on reproductive 

events and contraceptive use in column 1 and the reason for discontinuation in column 2. A sample twocolumn reproductive calendar is displayed in Figure 1. We make use of these data on discontinuation, 

which requires that all surveys in this study include the two-column calendar. On rare occasions, the 

reproductive calendar is modified with three or four columns to obtain additional monthly, retrospective 

data on marital or union status at the time of reproductive events and/or the source of the contraceptive 

method. The Egypt 2014 DHS is one such example of the expanded calendar (MoHP, El-Zanaty and 

Associates, and ICF International 2015). The analyses in this study do not use these data from additional 

calendar columns. 

The first column of the calendar records (1) pregnancies, births, and terminations followed by (2) 

episodes of contraceptive use, and (3) episodes of no contraceptive use. In each case, this involves 

working from the month of the interview to the beginning of the calendar period. An alphabetic P, B, or T 

code indicates that the respondent experienced a pregnancy, birth, or termination in that month. A 

numeric code 1-9 or alphabetic code J-Y indicates the method of contraception being used. The numeric 

code 0 indicates that the respondent was not using any method of contraception, and was not experiencing 

a pregnancy, birth, or termination. Only one method of contraception is recorded in each row (month) in 

the first column. If a respondent used more than one method in a given month, the code corresponding to 

the more effective method is recorded (Hatcher et al. 2011; ICF International 2012; World Health 

Organization Reproductive Health and Research (WHO/RHR) and Johns Hopkins Bloomberg School of 

Public Health Center for Communitation Programs (JHU/CCP) 2011). The interviewer uses the following 

prompts to establish the starting and ending month for each episode of contraceptive use and to ensure 

that all segments of the calendar period are completed (ICF International 2012, 2015): 

• When was the last time you used a method? Which method was that? 

• Between the (EVENT1) in (MONTH/YEAR) and the (EVENT2) in (MONTH/YEAR), did you or your 

(husband/partner) use a method of contraception? Which method was that? Note that EVENT1 may 

be the birth of a child, the termination of a pregnancy, the end of a prior episode of contraceptive use, 

and EVENT2 may be the start of a pregnancy or the beginning of a later episode of contraceptive use. 

• When did you start using that method? How many months after (EVENT1)/birth of (NAME) did you 

start using that method? 

• How many months did you use (METHOD)? 

• What happened when you stopped using that method: did you not use any method, did you start using 

a different method, or did you become pregnant? 

• IF DELIBERATELY STOPPED TO BECOME PREGNANT: How many months did it take you to 

get pregnant after you stopped using (METHOD)? 
8 

Figure 1. Sample DHS reproductive calendar 
9 

For the first column, a completed calendar is one in which there is a single code entered in every row 

from the start of the calendar and including the row corresponding to the month of interview. Unlike the 

first column, the second column of the calendar is not completed with a discontinuation code in every 

row; the number of codes in column 2 is the same as the number of interruptions of method use the 

respondent experiences in column 1. A discontinuation code appears only in those rows that correspond to 

the last month of each episode of contraceptive use, when the respondent stopped using the method of 

contraception. This code records the reason for discontinuation; only the primary reason for 

discontinuation is recorded. The interviewer uses the following questions to establish the reason for 

discontinuation (ICF International 2012, 2015): 

• Why did you stop using (METHOD)? 

• IF A PREGNANCY FOLLOWED: Did you become pregnant while using (METHOD), did you stop 

to get pregnant, or did you stop for some other reason? 

2.1.2. Structure of the calendar data 

In the standard individual recode data files available from The DHS Program4

, data from the reproductive 

calendar are recorded in a series of string variables (vcal variables) for each of the columns in the 

calendar (ICF International 2013). Each string variable allows up to 80 characters, with each character 

representing a single month in the calendar period. The first character in each variable represents the most 

recent month (month of interview) and is preceded by blank spaces for points in time after the date of 

interview, while the character in the last position represents data for January of the year in which the 

calendar started. 

To facilitate analysis of the calendar data, data in the string variables were transformed into event data 

files, in which each reproductive event in the calendar—pregnancy, birth, termination, episode of 

contraceptive use, or non-use—becomes one observation in the dataset. Thus, each respondent (case) may 

contribute more than one observation in the data file. In addition to a variable that classifies the type of 

reproductive event, each observation (row) in the data file includes variables that code the start date, end 

date (in century-month codes), and duration of the event. Each observation also contains data from the 

second column of the calendar that describes how the observation ended (e.g. if the observed episode of 

contraceptive use is discontinued or if the observation is censored) and the reason for discontinuation, as 

well as the previous and successive event types. We used CSPro to transform the data and create event 

data files for analysis in Stata 14.1. 

2.2. Domestic Violence Module 

This study uses the domestic violence module (ICF International 2016), which is a module first developed 

and standardized by The DHS Program in 2000 and is now commonly contained in DHS surveys. The 

domestic violence module has been included in 93 surveys since the module’s inception and in 40 of 58 

of the DHS surveys5

 conducted since 2010. The domestic violence module is frequently administered to a 

sub-sample of DHS survey respondents, e.g. in every second or third household. In contrast to the DHS 

survey, which interviews all eligible respondents in the household, the domestic violence module is 

administered to just one randomly selected eligible respondent in each selected household as an added 

ethical precaution, in accordance with the WHO guidelines on the ethical conduct of domestic violence 

research (ICF International 2016; World Health Organization 2001). The domestic violence module is 

 

4

 Available from http://www.dhsprogram.com/data/available-datasets.cfm. 5

 This figure includes standard DHS, continuous DHS, and special DHS surveys. 
10 

approved by the internal review board (IRB) at ICF International, along with the full DHS survey 

questionnaire. 

The domestic violence module investigates multiple forms of violence: emotional violence, physical 

violence, sexual violence, and marital control (both suspicion and isolating controlling behaviors). 

Previous comparative analysis has shown that these five forms of violence are distinct domains or factors 

across diverse sociocultural settings, with emotional and physical violence being related sub-factors to a 

common violence factor and with suspicion and isolation being related sub-factors to a common marital 

control factor (MacQuarrie, Winter, and Kishor 2013, 2014). The experience of emotional, physical, and 

sexual forms of violence is captured through the use of an abbreviated version of the conflict tactics 

scales (CTS) (Straus 1979, 1990; Straus et al. 1996). One advantage of the CTS scale approach is that the 

items that comprise it refer to specific behavioral acts, regardless of whether they are understood to 

constitute violence in a given cultural setting (Kishor and Bradley 2012). The violence instrument collects 

data on these items in a common manner across surveys. The instrument includes questions that ask evermarried women whether their current or most recent (if divorced, separated, or widowed) husband6

 has 

ever perpetuated a series of behavioral items. Women who respond in the affirmative to a particular item 

are then asked about the frequency with which they have experienced that violent behavior (often, 

sometimes, or not at all) in the 12 months preceding the interview, as depicted in Figure 2. 

This study focuses on emotional, physical, and sexual violence—hereafter referred to collectively as 

IPV—perpetrated by the current spouse. We exclude marital control (suspicion and isolation) from our 

analysis because these items are not time-bound7

. Elsewhere in the violence module, women are asked 

about their experience with physical and sexual forms of violence perpetuated by actors other than their 

current/most recent husband. Marital control by one’s spouse and physical and sexual violence by other 

actors are excluded from the present study. 

Figure 2. Emotional, physical, and sexual violence items in the DHS Domestic Violence Module 

Continued 

 

 

6

 The term husband refers equally to the woman’s legal spouse or partner who lives with her as if married. The two 

types of unions are not differentiated in this study. 

7

 Unlike emotional, physical, and sexual violence, we cannot discern from DHS data whether women experienced 

marital control often or sometimes in the last 12 months, ever in the past but not during the last 12 months, or never. 
11 

Figure 2—Continued 

2.3. Analytic Strategy 

The goal of this study is to investigate if IPV is associated with more interruptions to continuous and 

effective contraceptive use. Specifically, the study investigates whether women who experience IPV are 

more likely to discontinue contraception while still in need. 

2.3.1. Period of observation and unit of analysis 

This study uses data on the experience of IPV in the past 12 months as well as data from the reproductive 

calendar on contraceptive use. The term “period of observation” refers to the period during which we 

assess women’s exposure to the risk of contraceptive discontinuation. We define our period of 

observation as the 12 months preceding the interview, and exclude contraceptive episodes that occur in 

prior spells of the calendar. By restricting our period of observation in this manner, we are able to coposition our measures of contraceptive discontinuation and IPV in the same 12-month window. 

Because the phenomenon of interest in this study is contraceptive discontinuation, we limit ourselves to 

episodes in which women were using contraception at the start of our period of observation (12 months 

prior to interview). This means that our measures of IPV refer to the experience of violence after 

contraception has been adopted8

. 

We further restrict our analysis to the first episode of contraceptive use in our period of observation. This 

restriction means that each woman contributes a single episode to our analysis and eliminates potential 

 

8

 Women who experience IPV during our period of observation may also have experienced such violence prior to 

the period of observation. 
12 

unobserved effects from multiple episodes contributed by a single woman. Among the surveys included 

in this study, the proportion of women with more than one episode of contraceptive use in the period of 

observation ranges between 1.2% (Rwanda 2014-15) and 4.8% (Honduras 2011-12). 

In addition, a 12-month window is not likely to be sufficient to observe both the initiation of a subsequent 

episode of contraceptive use (which most likely occurs well into our 12-month observation period, after 

the first episode of contraceptive use has concluded) and whether or how that episode concludes. A recent 

study of contraceptive discontinuation in 60 countries indicates that 38% of episodes are discontinued 

within 12 months whereas the median duration of contraceptive use before discontinuation approaches 24 

months (Ali, Cleland, and Shah 2012). A second advantage to restricting our analysis to the first episode 

of contraceptive use is that we remove those episodes that are most likely to be censored, or incomplete, 

because discontinuation occurs at some point after we stop observing them. 

Our unit of analysis is episodes of contraceptive use. However, since each woman contributes one 

episode, this is equivalent to using women as the unit of analysis. For ease of interpretation, this study 

refers to women or contraceptive users rather than episodes of contraceptive use. 

2.3.2. Sample restriction 

Table 2 presents information on the derivation of the analytic sample. The figures presented here are 

weighted numbers. The number of women interviewed in the DHS surveys included in this study range 

from 8,208 in the Kyrgyz Republic to 22,757 in Honduras. The Kenya survey interviewed a total of 

31,079 women; however, we exclude 16,338 women who were interviewed with the short questionnaire 

rather than the full questionnaire that included the 2-column reproductive calendar. 

We restrict our analysis to currently married women. We exclude never-married women because the 

survey questions on intimate partner violence by the husband are not applicable to them. We exclude 

formerly married women because their marriages, by definition, have dissolved by the time of the 

interview and they could not have been exposed to IPV by their last husband throughout the 12-month 

observation period. Furthermore, formerly married women may not be exposed to the risk of 

discontinuation while still in need within the observation period if the change in their marital status 

conveys a change in their need status. Preliminary analyses conducted on samples including formerly 

married women yielded results similar to those restricted to currently married women and are not 

presented in this study. The weighted number of currently married women in the study surveys ranges 

from 5,256 in Kyrgyz Republic to 20,460 in Egypt. 

Since the probability of selection for the domestic violence module varies across surveys, the weighted 

number of currently married women with data on their experience of IPV ranges from 1,307 in Uganda to 

8,390 in Honduras. 

Finally, we restrict our analysis to currently married women who are using a modern, temporary method 

of contraception at the start of the observation period. We exclude women who/whose husbands were 

sterilized at the start of the observation period because these women are not at risk of discontinuation. The 

varying prevalence of modern, temporary contraceptive use across study surveys results in final analytic 

sample sizes range from 228 women in Uganda to 3,345 women in Egypt. 
13 

Table 2. Derivation of the analytic samples 

Survey 

weighted # of 

women interviewed

weighted # of 

currently married 

women 

weighted # of 

currently married 

women with the 

violence module 

weighted # of 

currently-married 

women using modern, 

temporary 

contraception 

12 months prior to 

interview 

(Analytic Sample) 

Cambodia 2014 17,578 11,898 2,977 931 

Egypt 2014 21,762 20,460 6,272 3,345 

Honduras 2011-12 22,757 12,847 8,930 3,283 

Jordan 2012 11,352 10,801 6,714 2,646 

Kenya 2014 14,741 8,503 3,352 1,437 

Kyrgyz Republic 2012 8,208 5,256 3,833 1,084 

Rwanda 2014-15 13,497 6,982 1,415 585 

Tajikistan 2012 9,656 6,504 3,812 879 

Uganda 2011 8,674 5,418 1,307 228 

Zambia 2013-14 16,411 9,859 7,145 2,422 

Zimbabwe 2010-11 9,171 5,703 4,094 1,899 

Note: 

Kenya figures include only those women respondents who were interviewed with the ‘full questionnaire’ that 

included the reproductive calendar. They exclude 16,338 women respondents who were administered the ‘short 

questionnaire’. A total of 31,079 women were interviewed with either the full or short questionnaire. 

2.3.3. Statistical analyses 

In the following sections of this report, we present descriptive data on contraceptive use, the experience of 

IPV, and contraceptive discontinuation in the 12-month observation period. Discontinuation data are 

disaggregated by discontinuation while still in need and discontinuation due to no further need. Our 

discussion of the study results focuses on discontinuation while still in need. 

Subsequently, we examine the bivariate associations between discontinuation while still in need and the 

experience of IPV. We assess these associations using unadjusted logistic regression models of 

discontinuation regressed over measures of IPV and present odds ratios. We evaluate associations of 

discontinuation with several measures of IPV: three separate forms of violence, the experience of any 

IPV, and the experience of multiple forms of violence (the latter is presented in the appendix). 

Finally, we estimate multivariate models of discontinuation while still in need. Multivariate models take 

the form of logistic regressions, with discontinuation while still in need regressed over the 

aforementioned measures of IPV, individual socio-demographic characteristics, and known correlates of 

discontinuation. These models also control for duration of contraceptive use prior to the observation 

period. 

While some studies of contraceptive discontinuation apply hazards models, such research neither does so 

consistently nor has it reached consensus on the shape of the hazard to be modeled, with studies applying 

Weibull, Gompertz, Cox, or discrete time models, among others (Ali and Cleland 2010b; Bradley, 

Schwandt, and Khan 2009; MacQuarrie et al. 2014; Staveteig, Mallick, and Winter 2015). We opt for 

logistic models rather than hazard models for several reasons. We have already taken steps to limit right 

censoring of episodes of contraceptive use by limiting our analysis to the first episode in the observation 
14 

period. In addition, our substantive focus is on whether women discontinue contraception—and 

specifically whether women who experience IPV are more or less likely to discontinue contraception than 

are women who do not—in the period of observation rather than on the timing of discontinuation. Finally, 

our measures of IPV refer to the 12-month period of observation; we are unable to introduce violence as a 

time-varying variable into a discrete-time hazard model with time intervals shorter than one year (e.g. in 

months). A hazard model with a single unit of time approximates a logistic model. The estimation of a 

logistic model rather than a hazards model may underestimate discontinuation and underestimate the true 

association of discontinuation with IPV if censoring is severe; however, this is a less egregious error than 

overestimating their true association. 

In all analyses presented in this study, each survey is analyzed in separate models. Data are not pooled 

across surveys. 

2.4. Measures 

2.4.1. Modern, temporary contraceptive use 

We restrict our analysis to women who are using modern, temporary contraception at the start of the 

observation period. The following methods are considered modern, temporary contraceptive methods: 

oral contraceptive pill, intrauterine device (IUD), injection, implants, male condom, female condom, 

lactational amenorrhea method (LAM), emergency contraception, standard days method, and vaginal 

methods such as diaphragm, foam, and jelly. We exclude male and female sterilization since these are not 

temporary methods and periodic abstinence, withdrawal, and other traditional/folk methods since these 

are not modern methods. For the remainder of this report, the term “contraceptive use” refers to the use of 

modern, temporary methods of contraception. 

Methods of contraception 

The contraceptive method used is a consistent and strong predictor of discontinuation (Ali and Cleland 

1995; Ali, Cleland, and Shah 2012; Bradley, Schwandt, and Khan 2009; Maslyanskaya et al. 2016; 

Modey, Aryeetey, and Adanu 2014; Steele and Curtis 2003). In our multivariate analysis, we control for 

contraceptive method with a variable that classifies methods as long-acting, reversible contraceptive 

methods (LARCs) and non-LARC methods, i.e. shorter term methods. LARCs include IUDs and 

implants. After insertion, LARCs offer highly effective protection against pregnancy for a period of 

several years, which is longer than the study’s period of observation. Although injections are sometimes 

categorized as a LARC method (Bertrand et al. 2014; Darroch 2013; Staveteig, Mallick, and Winter 

2015), we classify them as a non-LARC method in this study. We exclude them from the LARC category 

because they typically offer protection for three months, which is a far shorter period of protection than 

IUDs and implants. A one-month injection is also available in Egypt. Non-LARCs include injections, 

pills, condoms, and other modern methods. 

Another feature of LARCs is that, after insertion, they require that the user go to a health provider to 

remove the method in order to stop its use. Thus, their discontinuation requires action on the part of the 

user (active discontinuation). In contrast, IPV may interfere with the active discontinuation of LARC 

methods in the same way that it may interfere with women’s actions to adopt contraception, by interfering 

with a woman’s ability to access desired services in a timely manner. 

Users of non-LARCs, in contrast, may discontinue contraceptive use by simply failing to continue taking 

action to contracept, that is, by not having the next injection when due or by stopping taking the pill. This 

is called passive discontinuation. Prior evidence consistently shows higher discontinuation rates among 

non-LARC users than users of LARCs (Ali, Cleland, and Shah 2012; Bradley, Schwandt, and Khan 
15 

2009). We hypothesize that women who use non-LARC methods and who experience IPV are more likely 

to discontinue contraceptive use than are women who use LARC methods and who do not experience 

IPV. Therefore, we control for the use of a LARC or non-LARC method. We also estimated additional 

models that interacted LARC/non-LARC method use and IPV experience (not shown). In these analyses, 

the interaction term was seldom statistically significant and its inclusion did not alter the interpretation of 

the base variables. Therefore, this study shows only the more parsimonious models that omit this 

interaction term. 

2.4.2. Discontinuation 

We define discontinuation as the interruption of contraceptive use for one month or longer. Most women 

who discontinue contraception, abandon contraception and do not resume contraceptive use during the 

observation period. More than 95% of our samples in all study countries have a single episode of 

contraceptive use. We operationalize our discontinuation outcome as a dichotomous variable, coded 1 for 

women who are using contraception 12 months prior to the survey, but who cease using contraception 

before the completion of the observation period and coded 0 otherwise. We further disaggregate this 

overall discontinuation into two types of discontinuation. 

Discontinuation due to no further need 

Women may discontinue contraception while still in need (DWSIN) or they may discontinue due to no 

further need. All women who discontinue contraception are asked the reason they discontinued. Women 

are considered to have discontinued due to no further need if they report that they stopped using 

contraception because they wanted to become pregnant or for any of these other fertility-related reasons 

for discontinuation: 

1. Infrequent sex/husband away 

2. Marital dissolution/separation 

3. Difficult to get pregnant/menopausal 

Discontinuation due to no further need is operationalized similarly to overall discontinuation: women who 

stopped using contraception due to these fertility-related reasons during the period of observation are 

coded 1; women who discontinued for other reasons or did not discontinue are coded 0. 

Discontinuation while still in need 

Discontinuation while still in need (DWSIN) refers to discontinuing for reasons other than wanting to 

become pregnant or no longer being at risk of becoming pregnant. These include: 

1. Health concerns/side effects 

2. Method inconvenient to use 

3. Wanted a more effective method 

4. Costs too much 

5. Lack of access/too far 

6. Other reasons, such as husband opposition to contraception 
16 

In our study, DWSIN is operationalized in a parallel manner as the other discontinuation variables: 

women who stopped using contraception for one of the above reasons during the period of observation are 

coded 1; women who discontinued for fertility-related reasons or did not discontinue are coded 0. DWSIN 

is this study’s focal outcome. In subsequent sections of this report, data on DWSIN are either presented 

next to data on discontinuation due to no further need and total discontinuation for purposes of 

comparison or only DWSIN data are presented in the results sections, with supplemental data on 

discontinuation due to no further need and total discontinuation available in the appendices. 

2.4.3. Intimate partner violence 

Emotional, physical, and sexual violence 

Three forms of IPV are considered in this study: emotional violence, physical violence, and sexual 

violence perpetrated by the current spouse. We examine these three forms of IPV separately and in 

combination. Since marital control may also exert an influence to the same degree as these forms of 

IPV—and the literature on reproductive coercion suggests more so—on women’s ability to continue 

contraceptive use, we do not analyze either suspicion or isolation domains of marital control because we 

cannot place their experience in the same 12 month window as our period of observation. 

We create a dichotomous measure of each of these three forms of violence. Currently married women 

who report experiencing any item of emotional violence in the 12 months prior to the survey—either 

‘sometimes’ or ‘often’—are coded as 1; women who have not experienced any emotional violence item in 

the 12 months prior to the survey are coded as 0. Items that constitute emotional violence are those found 

in question DV04 of Figure 2, and are confirmed by prior factor analyses to load on this form of violence 

with robust factor loadings (MacQuarrie, Winter, and Kishor 2013, 2014). The reference category (0) 

includes women who have never experienced emotional violence, and also includes women who may 

have experienced either physical or sexual violence—but not emotional violence—in the prior 12 months, 

as well as women who may have experienced emotional violence in the period before the study’s 

observation period but not within the prior 12 months. 

Separate measures of physical and sexual violence are coded in an identical manner. Actions that 

constitute physical violence are items found in Figure 2, question DV05 a-h. All were determined to load 

robustly onto a physical violence factor, except DV05g, which loaded more inconsistently and weakly 

(MacQuarrie, Winter, and Kishor 2013, 2014). Items that constitute sexual violence are DV05j-k, and are 

all highly loading on this factor (MacQuarrie, Winter, and Kishor 2013, 2014). 

Any intimate partner violence 

Any IPV is a composite variable in which women who have experienced one or more of emotional, 

physical, or sexual violence in the prior 12 months are coded as 1 and women who have not are coded as 

0. Unlike the separate measures for the individual forms of violence, the reference category for this 

variable (0) excludes women with experience of any form of violence in the past 12 months. Like the 

separate measures, this variable includes in the reference category the women who may have experienced 

one or more forms of violence prior to the study’s observation period. 

Multiple forms of violence 

A second composite variable captures the concurrent experience of multiple forms of violence. Women 

are coded as 1 if they experience any combination of two or more forms of violence in the 12 months 

prior to the survey: emotional and physical violence, physical and sexual violence, emotional and sexual 

violence, or all three forms of violence. Women with no experience of violence or who experienced a 
17 

single form of violence in the prior 12 months are coded as 0. These bivariate results are not presented in 

the main text but can be found in Appendix Table 17. 

Alternate measures of violence 

Because the IPV variables are our key independent variables of interest, we conducted sensitivity 

analyses that tested several alternate constructions of IPV. In bivariate analyses, we regressed our 

discontinuation outcomes (any discontinuation, DWSIN, discontinuation due to no further need) on the 

following alternatives: (1) in lieu of dichotomous variables capturing any versus no experience of 

violence in the prior 12 months, a 3-category variable that distinguished experiencing violence often, 

sometimes, or not at all (reference category) in the prior 12 months (Appendix Table 18). This variation 

disaggregates the “yes” category by frequency of the IPV experience; (2) in lieu of dichotomous 

variables, a 3-category variable with categories for experience of emotional (for example) violence in the 

prior 12 months, experience of other forms of violence but not emotional (for example) violence, versus 

no violence at all as the reference category (Appendix Table 19). This variation disaggregates the 

reference category to ensure no women experience any other form of violence are included in the 

reference group; (3) a series of variables that considers prior experience of violence, with categories that 

indicate experience of IPV in the prior 12 months, experience of IPV before the observation period but 

not during the prior 12 months, and never any experience of IPV (reference category). This variation adds 

precision to the timing of IPV (Appendix Table 20). These last alternate construction of variables were 

also tested in their association with using contraception at the start of the observation period, to test for 

selection bias if prior experience of IPV influenced the likelihood of using or not using contraception 

(Appendix Table 16). In testing all 3 alternate constructions of IPV, we tested each separate form of 

violence (emotional, physical, and sexual violence), the experience of any IPV, and the experience of 

multiple forms of IPV in separate models. 

Since none of these alternate constructions led to substantively different conclusions about the 

relationship between IPV and the discontinuation of contraception, we present findings using the original 

construction in the main text. Results of the sensitivity testing are found in Appendix Tables 16-21. 

2.4.4. Duration of contraceptive use 

In our models, we include as a control a measure for the duration of contraceptive use because the 

likelihood of discontinuation increases the longer that a woman has been using a method of contraception. 

Our measure calculates from the calendar data, in months, the duration of continuous contraceptive use 

prior to the start of the observation period. This measure is then collapsed into three categories, with 

approximately one-third of women in each survey falling into each tercile. These are: 1-12 months of use 

before the observation period; 13-36 months of use before the observation period; and more than 37 

months of use before the observation period. 

2.4.5. Socio-demographic controls 

In addition to measures for IPV experience in the last 12 months, use of a non-LARC method, and 

duration of contraceptive use, discontinuation models also include a range of socio-demographic controls. 

These are: age, wealth, residence, religion, education, number of living children, and employment. Each 

of these variables are standard in DHS surveys and comparable across countries. 

Age 

The age variable captures age of the respondent at the time of the survey and is categorized in five-year 

age groups. The 15-19 year age group serves as the reference category. 
18 

Household wealth quintile 

We use household wealth quintile as a measure of relative wealth. This measure is calculated based on 

ownership of a range of assets and housing materials. The construction of this measure, now standard in 

DHS surveys, is described in detail elsewhere (Rutstein 2008; Rutstein and Johnson 2004). The poorest 

wealth quintile serves as the reference category. 

Place of residence 

Place of residence captures whether the respondent resides in a rural or an urban area at the time of the 

survey, based on a priori classification of primary sampling units selected for the survey. Urban is the 

reference category. 

Religion 

A variable that captures the respondent’s religion is available in eight of 11 study surveys. The surveys 

that do not contain a religion variable are Jordan, Kyrgyz Republic, and Tajikistan. To make this variable 

comparable across study surveys, country-specific religious categories are combined into major religious 

groupings of Christian, Muslim, and other. Christian is used as the reference category because it is the 

majority religious grouping in 6 of the 8 country surveys that include a religion measure. 

Education 

Women’s education at the time of the survey is categorized as no education, primary, secondary, and 

higher education. No education is used as the reference category. 

Employment status 

The employment variable assesses women’s employment status at the time of the survey and is 

categorized as not employed, not employed for cash, and employed for cash. Not employed is the 

reference category. 

Number of children 

We use a count of the number of a woman’s living children at the time of the survey. This variable is 

categorized as follows: no children, 1-2 children, 3-4 children, and 5 or more children. The reference 

category is 0 children. 

Marital duration 

Marital duration is calculated from two measures collected in DHS surveys: age at the time of marriage, 

subtracted from age at the time of the survey, in completed years. This measure in whole years is further 

reduced to 5-year categories as a standard variable in the standard recode datasets. The categories are: 0-4 

years, 5-9 years, 10-14 years, 15-19 years, 20-24 years, 25-29 years, and 30 years or more. Women in the 

shortest category of marital duration (0-4 years) serve as the reference category. This measure is included 

in bivariate analyses but excluded from multivariate analyses because of multicollinearity with number of 

children. 
19 

2.4.6. Other interruptions to contraceptive use 

In this study on interruptions to contraceptive use, we analyze contraceptive discontinuation (and 

specifically, discontinuation while still in need). Discontinuation, however, is not the only type of 

interruption that contracepting women may experience. Women may experience contraceptive failure by 

becoming pregnant while using contraception, for example. Women may also experience a temporary 

hiatus, by stopping contraceptive use for one month or more and later resuming to use contraception, or 

they may abandon contraceptive use altogether. We define discontinuation as the interruption of 

contraceptive use for one month or longer. Therefore, we do not distinguish in the main analyses 

presented here between discontinuation that is abandonment of or a hiatus in use. 

Exploratory analyses displayed in Appendix Table 21 show the percentage of women using contraception 

who experienced any interruption to their contraceptive use in the 12 months prior to the survey, 

consisting of (a) hiatus in use; (b) abandonment discontinuation (while still in need, due to no further 

need, and total); (c) failure; and (d) any interruption by experience of any IPV. We define a hiatus as the 

temporary cessation of contraception for one month or more followed by the resumption of contraceptive 

use during the 12 month observation period. We define abandonment discontinuation as the cessation of 

contraception without resumption of contraceptive use during the 12 month observation period. We 

classified women as experiencing contraceptive failure if they did not report that they discontinued 

contraception because they wanted to get pregnant but were using contraception at the time they became 

pregnant. There were few cases of hiatus discontinuation in the study countries. The experience of any 

IPV is not statistically significantly associated with either hiatus in contraceptive use or contraceptive 

failure in any of the study countries. The associations of any IPV with abandonment discontinuation are 

similar to those with discontinuation while still in need, no further need, and total discontinuation— 

without distinction to hiatus or abandonment—reported elsewhere in this study. 

We, further, do not consider method switching to be a type of interruption to contraceptive use. If a 

woman stops using one method and begins using another method, so long as a method of contraception is 

being used continuously, we classify her as not having discontinued contraceptive use. Method switching 

is certainly a change in contraceptive behavior, and one that may be related to a woman’s experience of 

IPV. Matters of method choice and switching methods are deserving of inquiry, but are beyond the scope 

of the present study. 

21 

3. Prevalence of Contraception and Intimate Partner Violence in 

Study Surveys 

3.1. Contraception Profile of Study Surveys 

The surveys selected for this study reflect a range of contraceptive experiences. Figure 3 summarizes 

contraceptive prevalence; specifically, it displays the proportion of currently married women who are 

using any method of contraception and the proportion using a modern method of contraception. Figure 4 

presents the method mix or, stated otherwise, the contribution of each method of contraception to the 

overall contraceptive prevalence. Shorter-term, non-LARC methods (injections, pill, and other modern 

methods) are depicted in shades of blue, LARC and permanent methods (IUD, implants, and sterilization) 

in reds, and traditional/folk methods in green. 

One widely used measure of the intensity of family planning programming in a given country is the 

Family Planning Effort Index score. These scores have been calculated at periodic intervals since 1972 

(Kuang and Brodsky 2016; Ross and Stover 2001; Ross and Smith 2011) and are based on data obtained 

from 10-15 experts in each country with a structured questionnaire9

. Experts rate national family planning 

programs on items that align with four components: 

• Policies—national policies on fertility reduction and family planning, the legal age of marriage, the 

support of public officials, program leadership and funding environment, and regulations affecting 

contraceptive supplies. 

• Services—service delivery mechanisms (e.g. private sector involvement, social marketing, 

postpartum integration, home visits, and community-based distribution (CBD), among others), 

administrative structure, training, personnel performance, logistics, supervision, and 

incentives/disincentives for contraceptive adoption. 

• Evaluation—record-keeping, evaluation, and use of data by management. 

• Access—access to specific contraceptive methods, access to safe abortion, reversibility of long-acting 

and permanent methods, and overall quality of family planning services. 

Index scores are standardized to range from 1 to 100 for each component and combined into an overall 

score, with 100 representing the maximum possible family planning program effort (Kuang and Brodsky 

2016; Ross and Stover 2001; Ross, Stover, and Adelaja 2007). Figure 5 displays the Family Planning 

Effort Index scores for each study country, as calculated by Avenir Health for 2014. In our study 

countries, Family Planning Effort Index scores range from 44 (Zambia) to 74 (Rwanda), out of a possible 

100 point index. 

 

9

 The Family Planning Effort questionnaire and data are available from Avenir Health at 

http://www.track20.org/pages/data/FPE. 
22 

Figure 3. Proportion of currently married women age 15-49 currently using contraception 

Note: Modern contraceptive methods include female/male sterilization and the following temporary methods: oral contraceptive pill, 

intrauterine device (IUD), injection, implants, male/female condom, lactational amenorrhea method (LAM), emergency contraception, standard 

days method, and vaginal methods like diaphragm, foam, and jelly. Traditional methods consist of: periodic abstinence, withdrawal, and other 

traditional/folk methods. 

One inclusion criterion for this study was a modern contraceptive prevalence rate (mCPR) equal to or 

greater than 25%. Figure 4 shows that, among currently married women, the mCPR ranges from 

approximately 26% in Tajikistan and Uganda to 64% in Honduras. Similarly, the overall CPR ranges 

from approximately 30% to 73% in these countries, respectively. The difference between these two 

indicators is greatest in Cambodia and Jordan, where the use of traditional/folk methods is substantial. 

The modern contraceptive rate exceeds 50% in Kenya, Egypt, and Zimbabwe. 

Figure 4 indicates that it is not uncommon for one or two methods to be the majority of all contraceptive 

use. However, there is diversity among the study countries in terms of the dominant method. The IUD 

and injections are the most commonly used methods in four countries. Injections are predominately used 

in several of the African countries, while IUDs are more commonplace in North African/Middle 

East/Central European countries. Pills are the most commonly used method in two countries, 

Zimbabwe—where they are used by 7 out of 10 contraceptive users—and Cambodia, and closely follow 

injections use in Zambia. The most commonly used method in Honduras is female sterilization, followed 

by injections. 

3.1.1. Cambodia 

Cambodia has a Family Planning Effort Index score of 55.4, which is near the median for countries 

included in this analysis and has remained steady since scores were last calculated in 2009. Its highest 

component score is for family planning policies (61) and lowest is in evaluation (53). More than half 

27.8

30.1

36.2

56.4

61.1

49.1

53.2

58.0 58.5 58.5

73.0

25.8 26.0

33.7

38.8 42.3 44.8 47.5

53.2 56.9 57.3

63.8

Tajikistan

2012

Uganda

2011

Kyrgyz

Republic

2012

Cambodia

2014

Jordan

2012

Zambia

2013-14

Rwanda

2014-15

Kenya

2014

Egypt

2014

Zimbabwe

2010-11

Honduras

2011-12

any method modern method
23 

(56%) of currently married women are using some method of contraception. Substantially fewer 

women—39%—are using a modern method. 

Shorter-term methods represent just over half of all contraceptive use. The most common method—

pills—are used by 18% of women and contribute nearly one-third of all contraceptive use. Also available 

in the Cambodian contraceptive market is a monthly oral contraceptive pill, produced by a Chinese 

manufacturer; this method is not as common as its more traditional daily counterpart (National Institute of 

Statistics, Directorate General for Health, and ICF International 2015). Traditional methods 

(predominantly withdrawal) closely follow pill use and also make up nearly one-third of all contraceptive 

use. Injections are the second most common modern method and contribute 16% to overall contraceptive 

use. LARC and permanent methods (IUD, implants, and sterilization) are not a prominent feature of 

contraceptive patterns in Cambodia. These three methods and other modern methods combined represent 

less than a quarter of all contraceptive use. 

3.1.2. Egypt 

The mCPR in Egypt is 57% among currently married women. Traditional methods are not a substantial 

portion of the contraceptive regime, raising the total CPR only slightly to 59%. Three in 10 currently 

married women use the IUD, a LARC method. This makes the IUD the most common contraceptive 

method in Egypt, followed by two shorter term methods: the pill and injections. The pill had dominated 

contraceptive use in Egypt until the late 1980’s, although expansion of the IUD that began about 30 years 

ago has displaced the pill as the dominant method. More recently in the last 15 years, there has also been 

a rapid expansion in injections (MoHP, El-Zanaty and Associates, and ICF International 2015). Together, 

these three methods now account for more than 93% of contraceptive use in Egypt; use of traditional and 

other modern methods is negligible. 

The Family Planning Effort Index score is 50, which is near the lower end of the continuum of countries 

in this study. This score has declined more than 10 points since the prior assessment in 2009. All 

component scores also fell during this period. Egypt receives scores above 50 for its family planning 

policies and evaluation (down from 72 and 70, respectively), but less than 50 in the services and access 

components (down from 58 and 51, respectively). After increases throughout the 1980’s and 1990’s, the 

CPR has remained relatively steady at about 56-60% since 2000 (MoHP, El-Zanaty and Associates, and 

ICF International 2015). 

3.1.3. Honduras 

Whether considering total (73%) or modern CPR (64%), Honduras has the highest levels of contraceptive 

use of the countries in the study. Current levels represent approximately an 8 point increase since 

2005-06. Much of this increase is attributed to an increase in injection use of more than 4 percentage 

points, from 13.8% to 18.1% of women using this method (Secretaria de Salud, INE, and ICF 

International 2013). 

Honduras also has a more balanced method mix, with no method representing more than 50% of use. 

Sterilization (almost entirely female sterilization) is the most common form of contraception, which 

contributes 31% to total contraceptive use. LARC methods are not prominent among contraceptive use. 

IUDs contribute less than 10% of contraceptive use and implants, 0%. The second most common method 

is injections, used by one in four contraceptive users. Pills account for 16% of contraceptive use. Despite 

the robust mCPR, many women also rely on traditional methods. These methods account for 13% of total 

contraceptive use. 
24 

The Family Planning Effort Index score for Honduras has increased about 4 points since 2009 and is 

currently at 54, which is about the median for the surveys in this study. Evaluation is the strongest 

component of its family planning program (65), followed by access (56), family planning policies (55), 

and lastly services (52). 

Figure 4. Dominant method and method mix among currently married women age 15-49 using 

contraception 

3.1.4. Jordan 

Jordan has a moderate mCPR of 42%, with an overall CPR of 61%. Like Cambodia, the use of traditional 

methods (particularly withdrawal) plays an important role in Jordan’s contraceptive regime. These 

methods represent 31% of all contraceptive use. This share of contraceptive use has increased slightly 

over time (Department of Statistics [Jordan] and ICF International 2013). Traditional methods are 

outpaced only by IUD use, which represents 5% of all contraception use. The use of IUDs increased 

rapidly during the 1990’s and has remained steady since about 2000. The use of pills and other modern 

methods lags behind at about 13-15% of total use. The proportion of currently married women who use 

condoms has increased over time, although this method is not a major contributor to contraceptive 

prevalence. Thus, Jordan has achieved a relatively well-balanced method mix. Shorter-term methods, 

LARC and permanent methods, as well as traditional methods account for almost equal portions of all 

contraceptive use. 

Jordan has one of the higher Family Planning Effort Index scores among the countries in the study, at 60 

points, with robust scores across all four components. Reflecting a common pattern, Jordan’s scores for 

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Zimbabwe 2011-11

Zambia 2013-14

Uganda 2011

Tajikistan 2012

Rwanda 2014-15

Kyrgyz Republic 2012

Kenya 2014

Jordan 2012

Honduras 2011-12

Egypt 2014

Cambodia 2014

injections pill other modern methods IUD implants female/male sterilization traditional/folk method
25 

policies (62) and evaluation (63) outpace those for services (54) and access (58). These scores represent 

an increase above the 2009 calculations. Improvements have been most notable in the services 

component, which has risen from 42 points in 2009 (Avenir Health 2015a). 

3.1.5. Kenya 

Kenya was an early adopter of strong family planning programs, although the priority of family planning 

in the national agenda slipped in the 1990s. Nevertheless, its Family Planning Effort Index score has 

remained steady at about 50 points since 2009 (Avenir Health 2015b). Kenya’s family planning policies 

component score, now at 62, and to a lesser extent its access score (47) have improved over the last 5 

years while its evaluation score has decreased. Services remain its weakest component, scored at 42 

points. 

Nonetheless, Kenya’s mCPR is 53% among currently married women. With an overall CPR of 58%, 

traditional methods do not make a substantial contribution to contraceptive patterns in the country. The 

shorter-term methods are most of all contraceptive use (63%); LARC and permanent methods (28%) and 

traditional methods (8%) are much less. Injections are the dominant method, which accounts for nearly 

46% of all use. Along with Rwanda and Zambia, Kenya is one of the few countries in which prevalence 

of implants is notable. Implants are the second most common method that represent 17% of all 

contraceptive use, followed by pills at 14%. 

3.1.6. Kyrgyz Republic 

Total and modern CPR are closely aligned with a little more than one-third of currently married Kyrgyz 

women using contraception. The method mix is highly skewed with a single method accounting for well 

over half of all contraceptive use. Sixty-one percent of all women who use contraception are using the 

IUD. However, use of implants, the other LARC method, is not measurable while the use of sterilization 

stands at just 4%. The methods included in the category “other modern methods” (mostly male condoms) 

contribute 22% of all contraceptive use, with use of other non-LARC methods and traditional methods 

lagging well behind. 

The Family Planning Effort Index score has increased approximately 9 points to 51 points between 2009 

and 2014. The Kyrgyz Republic receives particularly high marks for evaluation (74), although component 

scores for access and services are below 50 points. 

3.1.7. Rwanda 

Nearly 48% of currently married women in Rwanda are using a modern method of contraception. More 

than half of married women (53%) are using contraception when traditional methods are included. 

Shorter-term methods combine to dominate the method mix, with 7 out of 10 contraceptive users using a 

non-LARC method. Two of 10 women use a LARC or permanent method (typically implants) and onetenth uses a traditional method. 

Injections are the single most common method in Rwanda, with a 45% contribution to all contraceptive 

use. This is followed by the pill (16%) and implants (15%). Thus, Rwanda is the second of three countries 

with implant use that exceeds 10% of all contraception. The use of IUDs, sterilization, and other modern 

methods are negligible in Rwanda. 

Rwanda has the highest Family Planning Effort Index score—74—of all the countries included in the 

analysis. A score was not calculated for Rwanda in 2009, but the current score represents a near doubling 

of the 2004 score, which is a remarkable increase (Avenir Health 2015c). Rwanda has its highest 
26 

component score for family planning policies (86), with component scores for family planning services, 

evaluation, and access at about 70. Only Tajikistan has a higher score for access and the Kyrgyz Republic 

for evaluation. Rwanda has the highest policies and services scores of the countries in this study. 

Figure 5. Family Planning Effort Index scores 

Sources: Avenir Health. 2009. Family Planning Effort Index: Scores from 1972 to 2009. Retrieved on July 1, 2016 from 

http://www.track20.org/pages/data/FPE 

Avenir Health. 2015. Family Planning Effort Scores in 2014: Rwanda. Track20 FPE Policy Brief Series. Retrieved on July 1, 2016 from 

http://www.track20.org/pages/resources/track20_resources#FPEPolicyBriefs 

Kuang and Brodsky. 2016. “Global Trends in Family Planning Programs, 1999-2014.” International Perspectives on Sexual and Reproductive 

Health 42(1): 33-44. 

3.1.8. Tajikistan 

Tajikistan has the second highest Family Planning Effort Index score of the countries in this study, at 63 

points. This score has remained steady since 2009. Its highest component score is in access to family 

planning (74), followed by family planning policies (53), evaluation (61), and services (54). 

In spite of these high Effort Index scores, Tajikistan has the lowest mCPR and CPR of the study 

countries. Nearly 26% of currently married women use a modern method of contraception. Two percent 

of currently married women use a traditional method, which brings the total CPR to just under 28%. 

Tajikistan has perhaps the most skewed method mix of the countries in our study. Use of IUDs is more 

than two-thirds of all contraceptive use. Implant use is not measurable in Tajikistan and sterilization 

accounts for just 2%. Shorter-term methods combine to contribute nearly one-quarter of all contraceptive 

use (24%), although neither injections, pills, or other modern methods represent more than 10% of use. 

74

63 60 59 55 54 51 51 50 49

44

86

63 62 60 61

55

44

62

54

62

50

70

54

58

63

54 52 51 48 50

42 42

71

61 63 61

53

65

74

46

54

44 42

70

75

58

52

57 56 56

46 49 47

43

Rwanda

2014

Tajikistan

2014

Jordan

2014

Zimbabwe

2014

Cambodia

2014

Honduras

2014

Kyrgyz

Republic

2014

Uganda

2014

Egypt

2014

Kenya

2014

Zambia

2014

Total Score Policies Services Evaluation Access
27

Figure 6. Percentage of currently married women age 15-49 who experienced emotional, physical, sexual, and any intimate partnerviolence 

Emotional violence Physical violence 

Sexual violence Any IPV 

23.9

17.4

28.0

23.5

28.8

11.0

22.6

10.5

41.6

21.9

24.9

17.6

12.8

21.7

18.1

23.9

9.4

18.8

9.9

34.8

18.4

23.5

Cambodia

2014

Egypt 2014 Honduras

2011-12

Jordan

2012

Kenya 2014 Kyrgyz

Republic

2012

Rwanda

2014-15

Tajikistan

2012

Uganda

2011

Zambia

2013-14

Zimbabwe

2010-11

Ever In the last 12 months

14.9

24.0

16.7

20.1

33.7

22.3

28.4

18.6

41.0

36.9

26.9

9.1

13.4

10.1 11.6

22.4

16.6 17.7

14.1

26.0

21.8 21.1

Cambodia

2014

Egypt 2014 Honduras

2011-12

Jordan

2012

Kenya 2014 Kyrgyz

Republic

2012

Rwanda

2014-15

Tajikistan

2012

Uganda

2011

Zambia

2013-14

Zimbabwe

2010-11

Ever In the last 12 months

4.8

3.4

4.3

8.0

11.5

3.4

9.9

4.1

26.5

15.9

14.8

3.9 2.5 3.0

6.1

9.6

2.8

8.6

3.3

22.1

13.8 14.0

Cambodia

2014

Egypt 2014 Honduras

2011-12

Jordan

2012

Kenya 2014 Kyrgyz

Republic

2012

Rwanda

2014-15

Tajikistan

2012

Uganda

2011

Zambia

2013-14

Zimbabwe

2010-11

Ever In the last 12 months

27.6

29.2

31.6 30.6

43.4

25.4

37.5

23.6

58.8

45.4

41.6

19.9 18.6

23.5 22.8

33.1

19.6

27.6

19.1

47.0

32.9

36.9

Cambodia

2014

Egypt 2014 Honduras

2011-12

Jordan

2012

Kenya 2014 Kyrgyz

Republic

2012

Rwanda

2014-15

Tajikistan

2012

Uganda

2011

Zambia

2013-14

Zimbabwe

2010-11

Ever In the last 12 months
28 

3.1.9. Uganda 

Uganda has the second lowest mCPR (26%) and total CPR (30%) of study countries. Shorter term 

methods account for two thirds of all contraceptive use. Injections are the most common method, 

accounting for 47% of all use. Pill use, implants, sterilization, and other modern methods contribute about 

10% of contraceptive use. Traditional methods account for a slightly larger share: 13%, whereas IUDs 

less than 2%. 

Uganda’s Family Planning Effort Index score is 51, which is a slight increase over the 2009 score (Avenir 

Health 2015d). Uganda scores highest in the family planning policies component (62), followed by family 

services (48), evaluation (46), and access (46). 

3.1.10. Zambia 

Zambia has the lowest Family Planning Effort Index score (44 points) of the countries in the study. 

Zambia receives its highest score—50—in the family planning policies component. Scores in the 

services, evaluation, and access components all are lower at about 42 points (Avenir Health 2015e). 

Zambia has an mCPR of 45%, which places it at about the median among countries in this analysis. NonLARC methods constitute nearly three-quarters of contraceptive use, although no single method 

dominates more than 50% of the method mix. The most common method is injections at 40% of 

contraceptive use, followed by pills, which constitute 24% of contraceptive use. Although the combined 

use of LARC and permanent methods account for fewer than two in 10 contraceptive users, implant use is 

not uncommon in Zambia, since it accounts for 11% of all contraceptive use. Traditional methods 

represent 9% of all use. 

3.1.11. Zimbabwe 

Zimbabwe has the second highest mCPR of the countries in this analysis at 58%. Traditional method use 

is negligible bringing the total CPR to 59%. The method mix is highly skewed, with shorter term methods 

accounting for more than 90% of all contraceptive use. LARC and permanent methods account for less 

than 7% of contraceptive use. The method mix is dominated by a single method, with pills accounting for 

71% of all contraceptive use. The second most common method, injections, account for 14% of all use. 

The 2014 Family Planning Effort Index score for Zimbabwe is 59, barely unchanged from the score of 60 

calculated for 2009 (Avenir Health 2015f). Zimbabwe’s highest component score is in the area of family 

planning services (63). The scores for each of the other three components are approximately 60. 

3.2. IPV Profile 

As shown in Figure 6, 19.9% of currently married women age 15-49 in Cambodia reported experiencing 

any type of IPV in the last 12 months while 27.6% reported ever experiencing IPV. The most common 

type of violence in Cambodia was emotional violence (17.6% in the past 12 months and 23.9% ever) 

followed by physical and sexual violence. 

An estimated 18.5% of currently married women age 15-49 in Jordan reported experiencing IPV in the 

last 12 months and 29.2% reported ever experiencing IPV. Significantly more women reported ever 

experiencing physical violence than emotional or sexual violence. However, there was no significant 

difference between the proportion of women reporting emotional violence and the proportion of women 

reporting physical violence in the last 12 months (both at approximately 13%). 
29 

In Kenya, approximately a third of currently married women age 15-49 reported experiencing any IPV in 

the last 12 months before the survey. This estimate increased to 43.4% for ever experiencing IPV. There 

was no significant difference between the proportion of women reporting emotional and physical violence 

in the last 12 months (both were between 22-23%). However, significantly more women reported ever 

experiencing physical violence (33.7%) compared to emotional violence (28.8%). Approximately 1 in 10 

women reported experiencing sexual violence both in the last 12 months and ever experiencing. 

In the Kyrgyz Republic, approximately 1 in 5 currently married women age 15-49 reported experiencing 

any IPV in the last 12 months before the survey and a quarter of the women reported ever experiencing 

any IPV. Significantly more women reported experiencing physical violence compared to emotional 

violence (16.6% compared to 9.4% in the last 12 months and 22.3% compared to 11.0% for ever 

experiencing, respectively). Between 2-3% of women reported experiencing sexual violence both in the 

last 12 months and ever experiencing. 

Approximately a third (27.6%) of Rwandan currently married women age 15-49 reported experiencing 

any IPV in the last 12 months before the survey and more than a third (37.5%) reporting ever 

experiencing IPV. There was no significant difference between the proportion of reported emotional and 

physical violence in the last 12 months before the survey (approximately 18% for each type). However, 

significantly more women reported ever experiencing physical violence compared to emotional violence 

(28.4% and 22.6% respectively). Between 9-10% of women reporting experiencing sexual violence both 

in the last 12 months and ever experiencing. 

In Tajikistan, approximately 1 in 5 currently married women age 15-49 reported experiencing any IPV in 

the last 12 months before the survey and approximately a quarter of the women reported ever 

experiencing any IPV. Significantly more women reported experiencing physical violence compared to 

emotional violence (14.1% compared to 9.9% in the last 12 months and 18.6% compared to 10.5% for 

ever experiencing, respectively). Between 3-4% of women reported experiencing sexual violence both in 

the last 12 months and ever experiencing. 

Almost half of Ugandan currently married women age 15-49 reported experiencing any IPV in the last 12 

months and more than half (58.8%) reported ever experiencing any IPV. Significantly more women 

reported experiencing emotional compared to physical violence in the last 12 months (34.8% and 26.0% 

respectively) while an estimated 41% reported ever experiencing emotional and physical violence each. 

More than 1 in 5 women reported experiencing sexual violence in the last 12 months and more than a 

quarter of Ugandan women reported ever experiencing this type of violence. 

In Zambia, almost a third of currently married women age 15-49 reported experiencing any IPV in the last 

12 months. This increased to 45.4% of women who reported ever experiencing any IPV. Approximately 1 

in 5 women reported experiencing both emotional and physical violence in the last 12 months before the 

survey. Significantly more women reported ever experiencing physical violence (38.9%) compared to 

emotional violence (21.9%). 

More than a third (36.9%) of currently married women in Zimbabwe reported experiencing any IPV in 

the last 12 months before the survey and 41.6% reported ever experiencing any IPV. Slightly more than 1 

in 5 women reported experiencing both physical and emotional violence in the last 12 months and 

approximately a quarter reported ever experiencing these forms of violence. Between 14-15% of women 

reported experiencing sexual violence both in the last 12 months and ever experiencing. 

31 

4. Sample Profile 

Women are included in our analytic sample if they were currently married at the time of interview and 

were using a modern, temporary method of contraception at the start of the observation period (12 months 

prior to the survey). Table 3 summarizes the background characteristics of the women in this sample. 

As Table 3 shows, approximately 80% or more of these women were using a long-acting, reversible 

contraceptive (LARC) method at the start of the observation period in all countries except Egypt, Jordan, 

the Kyrgyz Republic, and Tajikistan. The level of LARC use ranges from a low of 25.5% in Tajikistan to 

96.4% in Zimbabwe. Details on the prevalence of methods used among women in the sample can be 

found in Appendix Table 1. 

In general, most women in the sample are between 25-34 years of age and have at least a primary level of 

education. Education levels are higher in Jordan, the Kyrgyz Republic, and Tajikistan compared to the 

remaining countries with most women in these countries having secondary or higher level education. The 

distribution of the sample across wealth quintiles is more or less equal except in Kenya and Uganda with 

less than 10% of the women in the lowest wealth quintile. This may reflect that contraceptive use is 

concentrated among wealthier quintiles in these countries. Very few women in the sample had no children 

at the time of interview, with most women having at least one. Other characteristics such as place of 

residence, employment status, and religion differ greatly across study countries, as shown in Table 3. 

Table 3. Background characteristics of the analytic sample: Currently married women age 15-49 using 

contraception 12 months prior to interview 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-2015

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Method used 12 

months prior to 

survey 

LARC 83.0 44.6 82.1 45.1 77.8 28.2 79.3 25.5 90.1 83.4 96.4

non-LARC 17.0 55.4 17.9 54.9 22.2 71.8 20.7 74.5 9.9 16.6 3.6

Duration of use before 

the observation 

period 

1-12 months 27.7 25.7 38.1 33.8 34.7 23 34.3 24.8 57.6 41.5 3.2

13-36 months 30.3 27.3 30.8 32.3 32.9 30.6 36.5 31.6 25.8 39.7 36.1

37+ months 42.1 47.1 31.1 33.9 32.4 46.4 29.2 43.6 16.6 18.7 31.9

Age 

15-19 0.8 0.8 7.4 0.8 0.9 0.1 0.1 0.1 2.1 2.7 2.5

20-24 11.8 9.4 20.6 6.8 14.9 6.2 10.1 8.1 10.5 14.8 20.8

25-29 22.1 20.4 24.3 16.3 28.8 17.5 20.4 17.3 33.0 24.2 25.4

30-34 28.5 22.2 20.5 22.7 23.5 22.3 31.3 21.0 21.6 23.3 21.3

35-39 14.7 20.0 14.0 23.3 16.2 22.9 18.3 23.0 22.3 18.7 16.0

40-44 15.7 16.1 8.6 21.9 10.8 18.3 13.5 21.2 7.3 11.3 9.6

45-49 6.4 11.1 4.6 8.1 4.9 12.8 6.3 9.2 3.1 4.9 4.4

Wealth quintile 

Lowest 19.5 17.1 17.4 16.1 7.4 20.6 14.0 16.9 8.4 12.0 16.1

Second 22.5 19.7 19.2 18.3 17.7 20.3 20.4 18.7 12.9 15.7 17.4

Middle 19.9 22.5 21.9 22.2 20.3 19.2 22.3 15.9 20.0 19.5 18.6

Fourth 20.9 21.0 22.0 22.7 25.5 19.2 21.1 21.6 19.5 24.8 24.1

Highest 17.2 19.7 19.5 20.7 29.1 20.7 22.2 26.9 39.3 28.0 23.7

Continued 
32 

Table 3—Continued 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-2015

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Place of residence 

Urban 11.9 35.8 49.6 84.1 47.5 33.9 18.6 26.5 25.9 51.7 36.5

Rural 88.1 64.2 50.4 15.9 52.5 66.1 81.4 73.5 74.1 48.3 63.5

Religion 

Muslim 2.5 96.1 0.0 na 2.6 na 3.6 na 17.2 0.7 0.6

Christian 0.7 3.8 86.4 na 96.5 na 96.1 na 80.8 98.8 92.6

Other 96.8 0.1 13.6 na 0.9 na 0.3 na 2.0 0.5 6.8

Education 

No education 14.1 24.1 3.5 1.1 2.2 0.0 13.8 1.6 6.7 6.9 2.4

Primary 57.1 10.7 59.3 5.1 56.7 0.1 75.2 3.2 63.2 51.8 27.4

Secondary 27.4 52.5 30.5 63.8 31.0 53.7 7.9 76.5 23.6 35.3 65.4

Higher 1.5 12.7 6.7 30.0 10.0 46.1 3.0 18.6 6.6 6.0 4.9

Employment 

Not employed 11.9 82.5 47.6 na 18.0 61.3 5.2 58.5 19.9 41.7 50.1

Employed for cash 81.0 14.8 48.7 na 66.6 35.6 61.8 34.3 63.2 42.3 47.5

Employed not for cash 7.0 2.6 3.7 na 15.4 3.2 33.0 7.2 16.9 16.0 2.5

Number of living 

children 

0 0.5 0.0 5.5 0.1 2.6 0.4 0.3 0.1 1.4 0.6 0.9

1-2 56.5 38.9 58.5 21.5 48.4 34.3 45.9 26.8 23.1 32.0 56.0

3-4 34.0 49.2 26.5 40.8 32.5 51.6 31.9 50.4 37.8 34.2 32.8

5+ 9.1 11.8 9.5 37.7 16.5 13.6 21.9 22.7 37.7 33.2 10.3

Marital duration in 

years 

 

0-4 12.8 11.4 24 9.8 19.4 9.3 18.3 7.9 8.9 15.8 24.2

5-9 23.9 23.3 24.4 20.5 24.5 17.1 27.6 21.1 21.8 21.1 25.0

10-14 22.9 20.6 21.1 22.9 21.4 20.7 18.9 17.8 25.7 23.3 21.5

15-19 18.6 18.6 14.8 20.5 18.7 21.9 17.2 22.1 26.6 17.7 14.6

20-24 14.0 14.6 9.6 17.5 10.0 21.0 12.1 21.0 12.9 12.0 7.5

25-29 6.7 7.9 4.9 6.4 5.3 8.9 4.6 8.8 3.6 7.7 4.9

30+ 1.1 3.6 1.3 2.3 0.7 1.2 1.3 1.2 0.5 2.5 2.3

Notes: 

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys.

Data on employment status was not collected in the Jordan 2012 DHS.
33 

5. Experience of Intimate Partner Violence 

Figure 7 summarizes the proportion of women in the sample who have experienced IPV in the 12 months 

prior to the survey. This figure presents Euler-style area proportional Venn diagrams indicating overall 

prevalence of each form of violence as well as their intersections (Micallef and Rodgers 2014). Women’s 

experience of any form of IPV ranges from 17.6% of currently married women using modern, temporary 

contraception at the start of the observation period in Egypt to 40.9% in Uganda. Sexual violence is the 

least frequently reported form of violence. In Cambodia, Honduras, Jordan, Kenya, Uganda, and 

Zimbabwe, more women report emotional violence compared to physical violence. The highest reported 

levels of emotional violence is found in Uganda (29.8%), followed by Kenya, Zimbabwe, and Honduras. 

However, the highest reported levels of physical violence is found in Kenya (23.7%) followed by Zambia, 

Rwanda, and Zimbabwe with Uganda. Uganda also has the highest reported prevalence of sexual violence 

(19.3%) followed by Zambia and Zimbabwe both with approximately 15%. 

The proportion of women who report experiencing multiple forms of violence is highest in Uganda 

(21.9%) followed by Kenya, Zambia, and Zimbabwe. In contrast, less than 10% of women in our sample 

in Egypt, Tajikistan, Cambodia, and the Kyrgyz Republic experience multiple forms of violence. When 

women experience multiple forms of violence, women most commonly experience emotional and 

physical violence together. The proportion experiences these two forms of violence range from 7% in 

Egypt to 16% in Uganda. The combinations of emotional and sexual violence or physical and sexual 

violence are less common and similar to one another in most countries. The proportion of women who 

experience all three forms of violence in the 12 months prior to the survey ranges from 1% in Tajikistan 

to 6% in Kenya and Rwanda and 7% in Uganda. 

In general, the lowest levels of IPV are found in Egypt. Many countries, such as Cambodia and Egypt, 

have consistently low levels of violence across all forms of violence or consistently high levels, such as 

Uganda and Kenya, across all forms of violence. For some countries, however, one form of violence 

dominates. For example, the Kyrgyz Republic has low levels of reported emotional (11.2%) and sexual 

(4.2%) violence, but a relatively high level of physical violence (20.5%). Similarly, Jordan has relatively 

low reported levels of physical (11.7%) and sexual violence (6.6%), but a high level of emotional 

violence (20.3%). 
34 

Figure 7. Proportion of currently married women age 15-49 in the analytic sample experiencing each form of intimate partner violence in the 

12 months prior to the survey 

Continued
35 

Figure 7—Continued
36 

5.1. Contraceptive Use by Experience of IPV 

Table 4 shows married women’s experience of IPV in the last twelve months, by use of a modern, 

temporary method twelve months prior to the survey in the first panel and, in the second panel, among 

women using a method, by LARC or non-LARC method. In addition, the p-values from chi square tests 

of independence used to determine significant differences between observed and expected values are 

presented in the table. 

Overall, among married women who completed the domestic violence module, approximately half or less 

are using modern, temporary contraception at the start of the survey. Women in Egypt have the highest 

proportion of users (53.3%) at this point. In contrast, only 17.4% of women are using modern, temporary 

contraception at the start of the observation period in Uganda. 

In six countries (Honduras, Jordan, Kenya, Kyrgyz Republic, Rwanda, and Tajikistan), there are 

significant differences in the use of modern, temporary contraception by experience of IPV. A higher 

proportion of women in these countries who have experienced IPV in the last twelve months are using 

contraception compared to women who have not experienced violence in the last twelve months. The 

largest percentage point difference (8.5%) occurs in Rwanda, where 47.5% of women who have 

experienced IPV in the last twelve months were using modern, temporary contraception compared to 

39.0% of women who had not experienced violence during this time. 

Near-significant differences (p≤0.10) in contraceptive use between women with an experience of recent 

IPV and with no experience of recent IPV appear among women in Uganda and Egypt. However, in these 

two countries, the direction of the suggested difference is opposite that found elsewhere—that is, in these 

two countries, contraceptive use is lower among women who experienced recent IPV (50.6% in Egypt 

and 15.2% in Uganda) versus those with no recent experience of IPV (54.0% in Egypt and 18.4% in 

Uganda). 

Among married women using contraception 12 months prior to the survey—our analytic sample— there 

seems to be no pattern of significant differences in the method type (use of a LARC or non-LARC 

method) based on a recent experience of violence. Reinforcing the results seen in Table 3, Table 4 shows 

that women in Cambodia, Honduras, and four of five sub-Saharan African countries in this study use nonLARCs more than LARC methods, regardless of IPV experience. In contrast, LARC use exceeded nonLARC use in Egypt, Jordan, the Kyrgyz Republic, and Tajikistan. Again, these patterns are found 

irrespective of IPV experience. The results of the chi square tests show significant differences in method 

type by IPV only in Kenya, where 26.5% of women who experienced IPV in the previous twelve months 

were using a LARC method compared to 19.7% among women who had not experienced IPV (p≤0.05). 

A sensitivity analysis further explored differences in contraceptive use and method type (LARC versus 

non-LARC) with a more finely tuned violence measure that captured the timing of IPV. This measure 

disaggregated women’s IPV experience as either no IPV ever, IPV ever but not in the last 12 months, and 

IPV in the last twelve months10. Appendix Table 16 shows these results. No new patterns of differences in 

contraceptive use or method type by timing of IPV experience are detected. The results using this 

measure resemble those of the dichotomous IPV experience measure. Therefore, we continue to use the 

simpler, dichotomous IPV measure for the remainder of this study’s analysis. 

 

10 DHS data on intimate partner violence can identify women who have a history of ever experiencing violence and, 

among these women, can distinguish between those who have experienced violence in the past 12 months and those 

who have ever experienced violence, but not in the past 12 months (i.e. experienced violence prior to the 12 months 

preceding the survey only). However, among those women experiencing violence in the 12 months prior to the 

survey, these data cannot distinguish between those who have also experienced violence prior to the previous 12 

months and those who have only experienced violence in the preceding 12 months. 
37 

Table 4. Proportion of currently married women age 15-49 using contraception at the start of the 

12-month observation period and distribution of method type by experience of intimate partner 

violence 

Using any modern, temporary 

method 

Method type among those using 

modern, temporary methods 

No Yes p-value Weighted n LARC 

nonLARC p-value Weighted n

Cambodia 2014 

No IPV in the last 12 months 69.1 30.9 2,384 17.3 82.7 736 

IPV in the last 12 months 67.2 32.8 592 15.8 84.2 194 

Total 68.7 31.3 2,977 17.0 83.0 931 

Egypt 2014 † 

No IPV in the last 12 months 46.0 54.0 5,107 56.0 44.0 2,757 

IPV in the last 12 months 49.4 50.6 1,164 52.4 47.6 589 

Total 46.7 53.3 6,272 55.4 44.6 3,345 

Honduras 2011-12 ** 

No IPV in the last 12 months 64.3 35.7 6,830 17.3 82.7 2,440 

IPV in the last 12 months 59.9 40.1 2,100 19.6 80.4 842 

Total 63.2 36.8 8,930 17.9 82.1 3,283 

Jordan 2012 * 

No IPV in the last 12 months 61.9 38.1 5,184 54.8 45.2 1,976 

IPV in the last 12 months 56.2 43.8 1,529 55.2 44.8 670 

Total 60.6 39.4 6,714 54.9 45.1 2,646 

Kenya 2014 ** * 

No IPV in the last 12 months 59.4 40.6 2,244 19.7 80.3 912 

IPV in the last 12 months 52.7 47.3 1,108 26.5 73.5 525 

Total 57.1 42.9 3,352 22.2 77.8 1,437 

Kyrgyz Republic 2012 *** 

No IPV in the last 12 months 73.2 26.8 3,084 71.2 28.8 827 

IPV in the last 12 months 65.7 34.3 750 73.7 26.3 257 

Total 71.7 28.3 3,833 71.8 28.2 1,084 

Rwanda 2014-15 ** 

No IPV in the last 12 months 61.0 39.0 1,025 20.7 79.3 400 

IPV in the last 12 months 52.5 47.5 390 20.9 79.1 185 

Total 58.7 41.3 1,415 20.7 79.3 585 

Tajikistan 2012 ** 

No IPV in the last 12 months 78.3 21.7 3,082 73.9 26.1 670 

IPV in the last 12 months 71.2 28.8 730 76.4 23.6 210 

Total 76.9 23.1 3,812 74.5 25.5 879 

Uganda 2011 † 

No IPV in the last 12 months 80.6 19.4 693 10.1 89.9 135 

IPV in the last 12 months 84.8 15.2 614 9.6 90.4 93 

Total 82.6 17.4 1,307 9.9 90.1 228 

Zambia 2013-14 

No IPV in the last 12 months 67.0 33.0 4,796 15.7 84.3 1,585 

IPV in the last 12 months 64.3 35.7 2,349 18.3 81.7 838 

Total 66.1 33.9 7,145 16.6 83.4 2,422 

Zimbabwe 2010-11 

No IPV in the last 12 months 54.2 45.8 2,585 4.1 95.9 1,184 

IPV in the last 12 months 52.6 47.4 1,509 3.0 97.0 716 

Total 53.6 46.4 4,094 3.6 96.4 1,899 

Notes: 

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

Modern, temporary contraceptive methods include: oral contraceptive pill, intrauterine device (IUD), injection, implants, 

male/female condom, lactational amenorrhea method (LAM), emergency contraception, standard days method, and 

vaginal methods like diaphragm, foam, and jelly. 

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods. 

39 

6. Discontinuation 

Figure 8 shows the proportion of women who have discontinued their contraceptive use during the 

12-month observation period. Women may discontinue while still in need or discontinue due to no further 

need. Details on the reason given for discontinuation in either state of need are presented in Appendix 

Table 2. The total level of discontinuation (discontinuation while still in need and due to no further need 

combined) is highest in Uganda (34.2%). Zimbabwe, Honduras, Zambia, and Jordan all have between 

20-21% of women discontinuing contraceptive use during the observation period. The lowest total 

discontinuation levels are found in the Kyrgyz Republic, Tajikistan, and Cambodia, with all between 

10-12%. 

Figure 8. Proportion of currently married women age 15-49 using contraception 12 months prior to 

the survey who discontinue their contraceptive use in the past 12 months 

Notes: 

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of

becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or

husband opposition). 

Discontinuation due to no further need is defined s women who discontinue because they want to become pregnant of for other fertilityrelated reasons (e.g. infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of 

contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis.

Discontinuation while still in need is the main outcome of interest. Similar to total levels of 

discontinuation, discontinuation while still in need during the observation period is highest in Uganda 

(25.8%). This is followed by Honduras, Zambia, and Jordan with proportions of women discontinuing 

while still in need of 13.0%, 12.5%, and 10.2%, respectively. The total discontinuation in Zimbabwe is 

relatively high at 21.5%, which is due primarily to women discontinuing due to no further need. The 

proportion of women in Zimbabwe who discontinued contraception while still in need is 6.7%. The 

Kyrgyz Republic has the lowest prevalence of discontinuation while still in need at 2.9%. Disaggregated 

details about discontinuation while still in need among LARC users and non-LARC users can be found in 

Appendix Table 3. 

2.9

6.8 6.4 8.8 6.3

9.5 10.2

13.0 12.5

6.7

25.8

7.4

4.9 5.5

6.3 10.5

8.5

9.7

7.6 8.2

14.7

8.4

10.3

11.7 12.0

15.1

16.7 18.0

20.0 20.6 20.6 21.5

34.2

Kyrgyz

Republic

2012

Tajikistan

2012

Cambodia

2014

Kenya 2014 Egypt 2014 Rwanda

2014-15

Jordan 2012 Honduras

2011-12

Zambia

2013-14

Zimbabwe

2010-11

Uganda 2011

Discontinuation while still in need Discontinuation due to no further need Total discontinuation

41 

7. Bivariate Association of IPV with Contraceptive 

Discontinuation 

7.1. Bivariate Associations between IPV and Discontinuation While Still in Need 

Figure 9 graphically presents the unadjusted odds of DWSIN—our focal outcome—and experience of 

IPV in the twelve months prior to the survey from unadjusted logistic regressions. Each panel of the 

figure demonstrates bivariate results, without accounting for method type or other controls, for a single 

form of IPV: emotional violence, physical violence, and sexual violence, respectively; the last panel 

represents any IPV. In the right hand column, a 90% confidence interval draws attention to any borderline 

significant results, along with those that are statistically significant with the more conventional 95% 

threshold. The null hypothesis states that the odds of DWSIN do not differ by experience of IPV (OR=1). 

For comparison purposes, comparable results for discontinuation due to no further need and total 

discontinuation (DWSIN plus discontinuation due to no further need) are presented in tabular form in 

Table 5. 

7.1.1. Emotional violence 

There are few significant associations between recent emotional violence and DWSIN, as seen in Figure 

9. Associations are found in 5 of the 11 study countries, although these associations are of borderline 

significance in four of five of these countries. Overall, a weighted average of each survey’s results11 is 

suggestive of a positive valence to the association between emotional violence and DWSIN, but the 

magnitude is small and not statistically significant. Nonetheless, more significant or borderline significant 

associations are found with emotional violence and discontinuation than other forms of violence. 

In three countries, women who have experienced recent emotional violence have higher odds of DWSIN 

than do women who have not experienced emotional violence. The magnitude of the effect is greatest in 

Egypt where women who have experienced emotional violence have 65% greater odds of discontinuing 

while still in need than women who have not (OR= 1.65, p≤0.05). The effect is somewhat more modest in 

Honduras (OR = 1.26, p≤0.10) and Kenya (OR = 1.67, p≤0.10) where the association is only nearsignificant. 

In contrast, women in two countries demonstrate an opposite, near-significant association. Women who 

experienced emotional violence had lower odds of discontinuing while still in need than women who did 

not in the Kyrgyz Republic (OR = 0.23, , p≤0.10) and Zambia (OR = 0.69, p≤0.10). There is no 

association between the experience of emotional violence and DWSIN in Cambodia, Jordan, Rwanda, 

Tajikistan, Uganda, and Zimbabwe. 

 

11 Overall results are weighted by sample size. 
42

Figure 9. Unadjusted odds of emotional, physical, sexual, and any intimate partner violence predicting discontinuing while still in need: Odds ratios from logistic regression models 

SurveyCambodia 2014Egypt 2014Honduras 2011-12Jordan 2012Kenya 2014Kyrgyz Republic 2012Rwanda 2014-15Tajikistan 2012Uganda 2011Zambia 2013-14Zimbabwe 2010-11Overall (I-squared = 43.9%, p = 0.058)

ES (90% CI) ES (90% CI)0.72 (0.31, 1.66) 0.72 (0.31, 1.66)1.65 (1.13, 2.42) 1.65 (1.13, 2.42)1.26 (1.01, 1.57) 1.26 (1.01, 1.57)1.31 (0.89, 1.93) 1.31 (0.89, 1.93)1.67 (1.05, 2.68) 1.67 (1.05, 2.68)0.23 (0.07, 0.80) 0.23 (0.07, 0.80)1.11 (0.62, 2.01) 1.11 (0.62, 2.01)1.16 (0.53, 2.57) 1.16 (0.53, 2.57)0.80 (0.43, 1.47) 0.80 (0.43, 1.47)0.69 (0.49, 0.98) 0.69 (0.49, 0.98)1.06 (0.72, 1.56) 1.06 (0.72, 1.56)1.08 (0.93, 1.25) 1.08 (0.93, 1.25)

1 .05 .2 .5 2 5 10

DWSIN--Spousal Emotional Violence

SurveyCambodia 2014Egypt 2014Honduras 2011-12Jordan 2012Kenya 2014Kyrgyz Republic 2012Rwanda 2014-15Tajikistan 2012Uganda 2011Zambia 2013-14Zimbabwe 2010-11Overall (I-squared = 0.0%, p = 0.647)

ES (90% CI) ES (90% CI)0.86 (0.33, 2.29) 0.86 (0.33, 2.29)1.49 (1.00, 2.21) 1.49 (1.00, 2.21)1.13 (0.85, 1.50) 1.13 (0.85, 1.50)1.31 (0.78, 2.20) 1.31 (0.78, 2.20)1.16 (0.70, 1.94) 1.16 (0.70, 1.94)0.45 (0.16, 1.26) 0.45 (0.16, 1.26)0.75 (0.40, 1.43) 0.75 (0.40, 1.43)1.09 (0.46, 2.57) 1.09 (0.46, 2.57)0.81 (0.40, 1.67) 0.81 (0.40, 1.67)0.83 (0.62, 1.12) 0.83 (0.62, 1.12)1.14 (0.80, 1.63) 1.14 (0.80, 1.63)1.07 (0.92, 1.26) 1.07 (0.92, 1.26)

1 .05 .2 .5 2 5 10

DWSIN--Spousal Physical Violence

SurveyCambodia 2014Egypt 2014Honduras 2011-12Jordan 2012Kenya 2014Kyrgyz Republic 2012Rwanda 2014-15Tajikistan 2012Uganda 2011Zambia 2013-14Zimbabwe 2010-11Overall (I-squared = 38.4%, p = 0.093)

ES (90% CI) ES (90% CI)1.80 (0.43, 7.44) 1.80 (0.43, 7.44)1.80 (0.91, 3.58) 1.80 (0.91, 3.58)1.33 (0.81, 2.18) 1.33 (0.81, 2.18)2.38 (1.29, 4.38) 2.38 (1.29, 4.38)1.78 (0.89, 3.54) 1.78 (0.89, 3.54)0.32 (0.06, 1.80) 0.32 (0.06, 1.80)0.89 (0.43, 1.84) 0.89 (0.43, 1.84)0.08 (0.01, 0.46) 0.08 (0.01, 0.46)0.96 (0.47, 1.97) 0.96 (0.47, 1.97)1.36 (0.99, 1.87) 1.36 (0.99, 1.87)0.85 (0.54, 1.35) 0.85 (0.54, 1.35)1.20 (0.95, 1.54) 1.20 (0.95, 1.54)

1 .05 .2 .5 2 5 10

DWSIN--Spousal Sexual Violence

SurveyCambodia 2014Egypt 2014Honduras 2011-12Jordan 2012Kenya 2014Kyrgyz Republic 2012Rwanda 2014-15Tajikistan 2012Uganda 2011Zambia 2013-14Zimbabwe 2010-11Overall (I-squared = 0.0%, p = 0.442)

ES (90% CI) ES (90% CI)0.78 (0.36, 1.66) 0.78 (0.36, 1.66)1.49 (1.06, 2.10) 1.49 (1.06, 2.10)1.24 (1.00, 1.54) 1.24 (1.00, 1.54)1.43 (0.98, 2.07) 1.43 (0.98, 2.07)1.44 (0.93, 2.24) 1.44 (0.93, 2.24)0.56 (0.24, 1.28) 0.56 (0.24, 1.28)0.94 (0.54, 1.63) 0.94 (0.54, 1.63)1.03 (0.50, 2.11) 1.03 (0.50, 2.11)0.72 (0.40, 1.29) 0.72 (0.40, 1.29)0.98 (0.75, 1.27) 0.98 (0.75, 1.27)1.00 (0.72, 1.39) 1.00 (0.72, 1.39)1.14 (1.01, 1.30) 1.14 (1.01, 1.30)

1 .05 .2 .5 2 5 10

DWSIN--Any IPV
43 

7.1.2. Physical violence 

Figure 9 reveals that recent experience of physical violence does not appear to have an association with 

DWSIN. As with emotional violence, an overall weighted average indicates that a weak, positive 

association is possible, although this result is also not significant. 

Women from only one country, Egypt, have higher odds of DWSIN if they experienced physical violence 

at the hands of their spouse in the 12 months, as compared to women who have no recent experience of 

physical violence. However, this relationship only approaches significance (OR = 1.49, p≤0.10); thus, the 

null hypothesis that there is no association cannot be rejected with certainty. No association is found in 

the remaining 10 study countries. 

7.1.3. Sexual violence 

Two of 11 study countries demonstrate associations between the experience of spousal sexual violence 

and DWSIN, as seen in Figure 9. Both associations are significant at the p≤0.05 level. However, the 

relationships are in different directions. 

In Jordan, women who experienced recent sexual violence have almost two and a half times the odds of 

DWSIN compared to women who have not recently experienced sexual violence (OR= 2.38, p≤0.05). In 

Tajikistan, on the other hand, women have 92% lower odds of DWSIN if they have experienced recent 

sexual violence compared to women who have not (OR = 0.08, p≤0.05). No statistically significant 

association is found in the remaining 9 study countries. 

An overall weighted average of all 11 separate results reiterates the lack of a clear pattern: a weak, 

positive relationship is suggested between sexual violence and DWSIN, as is the case with emotional and 

physical violence; however, as with these other forms, the overall association does not approach statistical 

significance. It is worth noting that the confidence intervals around the odds ratios are relatively large, 

perhaps reflecting that this is the least common form of IPV experienced in all study countries. 

7.1.4. Any IPV 

For experience of any IPV, borderline significant associations with DWSIN are only found among 

women in two countries, Egypt and Honduras. In both countries, the odds of DWSIN are higher among 

women who have experienced any form of IPV in the past twelve months than among women who have 

not. In Egypt, women have one and a half times the odds of DWSIN if they experienced IPV (OR = 1.49, 

p≤0.10) and women in Honduras have 1.24 times the odds (p≤0.10) of DWSIN if they experienced any 

recent violence compared to women who have not. 

A weighted average of individual survey results suggests that, overall, there is likely to be a positive 

association between experiencing any IPV and DWSIN; this result approaches significance at p≤0.10. 

However, the null hypothesis of no relationship cannot be definitively rejected. In contrast to the weak 

association found in Egypt and Honduras, the remaining 9 countries show no statistically significant 

association at all and odd ratios that are likely to be negative, were they to be significant, in as many 

countries as they are likely to be positive. 

7.2. Bivariate Associations between IPV and Discontinuation Due to No Further Need 

Table 5 presents a comparison of bivariate associations for forms of violence and DWSIN with 

associations for discontinuation due to no further need and total discontinuation. Results are expressed as 

odds ratios from logistic regressions. As with discontinuation while still in need, there are few statistically 
44 

significant associations between the experience of IPV and discontinuation due to no further need. Unlike 

with discontinuation while still in need, however, the few significant associations are consistent in 

direction. Where there is a relationship, women with a recent experience of violence are less likely to 

discontinue due to no further need. 

As was the case with discontinuation while still in need, there are more frequently associations with 

emotional violence than with any of the other individual form of violence. This relationship is significant 

in two countries and approaches significance in a third. Women in the Kyrgyz Republic who have 

experienced emotional violence in the 12 months prior to the survey have 80% lower odds (OR=0.20, 

p≤0.05) of discontinuing due to no further need in that same period compared with women who have not 

experienced emotional violence, while women in Kenya who recently experience emotional violence 

have 63% lower odds (OR = 0.37, p≤0.05). The possible effect is smaller in Honduras where women 

experiencing emotional violence face 28% lower odds of discontinuing due to no further need (OR=0.72, 

p≤0.10). In Honduras and Kenya, the direction of the association for discontinuing due to no further need 

is opposite the direction of the association for discontinuing while still in need. In the Kyrgyz Republic, 

the direction of the association for both types of discontinuation is negative. 

Table 5. Unadjusted odds of emotional, physical, sexual, and any intimate partner violence predicting 

discontinuation while still in need, discontinuation due to no further need, and total discontinuation in 

the 12 months prior to the survey among currently married women age 15-49: Odds ratios from 

logistic regression models 

 

DWSIN 

Discontinuation due to 

no further need Total discontinuation 

 OR 95% CI OR 95% CI OR 95% CI 

Emotional violence in last 12 months 

(ref=no emotional violence in last 12 months)

Cambodia 2014 0.72 (0.26-1.95) 0.71 (0.27-1.87) 0.70 (0.33-1.46) 

Egypt 2014 1.65* (1.05-2.61) 0.87 (0.56-1.34) 1.16 (0.84-1.61) 

Honduras 2011-12 1.26† (0.97-1.64) 0.72† (0.50-1.02) 1.04 (0.83-1.29) 

Jordan 2012 1.31 (0.82-2.08) 1.09 (0.61-1.95) 1.23 (0.85-1.78) 

Kenya 2014 1.67† (0.95-2.94) 0.37* (0.17-0.82) 1.00 (0.63-1.58) 

Kyrgyz Republic 2012 0.23† (0.05-1.02) 0.20* (0.06-0.68) 0.20** (0.07-0.54) 

Rwanda 2014-15 1.11 (0.55-2.25) 0.59 (0.27-1.31) 0.83 (0.49-1.43) 

Tajikistan 2012 1.16 (0.45-3.00) 0.72 (0.26-1.97) 0.97 (0.43-2.15) 

Uganda 2011 0.80 (0.38-1.66) 0.77 (0.27-2.22) 0.76 (0.39-1.46) 

Zambia 2013-14 0.69† (0.46-1.04) 0.91 (0.60-1.38) 0.76† (0.55-1.04) 

Zimbabwe 2010-11 1.06 (0.67-1.68) 1.02 (0.71-1.46) 1.03 (0.77-1.38) 

Physical violence in last 12 months 

(ref=no physical violence in last 12 months)

Cambodia 2014 0.86 (0.27-2.76) 0.46 (0.12-1.70) 0.66 (0.26-1.65) 

Egypt 2014 1.49† (0.93-2.39) 1.33 (0.91-1.94) 1.44* (1.05-1.96) 

Honduras 2011-12 1.13 (0.81-1.58) 0.86 (0.54-1.38) 1.03 (0.77-1.37) 

Jordan 2012 1.31 (0.71-2.43) 1.21 (0.60-2.43) 1.30 (0.83-2.04) 

Kenya 2014 1.16 (0.63-2.14) 0.29*** (0.15-0.58) 0.72 (0.44-1.18) 

Kyrgyz Republic 2012 0.45 (0.13-1.54) 0.66 (0.27-1.63) 0.59 (0.28-1.24) 

Rwanda 2014-15 0.75 (0.35-1.62) 0.65 (0.32-1.35) 0.68 (0.39-1.18) 

Tajikistan 2012 1.09 (0.39-3.03) 0.61 (0.22-1.71) 0.87 (0.39-1.91) 

Uganda 2011 0.81 (0.35-1.91) 1.23 (0.40-3.77) 0.91 (0.43-1.92) 

Zambia 2013-14 0.83 (0.58-1.18) 0.97 (0.66-1.42) 0.87 (0.66-1.14) 

Zimbabwe 2010-11 1.14 (0.74-1.75) 1.19 (0.84-1.68) 1.20 (0.89-1.61) 

 Continued
45 

Table 5—Continued 

 

DWSIN 

Discontinuation due to 

no further need Total discontinuation 

 OR 95% CI OR 95% CI OR 95% CI 

Sexual violence in last 12 months 

(ref=no sexual violence in last 12 months)

Cambodia 2014 1.80 (0.33-9.77) 0.03*** (0.00-0.22) 0.90 (0.17-4.73) 

Egypt 2014 1.80 (0.79-4.09) 1.40 (0.62-3.15) 1.64 (0.90-2.99) 

Honduras 2011-12 1.33 (0.73-2.40) 1.39 (0.64-3.05) 1.41 (0.85-2.34) 

Jordan 2012 2.38* (1.15-4.93) 1.06 (0.45-2.48) 1.82* (1.02-3.23) 

Kenya 2014 1.78 (0.78-4.04) 0.63 (0.21-1.88) 1.26 (0.64-2.51) 

Kyrgyz Republic 2012 0.32 (0.04-2.52) 0.09* (0.01-0.69) 0.14* (0.03-0.66) 

Rwanda 2014-15 0.89 (0.37-2.12) 0.76 (0.26-2.19) 0.81 (0.40-1.66) 

Tajikistan 2012 0.08* (0.01-0.65) 0.60 (0.08-4.21) 0.28 (0.06-1.39) 

Uganda 2011 0.96 (0.41-2.27) 1.24 (0.32-4.75) 1.05 (0.46-2.39) 

Zambia 2013-14 1.36 (0.93-1.98) 0.75 (0.48-1.16) 1.10 (0.81-1.49) 

Zimbabwe 2010-11 0.85 (0.49-1.47) 1.22 (0.81-1.86) 1.10 (0.77-1.58) 

Any IPV in last 12 months 

(ref=no IPV in last 12 months)

Cambodia 2014 0.78 (0.32-1.92) 0.70 (0.28-1.73) 0.73 (0.37-1.43) 

Egypt 2014 1.49† (1.00-2.24) 1.10 (0.78-1.56) 1.27† (0.97-1.68) 

Honduras 2011-12 1.24† (0.96-1.61) 0.68* (0.48-0.97) 1.01 (0.81-1.25) 

Jordan 2012 1.43 (0.92-2.22) 1.07 (0.63-1.81) 1.28 (0.91-1.80) 

Kenya 2014 1.44 (0.85-2.44) 0.37** (0.20-0.70) 0.86 (0.57-1.31) 

Kyrgyz Republic 2012 0.56 (0.21-1.50) 0.57 (0.23-1.37) 0.55† (0.27-1.10) 

Rwanda 2014-15 0.94 (0.49-1.81) 0.51† (0.26-1.00) 0.69 (0.42-1.14) 

Tajikistan 2012 1.03 (0.44-2.43) 0.54 (0.22-1.32) 0.80 (0.40-1.59) 

Uganda 2011 0.72 (0.36-1.44) 1.32 (0.50-3.46) 0.83 (0.44-1.58) 

Zambia 2013-14 0.98 (0.71-1.34) 0.94 (0.66-1.33) 0.96 (0.75-1.23) 

Zimbabwe 2010-11 1.00 (0.67-1.49) 1.19 (0.89-1.59) 1.14 (0.89-1.47) 

Notes: 

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

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no 

longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a more effective 

method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of 

for other fertility-related reasons (e.g. infrequent sex/husband away, marital dissolution/separation, difficult to get 

pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a 

method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from 

this analysis. 

Only among women in Kenya is there is a relationship between the experience of physical violence and 

discontinuation due to no further need; this relationship is highly significant. Women with a recent 

experience of physical violence have 71% lower odds (OR=0.29, p≤0.001) of discontinuing due to no 

further need in the last 12 months. Sexual violence is associated with discontinuing due to no further need 

in two countries—Cambodia (OR=0.03, p≤0.001) and the Kyrgyz Republic (OR=0.09, p≤0.05)—and the 

size of the effect is relatively large. Women who experience sexual violence in Cambodia and the Kyrgyz 

Republic have odds of discontinuing due to no further need that are more than 90% lower than women not 

experiencing sexual violence. 

The experience of any IPV, regardless of specific form of IPV, is significantly associated with lower odds 

of discontinuing due to no further need in Honduras (OR=0.68, p≤0.05) and Kenya (OR=0.37, p<0.01) 

and nearly significantly so in Tajikistan (OR=0.51, p≤0.10). 
46 

7.3. Bivariate Associations between IPV and Total Discontinuation 

In general, the results do not reveal consistent relationships between IPV (any IPV or any of the 

individual forms of IPV) and total discontinuation for any reason among women in most countries in this 

study. Furthermore, the direction of the association, where such exists, is not consistent within or across 

forms of IPV. 

A significant, negative relationship is found between emotional violence and total discontinuation in the 

Kyrgyz Republic (OR=0.20, p≤0.01), where emotional violence was significantly or nearly significantly 

associated with both discontinuing while still in need and discontinuing due to no further need; in Zambia 

there is a nearly significant relationship of smaller magnitude (OR=0.76, p≤0.10), where emotional 

violence was nearly significantly associated with only discontinuing while still in need but not with no 

further need. 

Significant, positive associations between discontinuation and physical violence exist only among women 

in Egypt (OR = 1.44, p≤0.05) and for sexual violence among women in Jordan (OR = 1.82, p≤0.05), 

whereby women in these two countries were more likely to discontinue if they experienced these types of 

violence compared to women who had not experienced that specific type of violence. This finding is 

similar to the positive relationship found between that form of violence and discontinuing while still in 

need in those two countries. 

The analysis also found a significant, negative association with experience of recent sexual IPV and 

discontinuation for any reason in Kyrgyz Republic. Women who experienced recent sexual violence had 

86% lower odds of discontinuing contraception than women who had not experienced this type of 

violence (OR = 0.14, p≤0.05). 

Overall experience of any IPV is weakly associated with increased odds of discontinuing contraception in 

Egypt (OR=1.27, p≤0.10), where IPV experience is associated with discontinuing while still in need, and 

also with decreased odds of discontinuing contraception in the Kyrgyz Republic (OR=0.55, p≤0.10), 

where IPV was not significantly associated with discontinuing for either reason (while still in need or due 

to no further need). 

In summary, we tested for bivariate relationships between 4 forms of IPV and 3 types of 

discontinuation—a total of 12 combinations—in 11 countries. Only 26 associations were detected from 

among a total of 132 possible associations, 12 of which are of borderline significance. There is no 

evidence of an association whatsoever between the recent experience of IPV (each individual form of 

violence or any IPV combined) and discontinuation for any reason (while still in need, no further need, or 

total discontinuation) in three countries: Rwanda, Uganda, and Zimbabwe. A single association was 

detected in Cambodia and Tajikistan and two each in Jordan and Zimbabwe. Multiple associations were 

found between various forms of violence and discontinuation for one or more reasons in the remaining 

four countries: Egypt, Honduras, Kenya, and the Kyrgyz Republic, but not always in the same direction. 
47 

8. Association of Socio-Demographic Factors with 

Discontinuation 

Tables 6-8 show the bivariate relationships between a range of women’s background characteristics and 

DWSIN, discontinuation due to no further need, and total discontinuation, by presenting unadjusted odds 

ratios from separate logistic regressions. These variables describe aspects of women’s contraceptive use 

(method type (LARC versus non-LARC) and duration of contraceptive use) and socio-demographic 

factors that may be associated with contraceptive discontinuation, such as age, wealth, place of residence, 

religion, education, employment, number of living children, and marital duration. Across the different 

types of discontinuation, there are few relationships found with higher wealth quintiles, place of 

residence, religion, education, and employment status. More often than not, significant associations with 

types of discontinuation are seen for age, number of living children, and marital duration. 

8.1. Discontinuation While Still in Need 

Significant or borderline significant associations are found between the type of method women are using 

and DWSIN in seven countries, except Kenya, Kyrgyz Republic, Uganda, and Zimbabwe. In the 

remaining countries, women had higher odds of DWSIN if they used a non-LARC method versus a 

LARC method. Women in Honduras show the largest effect, with an odds ratio of 4.74 (p≤0.001) of 

DWSIN if they were using a non-LARC compared to using a LARC method. In the other six countries 

with a significant association, the odds of DWSIN were more than double (OR>2.0) among women using 

a non-LARC method as compared to women using a LARC method. 

The odds of DWSIN decrease with an increasing duration of contraceptive use prior to the observation 

period in five countries: Egypt, Honduras, Jordan, the Kyrgyz Republic, and Tajikistan. There is no 

association between duration of contraceptive use and DWSIN in the remaining six countries. 

In Cambodia, Jordan, and the Kyrgyz Republic, women in older age groups have higher odds of DWSIN 

than the youngest age group, age 15-19. In Egypt, Honduras, and Tajikistan, the opposite is true: older 

age groups tend to have lower odds of DWSIN compared to the youngest age group age 15-19. No 

associations with age are detected among women in Kenya, Rwanda, Uganda, Zambia, and Zimbabwe. 

Household wealth quintiles are occasionally associated with DWSIN. This association is generally 

negative (6 countries) where such associations are detected; that is, women living in several richer wealth 

quintiles have lower odds of DWSIN. However, a positive association is found among certain wealth 

quintiles in Cambodia and the Kyrgyz Republic. 

Women living in rural areas have higher odds of DWSIN in Egypt, Jordan, Zambia, and Zimbabwe, but 

there are no associations found elsewhere. Religion is not associated with DWSIN outside of Kenya, 

where both Christian women and women who adhere to other religions have lower odds of DWSIN than 

do Muslim women. 

Increasing education is negatively associated with DWSIN in Jordan, Rwanda, Zambia, and Zimbabwe; 

this effect is most significant among women with higher education. Women’s employment status is 

seldom associated with DWSIN. In Kenya and Zimbabwe, employed women have lower odds of DWSIN, 

although in Zimbabwe this association is borderline significant and is found for women employed for 

cash. In the Kyrgyz Republic and Uganda, women who work but not for cash have higher odds of 

DWSIN; this association is also of borderline significance. 
48 

Table 6. Unadjusted odds of discontinuing while still in need in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-2015 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Method used 12 months prior to survey (ref=LARC)

non-LARC 2.95* 2.57*** 4.74*** 2.25*** 1.25 1.67 2.14† 2.19* 1.07 1.57† 1.56

Duration of use before the observation period (ref=1-12 months)

13-36 months 0.63 0.74 0.75* 0.37*** 0.72 0.47 0.92 0.16*** 1.26 1.04 1.17

37+ months 1.04 0.47*** 0.54*** 0.44*** 0.77 0.26* 1.10 0.25*** 0.46 0.76 1.15

Age (ref=15-19) 

20-24 ref 0.66 0.85 3.68** 3.51 12.07* 0.67 0.96 1.35 0.94 2.19

25-29 4.26* 0.51 0.76 1.19 2.23 4.49† 0.84 0.63 1.10 0.57 2.35

30-34 2.49 0.30 0.62* 1.66 1.66 5.50* 0.41 0.32* 2.14 0.66 2.07

35-39 1.10 0.28† 0.48** 1.45 0.81 12.36** 0.43 0.50 0.32 0.65 2.82

40-44 4.31* 0.14* 0.52* 1.11 0.65 7.79* 0.48 0.35† 0.18 0.59 2.41

45-49 8.40** 0.26† 0.72 na 1.56 na na na 0.42 0.47 1.72

Wealth quintile (ref=poorest)

Second 0.86 1.11 0.92 0.81 0.74 0.98 2.08 0.65 0.55 0.97 1.14

Middle 0.96 0.79 0.97 0.55* 0.82 1.13 0.91 0.38† 0.83 0.92 1.37

Fourth 2.42† 0.68 0.97 0.71 0.46† 2.35 1.56 0.51 0.48 0.61† 0.62

Highest 0.79 0.49* 1.07 0.31** 0.57 3.33† 1.07 0.42* 0.59 0.48** 0.47*

Place of residence (ref=urban) 

Rural 1.30 1.62* 1.10 1.85*** 0.94 0.60 1.77 1.22 1.59 1.54** 1.52*

Religion (ref=Muslim) (ref= 

Christian) 

 

Christian na 1.19 1.00 na 0.25** na 0.69 na 1.51 1.50 1.03

Other 1.46 na 0.97 na 0.05** na na na 1.56 na 1.33

Education (ref=no education)

Primary 1.00 1.14 0.95 0.60 1.83 (ref=secondary 

education) 

0.38* 0.30 1.00 0.99 0.55

Secondary 0.45 0.76 0.97 0.27* 1.69 1.00 0.35† 0.49 0.53 0.67 0.53

Higher 0.11* 0.68 0.85 0.24* 2.35 1.24 0.76 0.50 0.76 0.34* 0.13*

Employment (ref=not employed) 

Employed for cash 0.68 0.83 0.83 na 0.47* 1.15 3.81 0.92 1.28 0.87 0.68†

Employed not for cash 0.25 1.25 0.92 na 0.48* 2.76† 3.34 2.62 2.95† 0.98 1.13

Number of living children (ref=0) 

1-2 0.38† 1.40 0.72 1.27 0.59 1.65 1.33 0.26 0.93 1.18 0.22**

3-4 0.81 0.71 0.58* 0.64† 0.20* 1.95 0.82 0.23 0.62 1.06 0.30*

5+ na na 0.99 na 0.27 na na 0.15 0.90 1.26 0.41

Marital duration in years (ref=0-4 years)

5-9 0.44 0.91 1.00 0.85 0.77 0.14* 1.07 0.22** 1.72 0.76 1.54

10-14 0.95 0.40** 0.73† 0.70 0.65 0.64 0.54 0.22** 1.45 0.96 1.10

15-19 0.43 0.58† 0.72† 0.77 0.36** 1.34 0.55 0.28* 1.15 0.65† 1.75

20-24 1.28 0.33** 0.56* 0.48† 0.20** 0.65 0.27 0.38† 0.42 0.74 1.67

25-29 1.65 0.38* 0.98 0.29** 0.37 0.14* 1.18 0.24* 0.78 0.77 0.71

30+ 0.89 0.52 1.12 0.19** 0.94 na 8.01* 0.71 na 0.74 1.24

Weighted n 931 3345 3283 2625 1437 1083 584 878 228 2422 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. health 

concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. infrequent 

sex/husband away, marital dissolution/separation, difficult to get pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used continuously

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys.

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference category

Data on employment status was not collected in the Jordan 2012 DHS.
49 

Both the number of living children and marital duration are often significantly and negatively associated 

with DWSIN in the bivariate analysis. That is, the odds of DWSIN are reduced among women in higher 

categories of number of children compared to women with no children, while the odds of DWSIN are 

lowest among women who have been married longer compared to couples who have been married less 

than four years. Because these two demographic characteristics tend to be highly correlated, only the 

number of living children is included in our multivariate models predicting discontinuation; marital 

duration is excluded due to partial collinearity. 

8.2. Discontinuation Due to No Further Need 

In seven countries, women had significantly (or borderline significantly) higher odds of discontinuing due 

to no further need if they were using non-LARCs as compared to LARCs in seven countries: Egypt, 

Honduras, Jordan, the Kyrgz Republic, Rwanda, Zambia, and Zimbabwe. These results resemble those 

for DWSIN, which have a similar positive relationship also in seven countries. Only two countries, the 

Kyrgyz Republic and Zimbabwe, indicate this positive association between non-LARC use and both 

DWSIN and due to no further need. In the Kyrgyz Republic, women have the highest odds of all countries 

of discontinuing due to no further need among non-LARC users (OR 3.89, p≤0.001) as compared to 

LARC users. The odds ratios are lowest—but nonetheless sizable—in Egypt (OR=1.68, p≤0.001) and 

Honduras (OR=1.87, p≤0.05) where women who use shorter term methods have 68-87% higher odds of 

discontinuing due to no further need than do LARC users. 

As seen in Table 7, duration of contraceptive use prior to the observation period exhibits similar 

relationships with discontinuing due to no further need in the same countries and in the same direction as 

with DWSIN. In addition, data from Rwanda, Zambia, and Zimbabwe reveal a positive association 

between longer contraceptive use and discontinuation due to no further need that was not detected with 

DWSIN. In contrast, the negative association between contraceptive duration and DWSIN is not apparent 

with regards to discontinuing due to no further need. 

Age is significantly associated with discontinuing due to no further need in most countries, but this 

relationship is not necessarily found among all age groups. Women in Cambodia, Egypt, Jordan, Kenya, 

Tajikistan, Uganda, Zambia, and Zimbabwe have significantly or borderline significantly lower odds of 

discontinuing due to no need among some higher age groups compared to the lowest age group, whereas 

in Rwanda and Kyrgyz Republic, the relationships are in the opposite direction. 

Associations with wealth quintile, residence, and religion are fewer than relationships between these 

factors and DWSIN. Where they do exist, the patterns largely resemble those for DWSIN. In several 

countries—Cambodia, Egypt, and Kenya—a positive relationship is suggested between education and 

discontinuing due to no further need whereas no relationship or a slight negative relationship is detected 

with regards to DWSIN. Employment status is seldom associated with discontinuing due to no further 

need. However, women employed for cash in Egypt and women employed but not for cash in the Kyrgyz 

Republic have lower odds of discontinuing due to no further need. 

In most countries, both number of living children and years of marital duration are significantly 

associated with discontinuation due to no further need where women have reduced odds of discontinuing 

for no further need in higher categories of marital duration and number of children than women with 

fewer years of marriage and children. However, in Egypt and Rwanda, women who have either 1-2 

children or 3-4 children are more likely to discontinue due to no further need compared to women who 

have no children. 
50 

Table 7. Unadjusted odds of discontinuing due to no further need in the 12 months prior to the survey 

among currently married women age 15-49: Odds ratios from logistic regression models 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-2015 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Method used 12 months prior to survey (ref=LARC)

non-LARC 1.87* 2.45*** 2.17 3.89*** 2.54* 1.86 1.56 2.46* 4.34† 1.87* 2.45***

Duration of use before the observation period (ref=1-12 months)

13-36 months 0.71† 1.35 1.88† 1.83† 2.57** 1.74 2.40 2.00*** 2.48*** 0.71† 1.35

37+ months 0.71† 0.41** 2.40* 0.71 1.80 0.80 1.69 2.38*** 2.75*** 0.71† 0.41**

Age (ref=15-19) 

20-24 0.96 1.56 0.30 8.03† 5.13* 2.24 0.60 0.69 1.66 0.96 1.56

25-29 0.69 1.32 0.34 15.28** 4.30* 4.62* 0.19 1.00 1.58 0.69 1.32

30-34 0.58* 0.90 0.22 3.06 3.77* 2.71 0.08† 0.44† 1.20 0.58* 0.90

35-39 0.23*** 0.35 0.18 7.31† 2.02 2.15 0.03* 0.27** 0.67 0.23*** 0.35

40-44 0.28** 0.06** 0.01** 0.42 na 0.85 0.14 0.14* 0.32† 0.28** 0.06**

45-49 0.45 0.24 0.26 na na na na na 0.40 0.45 0.24

Wealth quintile (ref=poorest)

Second 0.77 0.95 0.47 1.68 1.33 2.14 1.46 0.84 0.90 0.77 0.95

Middle 0.92 1.08 0.52 1.82 1.45 0.47 0.59 0.65 0.77 0.92 1.08

Fourth 1.20 0.48* 0.61 2.75† 1.30 0.97 0.74 1.07 0.70† 1.20 0.48*

Highest 0.81 1.22 0.69 4.39** 1.07 1.06 0.81 0.52* 0.58* 0.81 1.22

Place of residence (ref=urban)

Rural 1.24 0.96 0.84 0.63 1.31 1.03 1.00 1.19 1.42* 1.24 0.96

Religion (ref=Muslim) (ref= 

Christian)

 

Christian 1.00 na 0.34 na 0.67 na 1.07 0.48 1.12 1.00 na

Other 0.82 na 0.44 na na na 0.92 1.11 1.06 0.82 na

Education (ref=no education)

Primary 1.97 0.77 3.25 (ref=secondary 

education) 

0.66 1.64 0.76 0.84 0.86 1.97 0.77

Secondary 2.02 1.16 5.67* 1.00 1.62 1.22 1.14 0.87 0.83 2.02 1.16

Higher 2.39 1.56 8.18** 1.17 0.81 na na 0.73 na 2.39 1.56

Employment (ref=not employed) 

Employed for cash 0.87 na 0.72 1.65 1.78 0.71 0.75 0.82 0.86 0.87 na

Employed not for cash 1.32 na 1.51 0.20* 2.53 0.11* 0.72 0.72 0.82 1.32 na

Number of living children (ref=0)

1-2 0.23*** 0.56 0.11*** 0.17† 8.16** 0.06* 1.69 0.21* 0.37* 0.23*** 0.56

3-4 0.11*** 0.27 0.06*** 0.05** 4.03† 0.03** 0.24 0.16** 0.19*** 0.11*** 0.27

5+ 0.07*** 0.07† 0.02*** 0.04** na 0.03** 0.07† 0.05*** 0.07*** 0.07*** 0.07†

Marital duration in years (ref=0-4 years)

5-9 0.48*** 0.46** 0.62 0.77 0.78 0.62 0.30† 1.06 0.86 0.48*** 0.46**

10-14 0.44*** 0.42* 0.42* 0.79 0.67 0.67 0.13** 0.85 0.65* 0.44*** 0.42*

15-19 0.38*** 0.10*** 0.28* 0.18** 0.54 0.36 na 0.24*** 0.42*** 0.38*** 0.10***

20-24 0.17*** 0.05*** 0.24* 0.09*** 0.08* 0.20* na 0.47* 0.23*** 0.17*** 0.05***

25-29 0.23** 0.01*** 0.09** na na 0.16* 0.32 na 0.17*** 0.23** 0.01***

30+ 0.53 0.47 na na na na na na 0.35 0.53 0.47

Weighted n 3283 2646 1437 1083 547 878 221 2304 1899 3283 2646 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. health 

concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. infrequent 

sex/husband away, marital dissolution/separation, difficult to get pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used continuously

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys.

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference category

Data on employment status was not collected in the Jordan 2012 DHS.
51 

8.3. Total Discontinuation 

When DWSIN and discontinuation due to no further need are aggregated, method type is significantly 

associated with total discontinuation in almost all countries. Similar to discontinuation disaggregated by 

need versus no further need, women have higher odds of discontinuing contraception during the 12 month 

observation period when they are using a non-LARC method versus a LARC method. The highest odds 

for total discontinuation appear among women using non-LARC methods in Honduras (OR = 3.41, 

p≤0.001). There are no significant differences in their odds of discontinuing regardless of need between 

women who use LARCs or shorter-term methods in Kenya and Uganda, nor are there differences between 

these women in the odds of DWSIN or discontinuing due to no further need. 

Longer duration of contraceptive use prior to the observation period is associated with decreased odds of 

total discontinuation in five countries—Egypt, Honduras, Jordan, Rwanda, and Zimbabwe—where 

duration of use is negatively associated with DWSIN. Longer duration of use is associated with increased 

odds of total discontinuation in the Kyrgyz Republic and Tajikistan, where duration of use is also 

positively associated with discontinuation due to no further need. 

No associations with age appear among women in Kenya, Jordan, and Rwanda and only a few age groups 

are associated with total discontinuation in Tajikistan and Uganda. In the remaining six countries, the 

direction of the association between women’s age and total discontinuation varies by country. As with 

DWSIN and discontinuation due to no further need, fewer associations occur between wealth, residence, 

religion, education, or employment and total discontinuation than with other background characteristics. 

Where such associations are apparent, the pattern of the association is the same as the association with 

DWSIN. Also similar to DWSIN and discontinuation due to no further need, in general, longer durations 

of marriage and higher number of children are associated with decreased odds of overall discontinuation. 
52 

Table 8. Unadjusted odds of total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-2015 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Method used 12 months prior to survey (ref=LARC)

non-LARC 2.11*** 3.41*** 2.61*** 1.59 3.23*** 2.48** 2.16** 1.21 1.97** 3.05* 2.11***

Duration of use before the observation period (ref=1-12 months)

13-36 months 0.96 0.71** 0.71† 1.03 1.19 1.54† 0.45** 1.67 1.37* 2.00*** 0.96

37+ months 0.41*** 0.57*** 0.39*** 1.22 0.48† 1.38 0.35*** 0.66 1.25 2.16*** 0.41***

Age (ref=15-19) 

20-24 1.16 0.88 4.43 0.84 9.55* 1.77 1.17 0.83 0.79 1.87 1.16

25-29 0.61 0.70† 2.13 0.65 13.33** 1.81 1.24 0.37 0.72 1.84 0.61

30-34 0.33* 0.56** 1.91 0.44 3.69 1.14 0.65 0.55 0.50† 1.42 0.33*

35-39 0.22** 0.34*** 1.07 0.26 9.01* 0.82 0.73 0.08* 0.42* 1.09 0.22**

40-44 0.09*** 0.38*** 0.56 0.10* 2.05 0.68 0.41† 0.09† 0.33** 0.68 0.09***

45-49 0.16** 0.56† 0.72 0.46 na na na 0.09 0.21** 0.63 0.16**

Wealth quintile (ref=poorest)

Second 1.38 0.85 0.85 0.59 1.46 1.81† 1.06 0.71 0.90 0.97 1.38

Middle 1.21 0.95 0.74 0.66 1.61 1.19 0.39* 0.72 0.79 0.95 1.21

Fourth 0.99 1.06 0.58* 0.49* 2.72* 1.49 0.62 0.48 0.76 0.64* 0.99

Highest 0.72 0.96 0.63 0.59 4.31** 1.08 0.58 0.58 0.46*** 0.51** 0.72

Place of residence (ref=urban)

Rural 1.66*** 1.17 1.44* 0.89 0.61 1.59 1.14 1.47 1.44** 1.51** 1.66***

Religion (ref=Muslim) (ref= 

Christian) 

Christian 0.70 1.00 na 0.23** na 0.64 na 1.44 0.81 1.10 0.70

Other na 0.90 na 0.14* na na na 1.41 0.64 1.17 na

Education (ref=no education)

Primary 1.05 1.21 0.59 2.25 (ref=secondary 

education) 

0.44** 0.83 1.43 0.92 2.08 1.05

Secondary 1.29 1.25 0.40† 2.76* 1.00 0.75 0.91 1.02 0.72 2.01 1.29

Higher 1.12 1.23 0.45 4.07* 1.20 0.75 0.84 1.26 0.45* 1.71 1.12

Employment (ref=not employed)

Employed for cash 0.48*** 0.83† na 0.52** 1.52 2.74 0.81 1.09 0.83 0.77* 0.48***

Employed not for cash 0.85 1.08 na 0.78 0.91 3.08† 1.35 2.29 0.85 0.92 0.85

Number of living children (ref=0)

1-2 3.46*** 0.33*** 1.15 0.15*** 0.22 2.71** 0.04* 1.33 0.32† 0.22** 3.46***

3-4 1.25 0.22*** 0.50 0.06*** 0.09** 1.40 0.03** 0.39 0.26* 0.15*** 1.25

5+ 0.31*** 0.37 0.05*** 0.06** na 0.02** 0.47 0.19** 0.11***

Marital duration in years (ref=0-4 years)

5-9 0.45*** 0.70* 0.53** 0.66 0.61 0.91 0.32* 0.65 0.88 1.02 0.45***

10-14 0.19*** 0.54*** 0.45** 0.50* 0.74 0.57† 0.33* 0.41 0.90 0.72* 0.19***

15-19 0.17*** 0.51*** 0.26*** 0.29*** 0.38* 0.51† 0.27** 0.24* 0.42*** 0.66† 0.17***

20-24 0.09*** 0.33*** 0.15*** 0.19*** 0.19** 0.14** 0.28** 0.09** 0.58* 0.48* 0.09***

25-29 0.13*** 0.55* 0.08*** 0.21** 0.02*** 0.47 0.18** 0.36 0.37** 0.25** 0.13***

30+ 0.09*** 0.80 0.31 0.43 na 3.18 0.40 na 0.35† 0.50 0.09***

Weighted n 3345 3283 2846 1437 1083 584 878 228 2422 1899 3345 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. health 

concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. infrequent 

sex/husband away, marital dissolution/separation, difficult to get pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used continuously

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys.

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference category

Data on employment status was not collected in the Jordan 2012 DHS. 
53 

9. Multivariate Analysis of the Association between IPV and 

Discontinuation While Still in Need 

Table 9 presents adjusted odds ratios for DWSIN, discontinuation due to no further need, and total 

discontinuation during the 12 month observation period from multivariable logistic regressions. The 

primary independent variables of interest are experience of different forms violence during the same 

observation—emotional, physical, and sexual violence—as well as any IPV. We conducted a separate 

regression for each form of violence for each reason for discontinuation, as well as total discontinuation, 

for each country. 

These models control for method type (LARC versus non-LARC), duration of contraceptive use before 

the observation period, age, household wealth quintile, place of residence, religion (except in Jordan, 

Kyrgyz Republic, and Tajikistan), employment status (except Jordan), education, and number of living 

children. Although we present unadjusted odds of the association between marital duration and 

discontinuation outcomes, we exclude this measure from multivariate models due to multicollinearity 

with number of living children12. For clarity, Table 9 displays the adjusted odds ratios only for our focal 

predictor variables—measures of experience of violence. Results of the full models are available in 

Appendix Tables 4-15. 

Overall, the adjusted models reveal only a small number of significant associations between different 

forms or any combination of IPV. The relationships are not consistent by either type of violence or even 

among women in different countries by reason for discontinuation. However, there is a strong relationship 

between type of method (LARC versus non-LARC) and discontinuation, for DWSIN, discontinuing due 

to no further need, and discontinuing for any reason. The exception to this is among women in Kenya and 

Uganda. 

 

12 Models that substitute marital duration for number of living children yield similar results. 
54 

Table 9. Adjusted odds of emotional, physical, sexual, and any intimate partner violence 

predicting discontinuation while still in need, discontinuation due to no further need, and 

total discontinuation in the 12 months prior to the survey among currently married women 

age 15-49: Odds ratios from logistic regression models controlling for contraceptive 

method type and socio-demographic controls 

DWSIN 

Discontinuation 

due to no further 

need 

Total 

discontinuation 

Emotional violence in last 12 months (ref=no emotional violence in last 12 months) 

Cambodia 2014 0.65 0.77 0.63 

Egypt 2014 1.60† 0.82 1.13 

Honduras 2011-12 1.24 0.78 1.08 

Jordan 2012 1.26 1.10 1.19 

Kenya 2014 2.11** 0.46 1.33 

Kyrgyz Republic 2012 0.22* 0.26* 0.24**

Rwanda 2014-15 1.31 0.76 1.08 

Tajikistan 2012 1.03 0.37 0.68 

Uganda 2011 0.83 0.50 0.65 

Zambia 2013-14 0.67† 0.84 0.71*

Zimbabwe 2010-11 1.04 1.01 1.02 

Physical violence in last 12 months (ref=no physical violence in last 12 months) 

Cambodia 2014 0.85 0.55 0.67 

Egypt 2014 1.22 1.14 1.21 

Honduras 2011-12 1.19 0.93 1.10 

Jordan 2012 1.27 1.03 1.17 

Kenya 2014 1.49 0.37** 0.93 

Kyrgyz Republic 2012 0.55 0.86 0.74 

Rwanda 2014-15 0.79 0.77 0.76 

Tajikistan 2012 0.97 0.37 0.69 

Uganda 2011 0.92 0.60 0.79 

Zambia 2013-14 0.78 0.82 0.78†

Zimbabwe 2010-11 1.18 1.12 1.16 

Sexual violence in last 12 months (ref=no sexual violence in last 12 months) 

Cambodia 2014 1.41 0.02** 0.74 

Egypt 2014 1.86 1.42 1.74 

Honduras 2011-12 1.31 1.69 1.51 

Jordan 2012 2.54* 0.98 1.81†

Kenya 2014 2.01† 0.83 1.52 

Kyrgyz Republic 2012 0.37 0.11* 0.18*

Rwanda 2014-15 1.07 0.85 0.99 

Tajikistan 2012 0.06* 0.57 0.22†

Uganda 2011 0.70 0.71 0.59 

Zambia 2013-14 1.28 0.60* 1.06 

Zimbabwe 2010-11 0.83 1.19 1.06 

Continued
55 

Table 9—Continued

DWSIN 

Discontinuation 

due to no further 

need 

Total 

discontinuation 

Any IPV in last 12 months (ref=no IPV in last 12 months) 

Cambodia 2014 0.72 0.75 0.67 

Egypt 2014 1.35 1.02 1.18 

Honduras 2011-12 1.25† 0.75 1.06 

Jordan 2012 1.43 1.10 1.29 

Kenya 2014 1.87* 0.47* 1.13 

Kyrgyz Republic 2012 0.65 0.76 0.71 

Rwanda 2014-15 1.01 0.55 0.76 

Tajikistan 2012 1.01 0.34* 0.65 

Uganda 2011 0.63 0.85 0.61 

Zambia 2013-14 0.92 0.81 0.87 

Zimbabwe 2010-11 0.96 1.14 1.09 

Notes: 

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

Models control for method type (LARC/non-LARC), duration of contraceptive use before observation period, 

age, household wealth quintile, place of residence, religion (except Jordan, Kyrgyz Republic, and 

Tajikistan), employment status (except Jordan), education, and number of living children. Full model results 

available in Appendix Table 4-15. 

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become 

pregnant or no longer at risk of becoming pregnant (e.g. health concerns/side effects, method 

inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become 

pregnant of for other fertility-related reasons (e.g. infrequent sex/husband away, marital dissolution/

separation, difficult to get pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study 

so long as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are 

excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS 

surveys and are excluded from regression models for these countries. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from these 

regression models. 

9.1. Emotional Violence 

After controlling for contraceptive experience and socio-demographic variables, emotional violence is 

significantly or marginally associated with discontinuation in a few countries for DWSIN, discontinuation 

due to no further need, and total discontinuation. All bivariate associations between the experience of 

emotional violence and DWSIN remain even after socio-demographic controls are included, except in 

Honduras. In Egypt, the positive association weakened slightly (OR 1.6, p≤0.10) with the inclusion of 

controls. The strongest association is seen in Kenya, where women who have experienced emotional 

violence in the twelve month observation period before the survey have over two times the odds of 

DWSIN compared to women who did not experience this type of violence (OR = 2.11, p≤0.01). This 

association increased in size and significance with the inclusion of controls. In the Kyrgyz Republic (OR 

= 0.22, p≤0.05) and Zambia (OR=0.67, p≤0.10), however, the odds of DWSIN are lower among women 

who experienced emotional violence than if they had not. This effect also strengthened slightly in the 

presence of controls. 

The negative association with emotional violence in Kyrgyz Republic also holds for discontinuation for 

no further need (OR = 0.26, p≤0.05) and for total discontinuation (OR = 0.24, p≤0.01); the size and 

strength of this effect changes little with the inclusion of controls in the multivariate models. In Zambia, 
56 

the odds of total discontinuation are also significantly lower among women who have experienced 

emotional violence compared to women who have not experienced recent emotional violence (OR = 0.71, 

p≤0.05). The strength of this association has increased in the multivariate model compared to the bivariate 

association (OR=0.76, p≤0.10). In contrast, the negative bivariate association in Kenya between 

emotional violence and discontinuation due to no further need (0.37, p≤0.05) disappears when controlling 

for other factors and no association with total discontinuation is detected. 

9.2. Physical Violence 

With recent physical violence, even fewer significant associations are present in the adjusted models, 

when examining the odds of discontinuation for any reason, no need, or while still in need. In fact, none 

of the adjusted models demonstrate significantly different odds of DWSIN or total discontinuation based 

on whether or not a woman has experienced physical violence in the twelve months prior to the survey. 

Only in Kenya are women significantly less likely to discontinue due to no further need if they have 

experienced recent physical violence (OR = 0.37, p≤0.01). Compared to the bivariate association 

(OR=0.29, p≤0.001), this association has both somewhat decreased in size and weakened in significance 

with the inclusion of controls. 

9.3. Sexual Violence 

Sexual violence within the twelve months prior to the survey is significantly, or marginally significantly, 

associated with DWSIN, discontinuation due to no further need, or total discontinuation among women in 

five countries after controlling for other socio-demographic factors. The bivariate associations in Jordan 

and Tajikistan of sexual violence with DWSIN remain and are stronger in multivariate models. In Jordan, 

women who experienced recent sexual violence have two and a half times the odds of DWSIN compared 

to women who have not experienced recent sexual violence (OR = 2.54, p ≤ 0.05). Meanwhile, women in 

Tajikistan have 94% lower odds of DWSIN if they had experienced recent sexual violence as compared to 

women who had not (OR = 0.06, p≤0.05). The positive and negative associations in these countries (OR = 

1.81, p≤ 0.10 and OR=0.22, p≤0.10, respectively) between the experience of sexual violence and total 

discontinuation are of marginal significance. 

Women in three countries presented with lower odds of discontinuing due to no further need if they had 

experienced recent sexual violence: in Cambodia (OR = 0.02, p≤ 0.01), Kyrgyz Republic (OR = 0.11, 

p≤ 0.05), and Zambia (OR = 0.6, p ≤ 0.05. This association had not been detectable in bivariate analysis 

in Zambia. The Kyrgyz Republic is the only country in which the analysis reveals a significant, negative 

association with total discontinuation (OR = 0.15, p≤ 0.05). The possible negative association in 

Tajikistan (OR=0.22, p≤0.10) and positive association in Jordan (OR=1.81, p≤0.10) between sexual 

violence and total discontinuation merely approaches significance. 

9.4. Any IPV 

The effects of any one form of violence on total discontinuation or disaggregated by reason for 

discontinuation seem to be diluted in the adjusted logistic regression models for any IPV. The most 

obvious example of this is among women in the Kyrgyz Republic: Although significant associations are 

seen among women in Kyrgyz Republic for two forms—emotional and sexual violence—with one or 

another type of discontinuation, nothing significant is evident when the forms of violence are combined 

into experience of any IPV. 
57 

Women who experience any IPV in Honduras have marginally higher odds of DWSIN (OR 1.25, p≤0.10) 

while women in Tajikistan have lower odds of discontinuing due to no further need (OR 0.34, p≤0,05). 

However, there is no association with total discontinuation in these countries. In Kenya, after controlling 

for socio-demographic covariates, women who experienced any IPV in the twelve months prior to the 

survey are at significantly higher odds of DWSIN than women who did not experience any IPV (OR = 

1.87, p < 0.05); yet, women who have experienced recent IPV have reduced odds of discontinuing for no 

further need (OR = 0.47, p < 0.05), and there is no association with total discontinuation for any reason. 

In fact, in none of the 11 study countries is experience of any IPV significantly associated with total 

discontinuation. 

59 

10. Discussion and Conclusions 

Prior studies using longitudinal data, in which these events are temporally ordered, suggest that the 

experience of IPV leads to less contraceptive use among these women (Maxwell et al. 2015; Stephenson, 

Koenig, and Ahmed 2006; Stephenson et al. 2008). Meanwhile, studies emerging from the literature on 

reproductive control and coercion indicate that women who experience IPV and a partner’s controlling 

behaviors face interference in their contraceptive practices and greater difficulty avoiding unintended 

pregnancy (Gee et al. 2009; Moore, Frohwirth, and Miller 2010; Park et al. 2016; Silverman and Raj 

2014). Based on this extant literature, the authors of this study hypothesized that women who experience 

intimate partner violence would be more likely to experience interruptions in their contraceptive use, 

namely, that they would be more likely to experience discontinuation while still in need (of 

contraception). 

This study takes advantage of detailed data in the reproductive calendars (ICF International 2012, 2015) 

and psychometrically tested measures of various forms of IPV (ICF International 2016; Straus 1979; 

Straus et al. 1996) found in The DHS Program surveys to test this hypothesis in 11 countries. Although 

we cannot fully establish the temporal order between IPV and the moment of contraceptive 

discontinuation, which is possible only in a true longitudinal design, we are able to co-locate these 

behaviors in the same 12-month observation period, which many cross-sectional studies are unable to do. 

More specifically, we examine discontinuation in the 12 months preceding the survey among samples of 

contraceptive users in relation to the experience of IPV following the start of their contraceptive use. We 

examine the odds of discontinuation while still in need and compare this to discontinuation due to no 

further need and total discontinuation. We examine the effects of three forms of violence separately—

emotional violence, physical violence, and sexual violence—and the experience of any of these forms of 

violence on discontinuation in the preceding 12 months. 

The countries chosen for this analysis all present with a modern contraceptive prevalence rate greater than 

25% but with a range of contraceptive methods, some LARC and some non-LARC, that dominates the 

method mix. The prevalence of IPV (any form) ranges from 24% (Tajikistan) to 59% (Uganda). There is 

no difference in the method type (LARC or non-LARC method) based on experience of violence, except 

in Kenya. Here, women who experience IPV are more likely to be using a LARC method compared to 

women with no experience of IPV in the preceding 12 months. In the other 10 countries, regardless of 

IPV experience, LARC use exceeds non-LARC use in Egypt, Jordan, the Kyrgyz Republic, and Tajikistan 

while non-LARC use exceeds LARC use in Cambodia, Honduras, Rwanda, Uganda, Zambia, and 

Zimbabwe. 

In contrast to our expectations, we find limited evidence of association between the experience of 

violence and discontinuation while still in need. Where associations are found, they are often weakly 

significant or of small magnitude. Additionally, they are inconsistent across countries in the direction of 

the association. For example, the experience of emotional violence in the previous 12 months is 

associated with a greater likelihood of discontinuation while still in need in the preceding 12 months in 

Egypt (where IUDs are the most common method). This same association is of borderline significance in 

Honduras and Kenya, where injections are the most common reversible method13. In the Kyrgyz 

Republic, however, where IUDs are also common, the experience of emotional violence is nearly 

significantly associated with a lower likelihood of discontinuation while still in need. No association is 

detected with emotional violence in the remaining seven countries. 

 

13 Injections are the second most common method in Honduras and follow female sterilization, however, women 

who use sterilization as their contraceptive method are excluded from this study. 
60 

Findings also vary with the form of violence assessed. Associations between emotional violence and 

discontinuation while still in need are more commonly detected than other forms or any IPV combined. 

Sexual violence in the preceding 12 months is positively associated with discontinuation while still in 

need in Jordan and negatively associated with discontinuation while still in need in Tajikistan (where 

IUDs dominate the method mix). Positive associations between physical violence (Egypt) or any form of 

violence (Egypt and Honduras) are of borderline significance. No other associations are observed in the 

other countries. 

In contrast to the varying direction of association with IPV and discontinuation while still in need, 

associations with discontinuation due to no further need are consistently negative where they are detected. 

However, these associations are not frequently observed. Women who experience emotional violence 

have significantly lower odds of discontinuing due to no further need in Kenya and the Kyrgyz Republic 

(and nearly significantly lower odds in Honduras), as do women who experience physical violence in 

Kenya, sexual violence in Cambodia (where the pill is the most common method) and the Kyrgyz 

Republic, or any IPV in Honduras, Kenya, and Tajikistan. These associations are not observed elsewhere. 

The multivariate models that assess the relationship between forms of IPV and discontinuation control for 

a number of factors that also may be associated with discontinuation: LARC/non-LARC method type, 

duration of contraceptive use before observation period, age, household wealth quintile, place of 

residence, religion14, employment status15, education, and number of living children. For many countries, 

using a non-LARC method is independently and positively associated with both discontinuation while 

still in need and due to no further need, and the magnitude of the effect (where it exists) is generally 

larger than that of experience with IPV. This finding reinforces results of previous studies indicating that 

discontinuation rates vary across methods (Ali and Cleland 1995; Ali, Cleland, and Shah 2012; Bradley, 

Schwandt, and Khan 2009; Maslyanskaya et al. 2016; Modey, Aryeetey, and Adanu 2014; Steele and 

Curtis 2003). No clear pattern emerges across countries with regard to other characteristics. For example, 

age, duration of contraceptive use prior to the observation period, and household wealth quintile are 

associated with discontinuation while still in need in some countries, but not in others. These findings 

would suggest that, like IPV, the factors influencing discontinuation while still in need (or due to no 

further need) are country-specific. 

This study attempts to fill a gap in the separate demographic literatures on contraceptive dynamics and on 

gender-based violence to explore the relationship between IPV and contraceptive discontinuation. Our 

primary finding is that these associations are generally modest and weak and are country-specific, rather 

than global in nature. Nonetheless, the country-wise variation in the relationship between IPV and 

contraceptive discontinuation emphasizes the need to redouble our efforts, rather than dissuading us, to 

screen for risk of gender-based violence in the context of contraceptive counseling. Instead of a consistent 

association with all forms, or a given form, of violence, this study finds that the pertinent form of violence 

to women’s discontinuation behavior is context-specific. While the pertinent form of violence or direction 

of association is context-specific, this study contributes to existing studies that, globally, IPV in some 

form impacts women’s behaviors and outcomes. 

The term “violence” often conjures to mind physical beatings, whereas IPV manifests in multiple forms: 

emotional, physical, or sexual violence, or marital control. Yet, our study found fewer associations 

between women’s discontinuation behavior and physical violence than other forms of violence. Given the 

statistically strong associations in certain countries between discontinuation while still in need and either 

emotional violence (e.g. Kenya, Kyrgyz Republic) or sexual violence (Jordan, Tajikistan), it is important 

that family planning workers become sensitized about, and for screening tools to include probes for, these 

 

14 Except in Jordan, Kyrgyz Republic, and Tajikistan, where data on religion is not available in the DHS. 15 Except in Jordan where data on employment status is not available in the DHS. 
61 

forms of violence as well as physical violence. Probing for all forms of violence could lead to further 

conversations with clients about their sexual agency, repercussion of their contraceptive use, and 

desirable attributes in their contraceptive method, all of which may lead to more informed contraceptive 

choice and less likelihood of premature discontinuation. Simultaneously, developing better measures of 

these forms of violence for data collection and research purposes and for instrument development is 

warranted (MacQuarrie, Winter, and Kishor 2014; WHO and Human Reproduction Programme 2016). 

Conversations between service providers and their clients about IPV are valuable even in settings where 

women who experience IPV do not appear to be de facto at a statistically heightened risk of 

discontinuation by virtue of their IPV experience. Such women may discontinue contraception for other 

reasons—health concerns, fear of or experience with side effects, issues of cost and access—as do women 

who do not experience IPV (Ali, Cleland, and Shah 2012; Bradley, Schwandt, and Khan 2009; Castle and 

Askew 2015; Jain et al. 2013). However, women who do experience IPV may have unique concerns and 

needs, including questions about method attributes, means of use, and effectiveness, that ultimately 

influence their method choice and ability to maintain a contraceptive regimen. Rather than targeting 

women at heightened risk of IPV because they are predicted to discontinue contraception, it may be 

worthwhile inquiring about women’s IPV experience as a part of a broader strategy to deliver high quality 

contraceptive services to all women by considering individual circumstances and concerns to better 

support their ongoing use of contraception to successfully achieve their reproductive aspirations (Jain et 

al. 2013). 

 

63 

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71 

Appendix Tables 

73 

Appendix Table 1. Proportion of currently married women age 15-49 in the analytic sample using 

specific methods contraception 12 months prior to interview 

LARC non-LARC

IUD Implants Pills Injections Weighted n

Condom 

(male) 

Other 

modern 

method 

Cambodia 2014 8.3 2.2 18.9 8.4 1.6 0.1 931 

Egypt 2014 45.1 0.6 19.7 14.6 0.4 0.1 3,345 

Honduras 2011-12 14.6 0.0 23.5 40.3 7.1 0.2 3,283 

Jordan 2012 43.4 0.3 13.5 1.5 12.9 3.5 2,646 

Kenya 2014 3.8 14.3 12.1 50.4 2.7 0.1 1,437 

Kyrgyz Republic 2012 62.8 0.0 2.3 0.6 14.8 0.4 1,084 

Rwanda 2014-15 0.5 15.4 11.8 45.8 3.0 1.3 585 

Tajikistan 2012 63.6 0.1 5.3 5.4 5.6 0.4 879 

Uganda 2011 0.0 3.9 3.4 58.7 5.7 0.4 228 

Zambia 2013-14 2.2 10.0 21.5 37.6 5.9 1.5 2,422 

Zimbabwe 2010-11 0.1 2.9 53.5 12.1 3.9 0.4 1,899 

Notes: 

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods. 

No reported implant users in Kyrgyz Republic. 

Appendix Table 2. Percent distribution of reason for discontinuation among currently married 

women age 15-49 who discontinued contraceptive use in the 12 months prior to the survey 

No further need While still in need

Total

weighted 

n

Desire to 

become 

pregnant 

Other 

fertility 

related 

reason 

Side 

effects/

health 

concerns

Methodrelated 

reasons 

Cost/ 

Access 

Other 

reasons 

Country % % % % % % 

Cambodia 2014 43.0 3.1 34.9 8.4 0.0 10.5 100.0 111 

Egypt 2014 47.3 15.2 35.6 0.6 0.5 0.9 100.0 560 

Honduras 2011-12 25.8 11.0 39.9 9.6 5.7 8.1 100.0 676 

Jordan 2012 40.9 7.9 29.8 5.2 0.7 15.5 100.0 528 

Kenya 2014 35.9 5.8 39.7 2.8 3.9 12.0 100.0 216 

Kyrgyz Republic 2012 56.8 15.2 24.7 2.2 0.0 1.1 100.0 112 

Rwanda 2014-15 40.7 6.5 40.3 1.9 0.0 10.7 100.0 105 

Tajikistan 2012 27.1 14.6 24.1 14.8 1.0 18.3 100.0 103 

Uganda 2011 20.8 3.8 62.8 3.6 3.9 5.2 100.0 78 

Zambia 2013-14 36.1 3.5 35.7 3.1 5.8 15.8 100.0 500 

Zimbabwe 2010-11 56.6 12.1 16.0 5.9 5.8 3.6 100.0 408 

Notes: 

Reasons for discontinuation are mutually exclusive and add to 100%. Those who experienced contraceptive failure 

(became pregnant while using a method of contraception) or who switched methods are excluded. 

Other fertility-related reasons include infrequent sex/husband away, difficult to get pregnant/menopausal, and marital 

dissolution/separation. 

Method-related reasons include wanted more effective method and inconvenient to use. 

Cost/access includes lack of access, too far, and costs too much. 
74 

Appendix Table 3. Proportion of currently married women age 15-49 discontinuing while still in need 

in the 12 months prior to the survey, by type of contraception 

LARC non-LARC Total 

weighted 

% n

weighted 

number % 

weighted 

number % 

weighted 

number 

Cambodia 2014 0.4 4 6.0 56 6.4 60 931 

Egypt 2014 2.1 71 4.2 139 6.3 210 3,345 

Honduras 2011-12 0.6 21 12.4 406 13.0 428 3,283 

Jordan 2012 3.8 100 6.4 170 10.2 270 2,646 

Kenya 2014 1.7 24 7.1 102 8.8 126 1,437 

Kyrgyz Republic 2012 1.8 19 1.1 12 2.9 31 1,084 

Rwanda 2014-15 1.1 6 8.4 49 9.5 55 585 

Tajikistan 2012 4.0 35 2.8 25 6.8 60 879 

Uganda 2011 2.4 6 23.3 53 25.8 59 228 

Zambia 2013-14 1.5 35 11.0 267 12.5 302 2,422 

Zimbabwe 2010-11 0.2 3 6.6 125 6.7 128 1,899 

Notes: 

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or 

no longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a more 

effective method, cost, lack of access, or husband opposition). 
75 

Appendix Table 4. Adjusted odds of discontinuing while still in need in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models with emotional violence and 

socio-demographic controls 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no emotional violence in last 12 months)

Emotional violence in 

last 12 months 

0.65 1.60† 1.24 1.26 2.11** 0.22* 1.31 1.03 0.83 0.67† 1.04

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.16† 2.43*** 4.46*** 1.76** 1.32 1.56 2.08† 2.10* 2.11 1.45 1.32

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.48 0.90 0.81 0.40*** 0.93 0.39† 1.05 0.14*** 1.59 1.24 1.13

37+ months 0.58 0.91 0.76 0.60* 1.41 0.19** 1.50 0.16*** 1.16 1.07 1.32

Age (ref=15-19) 

20-24 0.21† 0.77 0.90 2.22 3.21 5.27 0.67 0.15† 1.54 1.02 2.32

25-29 0.88 0.68 0.83 0.90 2.78 2.42 0.71 0.13** 1.19 0.58 2.75

30-34 0.39† 0.41 0.67 1.70 2.57 3.36 0.41 0.10** 1.35 0.66 2.02

35-39 0.17* 0.42 0.48* 1.34 1.18 8.39* 0.49 0.19** 0.10† 0.59 2.40

40-44 0.63 0.21† 0.48* 1.22 1.06 8.93* 0.48 0.19** 0.07† 0.51 1.86

45-49 na 0.36 0.62 na 3.06 na na na 0.12 0.40 1.24

Household wealth quintile (ref=poorest wealth quintile)

Poorer 1.00 1.14 1.00 1.02 0.90 0.91 2.43† 0.70 0.44 1.00 1.15

Middle 1.30 0.85 1.33 0.69 0.84 1.06 1.06 0.40 0.81 1.01 1.34

Richer 3.37* 0.74 1.43† 1.05 0.38† 4.08 1.99 0.56 0.92 0.72 0.57

Richest 1.50 0.72 1.84* 0.46† 0.39† 13.47* 1.96 0.51 1.73 0.65 0.50

Place of residence (ref=urban)

Rural 1.40 1.13 1.21 1.45† 0.94 3.42 2.00 1.26 1.71 1.06 0.88

Religion (ref=Muslim)

Christian na 1.19 (ref) na 0.28† na 0.42 na 2.04 1.02 0.99

Other 1.50 na 0.91 na 0.10† na na na 2.21 na 1.11

Education (ref=no education)

Primary 1.01 1.19 1.00 0.61 2.67 na 0.29** 0.33 0.78 1.05 0.55

Secondary 0.40 0.68 0.96 0.32† 2.62 (ref) 0.26* 0.58 0.27† 0.80 0.68

Higher 0.10† 0.66 0.98 0.30* 4.63* 1.19 0.94 0.85 0.52 0.51 0.28

Employment (ref=not employed)

Employed for cash 0.64 1.19 0.90 na 0.52* 1.11 3.85 0.96 1.63 1.05 0.76

Employed not for cash 0.22† 1.19 1.04 na 0.49† 5.20* 2.88 2.03 3.82* 0.88 1.07

Number of living children (ref=0)

1-2 0.51 1.23 0.97 1.17 0.76 0.65 2.58 0.27 1.18 1.06 0.22**

3-4 1.15 0.76 1.06 0.64 0.27 1.27 1.42 0.24 0.83 1.07 0.28*

5+ na na 2.15* na 0.38 na na 0.10* 2.88 1.24 0.39

Weighted n 915 3339 3281 2624 1437 1077 580 878 228 2402 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
76 

Appendix Table 5. Adjusted odds of discontinuing while still in need in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models with physical violence and 

socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no physical violence in last 12 months)

Physical violence in last 

12 months 

0.85 1.22 1.19 1.27 1.49 0.55 0.79 0.97 0.92 0.78 1.18

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.08† 2.41*** 4.49*** 1.76** 1.29 1.56 2.05 2.10* 2.13 1.47 1.31

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.48 0.89 0.81 0.40*** 0.94 0.41† 1.04 0.14*** 1.59 1.24 1.14

37+ months 0.59 0.91 0.76 0.60* 1.36 0.20** 1.43 0.16*** 1.15 1.07 1.33

Age (ref=15-19) 

20-24 0.22† 0.77 0.89 2.25 3.57 5.47 0.62 0.15* 1.50 1.02 2.33

25-29 0.91 0.67 0.82 0.93 2.99 2.63 0.64 0.13** 1.18 0.58 2.79

30-34 0.40 0.42 0.66 1.72 2.77 3.47 0.39 0.10** 1.32 0.65 2.07

35-39 0.17* 0.42 0.47* 1.35 1.36 8.56* 0.49 0.19** 0.10† 0.59 2.46

40-44 0.65 0.21† 0.48* 1.25 1.25 9.28* 0.48 0.19** 0.07† 0.49 1.90

45-49 na 0.36 0.62 na 3.33 na na na 0.12 0.40 1.28

Household wealth quintile (ref=poorest wealth quintile)

Poorer 1.01 1.13 1.00 1.02 0.85 0.89 2.27† 0.70 0.47 0.99 1.14

Middle 1.28 0.83 1.34 0.70 0.80 0.94 0.99 0.40 0.82 1.00 1.34

Richer 3.41* 0.74 1.44† 1.07 0.37* 4.01 1.83 0.56 0.91 0.72 0.57

Richest 1.55 0.71 1.86* 0.46† 0.36† 13.49* 1.75 0.51 1.80 0.66 0.50

Place of residence (ref=urban)

Rural 1.42 1.10 1.19 1.46† 0.89 3.52 2.01 1.26 1.72 1.08 0.88

Religion (ref=Muslim)

Christian na 1.20 (ref) na 0.28† na 0.41 na 2.11 1.05 1.04

Other 1.51 na 0.90 na 0.09* na na na 2.27 na 1.15

Education (ref=no education)

Primary 1.04 1.20 1.00 0.62 2.47 na 0.30** 0.33 0.75 1.05 0.55

Secondary 0.41 0.68 0.96 0.32† 2.36 (ref) 0.26* 0.58 0.27† 0.81 0.69

Higher 0.10† 0.66 0.96 0.30* 4.31† 1.19 0.92 0.85 0.51 0.51 0.29

Employment (ref=not employed)

Employed for cash 0.65 1.19 0.90 na 0.54† 1.07 3.99 0.97 1.63 1.04 0.75

Employed not for cash 0.21† 1.21 1.03 na 0.50† 4.55* 2.91 2.04 3.86* 0.88 1.08

Number of living children (ref=0)

1-2 0.50 1.22 0.99 1.17 0.72 0.66 2.61 0.28 1.14 1.11 0.21**

3-4 1.11 0.76 1.08 0.63 0.26 1.31 1.42 0.24 0.82 1.11 0.27*

5+ na na 2.21* na 0.38 na na 0.10* 2.83 1.29 0.39

Weighted n 915 3339 3281 2624 1437 1077 580 878 228 2402 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
77 

Appendix Table 6. Adjusted odds of discontinuing while still in need in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models with sexual violence and sociodemographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no sexual violence in last 12 months)

Sexual violence in last 

12 months 

1.40 1.86 1.31 2.54* 2.01† 0.37 1.07 0.06* 0.70 1.28 0.83

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.03† 2.42*** 4.43*** 1.75** 1.31 1.55 2.03 2.17* 2.33 1.48 1.32

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.47 0.89 0.81 0.39*** 0.94 0.42† 1.04 0.13*** 1.58 1.25 1.13

37+ months 0.58 0.89 0.76 0.58* 1.39 0.20** 1.45 0.16*** 1.23 1.08 1.32

Age (ref=15-19)

20-24 0.23† 0.77 0.89 2.33 3.62 5.92 0.67 0.16* 1.61 0.98 2.26

25-29 0.95 0.67 0.81 0.94 3.00 2.84 0.69 0.13** 1.24 0.57 2.69

30-34 0.42 0.41 0.65 1.70 2.88 3.89 0.41 0.11** 1.44 0.65 1.96

35-39 0.18* 0.42 0.46* 1.37 1.40 9.58* 0.50 0.19** 0.10† 0.60 2.32

40-44 0.67 0.20† 0.47* 1.24 1.30 10.58* 0.49 0.19** 0.07† 0.50 1.79

45-49 na 0.35 0.61 na 3.37 na na na 0.12 0.42 1.19

Wealth quintile (ref=poorest wealth quintile)

Poorer 1.01 1.13 1.00 1.08 0.84 0.91 2.37† 0.72 0.41 1.01 1.16

Middle 1.29 0.83 1.34 0.72 0.75 0.96 1.03 0.43 0.74 1.02 1.34

Richer 3.43* 0.73 1.45† 1.16 0.36* 4.15 1.92 0.55 0.86 0.75 0.57

Richest 1.61 0.70 1.86* 0.51 0.34* 14.97* 1.86 0.51 1.65 0.71 0.50

Place of residence (ref=urban)

Rural 1.44 1.09 1.19 1.49* 0.90 3.71 1.98 1.29 1.75 1.10 0.89

Religion (ref=Muslim) 

Christian na 1.19 (ref) na 0.28† na 0.41 na 2.05 1.01 na

Other 1.57 na 0.90 na 0.10† na na na 2.14 na 1.08

Education (ref=no education)

Primary 1.05 1.21 0.98 0.68 2.63 na 0.29** 0.30 0.75 1.03 0.55

Secondary 0.42 0.68 0.95 0.35* 2.58 (ref) 0.25* 0.57 0.26† 0.79 0.69

Higher 0.10† 0.65 0.96 0.33* 4.50† 1.22 0.91 0.85 0.53 0.50 0.28

Employment (ref=not employed)

Employed for cash 0.64 1.18 0.90 na 0.52* 1.05 3.97 0.90 1.64 1.01 0.76

Employed not for cash 0.22† 1.24 1.02 na 0.49† 4.49* 2.92 2.04 3.76* 0.86 1.07

Number of living children (ref=0)

1-2 0.49 1.22 1.00 1.14 0.77 0.72 2.53 0.29 1.25 1.19 0.21**

3-4 1.08 0.76 1.10 0.60 0.29 1.40 1.39 0.24 0.86 1.18 0.27*

5+ na na 2.23* na 0.40 na na 0.11* 2.95 1.39 0.39

Weighted n 915 3339 3281 2624 1437 1077 580 878 228 2402 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
78 

Appendix Table 7. Adjusted odds of discontinuing while still in need in the 12 months prior to the survey among 

currently married women age 15-49: Odds ratios from logistic regression models with any intimate partner 

violence and socio-demographic controls 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no intimate partner violence in last 12 months)

Any intimate partner 

violence in last 12 

months 

0.72 1.35 1.25† 1.43 1.87* 0.65 1.01 1.01 0.63 0.92 0.96

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.15† 2.42*** 4.474*** 1.76** 1.35 1.55 2.04 2.10* 2.12 1.48 1.31

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.48 0.89 0.81 0.40*** 0.91 0.41† 1.04 0.14*** 1.54 1.24 1.13

37+ months 0.58 0.91 0.76 0.60* 1.38 0.20** 1.45 0.16*** 1.24 1.07 1.31

Age (ref=15-19) 

20-24 0.22† 0.75 0.91 2.18 3.42 5.81 0.66 0.15* 1.81 1.01 2.30

25-29 0.89 0.66 0.83 0.87 2.90 2.71 0.69 0.13** 1.26 0.58 2.73

30-34 0.39† 0.41 0.67 1.64 2.77 3.63 0.41 0.10** 1.51 0.65 1.99

35-39 0.17* 0.41 0.48* 1.31 1.29 8.82* 0.50 0.19** 0.11† 0.59 2.37

40-44 0.64 0.21† 0.48* 1.19 1.19 9.68* 0.49 0.19** 0.07 0.50 1.83

45-49 na 0.35 0.63 na 3.25 na na na 0.11 0.41 1.22

Wealth quintile (ref=poorest wealth quintile)

Poorer 1.01 1.13 0.99 1.01 0.88 0.89 2.35† 0.70 0.41 1.00 1.15

Middle 1.30 0.84 1.33 0.69 0.84 0.95 1.02 0.40 0.74 1.01 1.34

Richer 3.39* 0.74 1.43† 1.06 0.38* 4.08 1.91 0.56 0.88 0.74 0.57

Richest 1.51 0.72 1.85* 0.46† 0.37† 14.01* 1.84 0.51 1.55 0.68 0.50

Place of residence (ref=urban)

Rural 1.40 1.12 1.21 1.47* 0.91 3.62 1.98 1.26 1.79 1.10 0.88

Religion (ref=Muslim) 

Christian na 1.19 (ref) na 0.27† na 0.41 na 1.84 1.02 0.97

Other 1.53 na 0.91 na 0.08* na na na 1.87 na 1.09

Education (ref=no education)

Primary 1.02 1.21 1.00 0.62 2.50 na 0.29** 0.33 0.77 1.05 0.55

Secondary 0.40 0.69 0.96 0.32* 2.43 (ref) 0.25* 0.58 0.26† 0.81 0.68

Higher 0.10† 0.67 0.97 0.30* 4.57* 1.21 0.90 0.85 0.48 0.51 0.28

Employment (ref=not employed)

Employed for cash 0.65 1.18 0.89 na 0.51* 1.08 3.89 0.97 1.67 1.04 0.76

Employed not for cash 0.22† 1.20 1.04 na 0.49† 4.65* 2.86 2.04 3.65* 0.88 1.07

Number of living children (ref=0)

1-2 0.51 1.22 0.97 1.19 0.76 0.68 2.54 0.27 1.37 1.14 0.22**

3-4 1.15 0.76 1.05 0.63 0.27 1.35 1.40 0.24 0.92 1.14 0.28*

5+ na na 2.14* na 0.38 na na 0.10* 3.19 1.33 0.40

Weighted n 915 3339 3281 2624 1437 1077 580 878 228 2402 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
79 

Appendix Table 8. Adjusted odds of discontinuing due to no further need in the 12 months prior to the survey

among currently married women age 15-49: Odds ratios from logistic regression models with emotional violence 

and socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no intimate partner violence in last 12 months)

Emotional violence in 

last 12 months 

0.77 0.82 0.78 1.10 0.46 0.26* 0.76 0.37 0.50 0.84 1.01

Method used 12 months prior to survey (ref=LARC method) 

non-LARC 3.49* 1.73*** 1.54 2.34*** 1.83 2.92** 2.59† 2.30* 0.42 2.99** 5.30†

Duration of use before the observation period (ref=1-2 months)

13-36 months 2.32† 1.65** 0.84 2.05** 3.40*** 2.00† 3.435** 1.67 3.93* 3.07*** 3.01***

37+ months 2.89* 1.36 1.19 1.52 5.99*** 1.56 4.18** 1.55 8.41* 6.89*** 6.31***

Age (ref=15-19) 

20-24 0.09† 1.92 1.24 1.36 0.43 4.33 4.03 1.81 1.25 0.60 1.24

25-29 0.04* 1.11 1.07 1.24 0.60 9.33† 2.58 5.07† 0.56 0.96 1.11

30-34 0.03** 0.80 1.01 0.87 0.47 3.03 2.66 2.85 0.57 0.44 0.76

35-39 0.00*** 0.52 0.45† 0.42 0.44 6.94† 1.75 2.84 0.13 0.30* 0.41

40-44 0.00*** 0.21* 0.68 0.09* 0.03** 0.47 na 0.97 2.18 0.12* 0.20*

45-49 0.00** 0.36 1.34 0.38 0.73 na na na na na 0.25

Wealth quintile (ref=poorest wealth quintile) 

Poorer 5.08* 1.32 0.73 0.95 0.36* 1.42 1.69 2.85† 0.89 0.92 0.82

Middle 4.77* 1.16 0.98 0.98 0.29* 1.45 1.60 0.52 0.32 0.63 0.76

Richer 3.02 1.22 1.37 0.47† 0.39† 2.17 1.99 0.81 0.53 0.93 0.60†

Richest 3.32 1.32 0.80 1.31 0.24** 4.04 1.87 0.82 0.26 0.35* 0.47*

Place of residence (ref=urban) 

Rural 1.83 1.61† 1.53† 0.96 1.27 2.26 1.60 1.13 1.39 1.31 1.28

Religion (ref=Muslim) 

Christian 16.54 na (ref) na 0.22† na na na 0.70 0.65 1.30

Other 8.06 na 0.65 na 0.90 na na na 0.59 2.16 1.02

Education (ref=no education) 

Primary 0.64 0.90 1.51 0.49 2.87 na 0.34* 0.72 2.15 0.81 0.52

Secondary 0.95 1.22 1.17 0.74 5.91* (ref) 0.84 0.99 1.18 0.81 0.58

Higher 9.45† 1.37 1.51 0.91 6.04† 1.36 0.60 na na 0.68 na

Employment (ref=not employed) 

Employed for cash 0.77 0.37*** 0.96 na 0.68 1.23 2.53 0.70 0.48 0.95 0.87

Employed not for cash 1.18 1.07 1.46 na 2.00 0.24† 3.12 0.09* 0.39 0.67† 1.04

Number of living children (ref=0) 

1-2 0.001*** 2.88** 0.22*** 0.73 0.06*** 0.45 5.38† 0.05** 1.66 0.14** 0.26**

3-4 0.001*** 1.66 0.11*** 0.63 0.03*** 0.26 2.87 0.03** 0.20 0.09*** 0.17***

5+ 0.006** na 0.08*** 0.29 0.01*** 0.28 na 0.03** 0.03 0.05*** 0.10***

Weighted n 931 3339 3281 2646 1437 1082 543 864 207 2295 1853 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
80 

Appendix Table 9. Adjusted odds of discontinuing due to no further need in the 12 months prior to the survey 

among currently married women age 15-49: Odds ratios from logistic regression models with physical violence 

and socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no physical violence in last 12 months)

Physical violence in last 

12 months 

0.55 1.14 0.93 1.03 0.37** 0.86 0.77 0.37 0.60 0.82 1.12

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.64* 1.73*** 1.54 2.34*** 1.84 2.90** 2.64* 2.22* 0.37 3.00** 5.27†

Duration of use before the observation period (ref=1-2 months)

13-36 months 2.31† 1.66** 0.85 2.04** 3.51*** 2.14† 3.46** 1.74 3.80* 3.08*** 3.02***

37+ months 2.91* 1.37 1.19 1.52 6.00*** 1.62 4.17** 1.62 8.41* 6.91*** 6.37***

Age (ref=15-19) 

20-24 0.09† 1.89 1.26 1.37 0.46 4.11 3.82 1.95 1.27 0.60 1.25

25-29 0.04* 1.11 1.08 1.25 0.65 9.21† 2.43 4.97† 0.52 0.96 1.12

30-34 0.03** 0.80 1.04 0.88 0.49 2.86 2.52 3.03 0.50 0.44 0.78

35-39 0.000*** 0.52 0.47 0.42 0.45 6.74† 1.67 3.01 0.13 0.30* 0.42

40-44 0.003*** 0.21* 0.70 0.09* 0.03** 0.46 na 1.00 1.83 0.12* 0.21*

45-49 0.002** 0.36 1.36 0.38 0.76 na na na na na 0.25

Household wealth quintile (ref=poorest wealth quintile) 

Poorer 5.13* 1.32 0.72 0.94 0.36† 1.35 1.66 2.77† 0.98 0.92 0.82

Middle 4.71* 1.16 0.97 0.97 0.27* 1.38 1.57 0.50 0.29 0.63 0.76

Richer 3.00 1.22 1.36 0.47† 0.37† 2.21 2.00 0.81 0.46 0.93 0.60†

Richest 3.35 1.32 0.81 1.30 0.25** 4.19 1.86 0.78 0.24 0.35* 0.47*

Place of residence (ref=urban) 

Rural 1.79 1.63† 1.56† 0.96 1.30 2.36 1.64 1.12 1.32 1.30 1.28

Religion (ref=Muslim) 

Christian 13.00 0.52 (ref) na 0.25 na 0.61 na 0.71 0.66 1.35

Other 6.41 na 0.66 na 1.09 na na na 0.53 2.02 1.05

Education (ref=no education) 

Primary 0.63 0.89 1.52 0.49 3.03 na 0.35* 0.76 2.02 0.81 0.51†

Secondary 0.92 1.24 1.18 0.74 6.19* (ref) 0.87 1.02 1.33 0.81 0.57

Higher 9.42† 1.40 1.53 0.91 5.56† 1.33 0.63 na na 0.67 na

Employment (ref=not employed) 

Employed for cash 0.78 0.37*** 0.95 na 0.71 1.23 2.53 0.65 0.49 0.96 0.86

Employed not for cash 1.22 1.06 1.47 na 2.10† 0.24† 3.13 0.09* 0.35 0.67† 1.05

Number of living children (ref=0) 

1-2 0.002*** 2.87** 0.21*** 0.69 0.058*** 0.43 5.58† 0.05** 1.63 0.14** 0.26**

3-4 0.001*** 1.65 0.11*** 0.60 0.026*** 0.25 2.97 0.03** 0.21 0.09*** 0.17***

5+ 0.01** na 0.07*** 0.27 0.007*** 0.26 na 0.03** 0.03 0.05*** 0.10***

Weighted n 931 3339 3281 2646 1437 1082 543 864 207 2295 1853 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
81 

Appendix Table 10. Adjusted odds of discontinuing due to no further need in the 12 months prior to the survey 

among currently married women age 15-49: Odds ratios from logistic regression models with sexual violence 

and socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no sexual violence in last 12 months)

Sexual violence in last 

12 months 

0.02** 1.42 1.69 0.98 0.83 0.11* 0.85 0.57 0.71 0.60* 1.19

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.59* 1.73*** 1.54 2.34*** 1.95 2.98** 2.64* 2.28* 0.40 3.05*** 5.24†

Duration of use before the observation period (ref=1-2 months)

13-36 months 2.35† 1.65** 0.85 2.03** 3.44*** 2.17† 3.42** 1.79 3.83* 3.08*** 3.03***

37+ months 2.98* 1.36 1.19 1.52 6.15*** 1.65 4.21** 1.69 8.97* 6.87*** 6.34***

Age (ref=15-19) 

20-24 0.06† 1.88 1.27 1.37 0.37 4.36 4.07 2.10 1.24 0.62 1.27

25-29 0.03** 1.10 1.10 1.25 0.54 9.49† 2.61 5.04† 0.57 0.98 1.12

30-34 0.02** 0.78 1.06 0.88 0.43 3.06 2.66 2.98 0.58 0.44 0.78

35-39 0.000*** 0.52 0.48 0.42 0.39 6.94† 1.74 2.95 0.13 0.29* 0.42

40-44 0.002*** 0.20* 0.71 0.09* 0.03** 0.46 na 0.99 1.82 0.12* 0.21*

45-49 0.001** 0.36 1.39 0.37 0.67 na na na na na 0.26

Wealth quintile (ref=poorest wealth quintile) 

Poorer 4.63* 1.32 0.72 0.94 0.38† 1.35 1.69 2.49 0.94 0.90 0.81

Middle 4.28** 1.16 0.98 0.97 0.31* 1.36 1.61 0.49 0.33 0.63 0.76

Richer 2.85 1.22 1.38 0.46* 0.41† 2.15 2.05 0.76 0.57 0.92 0.60†

Richest 3.11 1.31 0.82 1.29 0.27* 4.04† 1.94 0.74 0.31 0.35* 0.47*

Place of residence (ref=urban) 

Rural 1.82 1.61 1.57† 0.95 1.32 2.29 1.61 1.16 1.32 1.34 1.27

Religion (ref=Muslim) 

Christian 20.66 0.52 (ref) na 0.22† na 0.60 na 0.72 0.65 1.31

Other 9.89 na 0.65 na 0.77 na na na 0.57 2.42 1.03

Education (ref=no education) 

Primary 0.59 0.89 1.52 0.49 3.55 na 0.34* 0.75 2.07 0.82 0.52

Secondary 0.88 1.23 1.18 0.73 7.30* (ref) 0.84 0.96 1.31 0.81 0.57

Higher 8.72† 1.40 1.53 0.90 7.54* 1.36 0.60 na na 0.67 na

Employment (ref=not employed) 

Employed for cash 0.74 0.36*** 0.94 na 0.68 1.23 2.32 0.65 0.52 0.98 0.87

Employed not for cash 1.17 1.07 1.44 na 2.00 0.23† 2.91 0.09* 0.45 0.70 1.03

Number of living children (ref=0) 

1-2 0.002*** 2.86** 0.21*** 0.70 0.06*** 0.44 5.48† 0.04** 1.59 0.13** 0.27**

3-4 0.001*** 1.65 0.11*** 0.60 0.02*** 0.26 2.92 0.03** 0.19 0.09*** 0.18***

5+ 0.006** na 0.07*** 0.27 0.006*** 0.27 na 0.03** 0.03 0.05*** 0.10***

Weighted n 931 3339 3281 2646 1437 1082 543 864 207 2295 1853 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
82 

Appendix Table 11. Adjusted odds of discontinuing due to no further need in the 12 months prior to the survey 

among currently married women age 15-49: Odds ratios from logistic models with any intimate partner violence 

and socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no intimate partner violence in last 12 months)

Any intimate partner 

violence in last 12 

months 

0.75 1.02 0.75 1.10 0.47* 0.76 0.55 0.34* 0.85 0.81 1.14

Method used 12 months prior to survey (ref=LARC method)

non-LARC 3.4* 1.73*** 1.53 2.34*** 1.77 2.89** 2.66* 2.24* 0.39 3.00** 5.25†

Duration of use before the observation period (ref=1-2 months)

13-36 months 2.33† 1.66** 0.84 2.05** 3.38*** 2.12† 3.49** 1.62 3.91* 3.09*** 3.03***

37+ months 2.90* 1.36 1.19 1.52 5.82*** 1.62 4.08** 1.49 8.84* 6.88*** 6.38***

Age (ref=15-19) 

20-24 0.09† 1.90 1.23 1.37 0.46 4.21 3.37 1.84 1.26 0.60 1.26

25-29 0.04* 1.11 1.05 1.25 0.64 9.25† 2.15 5.24† 0.56 0.95 1.12

30-34 0.03** 0.80 1.00 0.88 0.49 2.90 2.34 3.03 0.57 0.43 0.78

35-39 0.000*** 0.52 0.44† 0.42 0.47 6.72† 1.60 3.06 0.13 0.29* 0.42

40-44 0.003*** 0.21* 0.67 0.09* 0.03** 0.46 na 1.04 1.95 0.12* 0.21*

45-49 0.002** 0.36 1.32 0.38 0.76 na na na na na 0.26

Wealth quintile (ref=poorest wealth quintile) 

Poorer 5.07* 1.32 0.73 0.95 0.36* 1.34 1.59 2.97† 1.01 0.92 0.82

Middle 4.73* 1.16 0.98 0.97 0.29* 1.36 1.48 0.53 0.34 0.63 0.77

Richer 3.02 1.23 1.37 0.47* 0.38† 2.18 1.94 0.85 0.56 0.92 0.60†

Richest 3.32 1.32 0.80 1.31 0.24** 4.11 1.71 0.85 0.31 0.35* 0.47*

Place of residence (ref=urban) 

Rural 1.83 1.63† 1.52† 0.96 1.26 2.37 1.62 1.15 1.32 1.30 1.27

Religion (ref=Muslim) 

Christian 16.31 0.51 (ref) na 0.23† na 0.56 na 0.70 0.66 1.35

Other 7.96 na 0.65 na 1.02 na na na 0.58 2.31 1.05

Education (ref=no education) 

Primary 0.65 0.89 1.50 0.50 2.96 na 0.35* 0.73 2.13 0.82 0.51†

Secondary 0.95 1.23 1.16 0.74 6.11* (ref) 0.85 0.99 1.36 0.82 0.57

Higher 9.42† 1.38 1.51 0.92 5.70† 1.34 0.60 na na 0.68 na

Employment (ref=not employed) 

Employed for cash 0.77 0.37*** 0.96 na 0.72 1.23 2.14 0.66 0.52 0.97 0.86

Employed not for cash 1.17 1.06 1.46 na 2.06† 0.24† 2.63 0.08* 0.44 0.68 1.03

Number of living children (ref=0) 

1-2 0.001*** 2.88** 0.22*** 0.73 0.06*** 0.43 5.94† 0.05* 1.54 0.13** 0.26**

3-4 0.001*** 1.65 0.11*** 0.62 0.03*** 0.25 3.01 0.03** 0.19 0.09*** 0.17***

5+ 0.005** na 0.08*** 0.28 0.01*** 0.26 na 0.03** 0.03 0.05*** 0.10***

Weighted n 931 3339 3281 2646 1437 1082 543 864 207 2295 1853 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
83 

Appendix Table 12. Adjusted odds of total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models with emotional violence and sociodemographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no intimate partner violence in last 12 months)

Emotional violence in 

last 12 months 

0.63 1.13 1.08 1.19 1.33 0.24** 1.08 0.68 0.65 0.71* 1.02

Method used 12 months prior to survey (ref=LARC method)

non-LARC 2.93** 2.16*** 3.02*** 2.14*** 1.52 2.51** 2.59** 2.28** 1.79 1.94** 3.24*

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.98 1.37* 0.80† 0.93 1.57† 1.16 2.00* 0.42** 2.19† 1.87*** 2.31***

37+ months 1.15 1.18 0.89 0.90 2.62** 0.74 2.66** 0.38* 2.07 2.46*** 4.24***

Age (ref=15-19) 

20-24 0.17 1.40 1.03 4.56 0.98 4.60 1.75 0.32 1.39 0.82 1.59

25-29 0.16 0.85 0.90 2.67 1.03 7.70* 1.43 0.49 0.77 0.76 1.55

30-34 0.08† 0.55 0.77 2.89 0.88 3.32 1.05 0.33* 0.86 0.55 1.05

35-39 0.02** 0.42 0.45** 1.66 0.54 8.09* 0.90 0.44 0.06* 0.44† 0.72

40-44 0.07† 0.18** 0.52* 1.01 0.25† 2.37 0.72 0.31* 0.10† 0.28** 0.43

45-49 0.11 0.32* 0.78 1.33 1.22 na na na 0.09 0.19** 0.37

Wealth quintile (ref=poorest wealth quintile) 

Poorer 2.10 1.26 0.88 0.97 0.59 1.30 2.39* 1.26 0.49 0.95 0.93

Middle 2.25† 1.00 1.22 0.78 0.55 1.33 1.39 0.43† 0.64 0.86 0.94

Richer 3.53* 0.98 1.52* 0.70 0.35** 2.87† 2.18* 0.62 0.81 0.81 0.56*

Richest 1.91 1.02 1.45 0.79 0.28** 7.02** 2.17 0.60 1.23 0.48* 0.45**

Place of residence (ref=urban) 

Rural 1.51 1.45† 1.38* 1.27 1.08 2.80† 1.96 1.26 1.85 1.18 1.15

Religion (ref=Muslim) 

Christian 1.46 0.76 (ref) na 0.19** na 0.43 na 1.54 0.76 1.22

Other 2.30 na 0.78 na 0.27 na na na 1.40 0.59 1.08

Education (ref=no education) 

Primary 0.83 1.04 1.11 0.51 3.28* na 0.25*** 0.62 1.10 0.96 1.68

Secondary 0.61 0.96 0.96 0.37* 4.38* (ref) 0.43† 0.89 0.37 0.79 1.99

Higher 2.59 1.03 1.08 0.41† 6.47** 1.29 0.68 1.13 0.63 0.57 2.62

Employment (ref=not employed) 

Employed for cash 0.71 0.59* 0.91 na 0.53* 1.25 3.63 0.76 1.32 1.01 0.81

Employed not for cash 0.50 1.15 1.22 na 0.85 1.34 3.37 1.04 2.98† 0.80 1.04

Number of living children (ref=0) 

1-2 0.01*** 1.92* 0.40*** 0.91 0.13*** 0.58 3.85** 0.04* 1.93 0.25* 0.16***

3-4 0.01*** 1.06 0.32*** 0.58 0.05*** 0.49 1.87 0.03** 0.58 0.20* 0.13***

5+ 0.01** na 0.53* 0.58 0.04*** 0.46 na 0.02** 1.49 0.18* 0.13***

Weighted n 931 3339 3281 2646 1437 1082 580 878 228 2414 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
84 

Appendix Table 13. Adjusted odds of total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models with physical violence and sociodemographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no physical violence in last 12 months)

Physical violence in last 

12 months 

0.67 1.21 1.10 1.17 0.93 0.74 0.76 0.69 0.79 0.78† 1.16

Method used 12 months prior to survey (ref=LARC method)

non-LARC 2.93** 2.15*** 3.04*** 2.14*** 1.48 2.48** 2.59** 2.23** 1.78 1.96** 3.22*

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.99 1.37* 0.80† 0.93 1.57† 1.25 1.99* 0.42** 2.20† 1.89*** 2.32***

37+ months 1.17 1.20 0.89 0.90 2.57** 0.78 2.60** 0.38* 2.05 2.47*** 4.29***

Age (ref=15-19) 

20-24 0.17 1.37 1.03 4.60 1.06 4.55 1.61 0.34 1.36 0.81 1.60

25-29 0.16 0.84 0.91 2.71 1.10 7.91* 1.30 0.49 0.74 0.76 1.57

30-34 0.08† 0.54 0.77 2.92 0.93 3.27 0.99 0.35† 0.82 0.55 1.07

35-39 0.02** 0.41 0.46** 1.67 0.58 8.00* 0.88 0.46 0.06* 0.43† 0.73

40-44 0.065† 0.18** 0.52* 1.03 0.27 2.36 0.71 0.32* 0.09† 0.27** 0.44

45-49 0.11 0.31* 0.78 1.33 1.28 na na na 0.09 0.19** 0.38

Household wealth quintile (ref=poorest wealth quintile) 

Poorer 2.13 1.26 0.88 0.97 0.57 1.25 2.29* 1.22 0.53 0.94 0.92

Middle 2.24† 1.00 1.23 0.79 0.53 1.24 1.32 0.42† 0.64 0.86 0.94

Richer 3.55* 0.98 1.52* 0.71 0.34** 2.90 2.08* 0.61 0.79 0.81 0.56*

Richest 1.98 1.01 1.46 0.79 0.27** 7.25** 1.99 0.59 1.32 0.49* 0.45**

Place of residence (ref=urban) 

Rural 1.50 1.45† 1.38* 1.27 1.05 2.92† 1.97 1.24 1.87 1.19 1.15

Religion (ref=Muslim) 

Christian 1.40 0.76 (ref) na 0.20** na 0.43 na 1.65 0.77 1.28

Other 2.23 na 0.78 na 0.30 na na na 1.49 0.52 1.12

Education (ref=no education) 

Primary 0.83 1.04 1.11 0.51 3.03* na 0.26*** 0.61 1.02 0.96 1.68

Secondary 0.61 0.97 0.96 0.37* 4.01* (ref) 0.43† 0.87 0.37 0.80 2.00

Higher 2.63 1.04 1.08 0.41† 5.78** 1.28 0.70 1.09 0.62 0.57 2.68

Employment (ref=not employed) 

Employed for cash 0.72 0.59* 0.91 na 0.54* 1.24 3.76 0.75 1.34 1.00 0.80

Employed not for cash 0.49 1.14 1.22 na 0.86 1.26 3.42 1.04 3.05† 0.80 1.05

Number of living children (ref=0) 

1-2 0.01*** 1.91* 0.40*** 0.83 0.13*** 0.55 3.95** 0.04* 1.85 0.26* 0.16***

3-4 0.01*** 1.05 0.33*** 0.53 0.05*** 0.46 1.90 0.03** 0.58 0.20* 0.13***

5+ 0.01** na 0.53* 0.53 0.04*** 0.43 na 0.02** 1.48 0.19* 0.13***

Weighted n 931 3339 3281 2646 1437 1082 580 878 228 2414 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
85 

Appendix Table 14. Adjusted odds of total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models with sexual violence and sociodemographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no sexual violence in last 12 months)

Sexual violence in last 

12 months 

0.74 1.74 1.51 1.81† 1.52 0.18* 0.99 0.22† 0.59 0.98 1.06

Method used 12 months prior to survey (ref=LARC method)

non-LARC 2.914** 2.16*** 3.02*** 2.13*** 1.53 2.53** 2.58** 2.30** 2.06 1.98** 3.23*

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.98 1.36* 0.80† 0.92 1.58† 1.27 1.99* 0.42** 2.22† 1.88*** 2.31***

37+ months 1.17 1.18 0.88 0.88 2.64** 0.79 2.64** 0.38* 2.27 2.45*** 4.24***

Age (ref=15-19) 

20-24 0.17 1.38 1.03 5.26† 1.01 4.68 1.74 0.35 1.50 0.80 1.59

25-29 0.16 0.83 0.90 3.08 1.04 8.08* 1.42 0.49 0.84 0.76 1.56

30-34 0.08† 0.53 0.76 3.26 0.91 3.45 1.05 0.36† 0.97 0.55 1.05

35-39 0.02** 0.41 0.45** 1.89 0.56 8.31* 0.91 0.46 0.06* 0.44† 0.72

40-44 0.06† 0.18** 0.52* 1.14 0.26 2.44 0.72 0.32* 0.09† 0.28** 0.43

45-49 0.11 0.31* 0.77 1.49 1.25 na na na 0.09 0.20** 0.37

Wealth quintile (ref=poorest wealth quintile) 

Poorer 2.12 1.26 0.88 1.01 0.57 1.26 2.37* 1.22 0.44 0.95 0.93

Middle 2.26* 0.99 1.23 0.81 0.52† 1.24 1.38 0.43† 0.58 0.87 0.94

Richer 3.61** 0.97 1.53* 0.75 0.34** 2.85† 2.16* 0.60 0.73 0.83 0.56*

Richest 2.05 1.00 1.47† 0.85 0.27** 7.18** 2.13 0.57 1.22 0.51* 0.45**

Place of residence (ref=urban) 

Rural 1.54 1.43† 1.38* 1.28 1.07 2.86† 1.95 1.27 1.89 1.22 1.15

Religion (ref=Muslim) 

Christian 1.68 0.76 (ref) na 0.19** na 0.43 na 1.65 0.75 1.22

Other 2.64 na 0.77 na 0.28 na na na 1.44 0.52 1.08

Education (ref=no education) 

Primary 0.83 1.04 1.10 0.53 3.33* na 0.25*** 0.59 1.02 0.96 1.68

Secondary 0.62 0.97 0.95 0.39* 4.51* (ref) 0.42† 0.87 0.36 0.79 1.99

Higher 2.56 1.04 1.07 0.43† 6.67** 1.30 0.68 1.11 0.63 0.57 2.63

Employment (ref=not employed) 

Employed for cash 0.72 0.59* 0.91 na 0.52* 1.23 3.63 0.72 1.34 0.99 0.81

Employed not for cash 0.50 1.16 1.20 na 0.84 1.23 3.35 1.03 3.03† 0.80 1.04

Number of living children (ref=0) 

1-2 0.01*** 1.90* 0.40*** 0.77 0.13*** 0.55 3.84** 0.04* 2.02 0.27* 0.16***

3-4 0.01*** 1.05 0.33*** 0.49 0.05*** 0.47 1.86 0.03** 0.59 0.21* 0.13***

5+ 0.01** na 0.52* 0.50 0.04*** 0.43 na 0.02** 1.49 0.20* 0.13**

Weighted n 931 3339 3281 2646 1437 1082 580 878 228 2414 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
86 

Appendix Table 15. Adjusted odds of total discontinuation in the 12 months prior to the survey among currently 

married women age 15-49: Odds ratios from logistic regression models with any intimate partner violence and 

socio-demographic controls 

 

Cambodia 

2014 

Egypt 

2014 

Honduras 

2011-12 

Jordan 

2012 

Kenya 

2014 

Kyrgyz 

Republic 

2012 

Rwanda 

2014-15 

Tajikistan 

2012 

Uganda 

2011 

Zambia 

2013-14 

Zimbabwe 

2010-11 

Experience of intimate partner violence (ref=no intimate partner violence in last 12 months)

Any intimate partner 

violence in last 12 

months 

0.67 1.18 1.06 1.29 1.13 0.71 0.76 0.65 0.61 0.87 1.09

Method used 12 months prior to survey (ref=LARC method)

non-LARC 2.91** 2.16*** 3.03*** 2.14*** 1.51 2.48** 2.58** 2.24** 1.83 1.97** 3.23*

Duration of use before the observation period (ref=1-2 months)

13-36 months 0.99 1.37* 0.80† 0.94 1.57† 1.24 1.99* 0.42** 2.13† 1.88*** 2.32***

37+ months 1.17 1.19 0.89 0.90 2.59** 0.78 2.58** 0.38* 2.22 2.45*** 4.263***

Age (ref=15-19) 

20-24 0.17 1.37 1.03 4.65 1.01 4.65 1.64 0.32 1.62 0.81 1.60

25-29 0.17 0.83 0.90 2.69 1.05 7.93* 1.33 0.50 0.81 0.76 1.57

30-34 0.08† 0.54 0.76 2.92 0.91 3.29 1.03 0.35† 0.95 0.55 1.06

35-39 0.02** 0.41 0.45** 1.69 0.56 7.99* 0.91 0.46 0.06* 0.44† 0.73

40-44 0.07† 0.18** 0.52* 1.03 0.26 2.36 0.74 0.32* 0.10† 0.28** 0.44

45-49 0.11 0.31* 0.78 1.38 1.25 na na na 0.09 0.19** 0.38

Wealth quintile (ref=poorest wealth quintile) 

Poorer 2.11 1.26 0.88 0.97 0.58 1.24 2.29* 1.25 0.48 0.95 0.93

Middle 2.25† 1.00 1.22 0.78 0.54 1.23 1.31 0.43† 0.61 0.87 0.94

Richer 3.55** 0.99 1.52* 0.71 0.35** 2.88† 2.08* 0.63 0.79 0.82 0.56*

Richest 1.92 1.02 1.45 0.80 0.27** 7.18** 1.98 0.61 1.19 0.49* 0.45**

Place of residence (ref=urban) 

Rural 1.50 1.46† 1.38* 1.28 1.06 2.94† 1.96 1.27 1.92 1.20 1.15

Religion (ref=Muslim) 

Christian 1.49 0.76 (ref) na 0.19** na 0.41 na 1.48 0.76 1.25

Other 2.35 na 0.78 na 0.28 na na na 1.24 0.56 1.09

Education (ref=no education) 

Primary 0.83 1.04 1.11 0.51 3.14* na 0.25*** 0.61 1.06 0.96 1.68

Secondary 0.61 0.97 0.96 0.37* 4.18* (ref) 0.42† 0.88 0.37 0.80 1.99

Higher 2.58 1.04 1.08 0.41† 6.20** 1.28 0.67 1.11 0.58 0.57 2.65

Employment (ref=not employed) 

Employed for cash 0.72 0.59* 0.91 na 0.53* 1.24 3.41 0.75 1.36 1.01 0.80

Employed not for cash 0.49 1.14 1.22 na 0.85 1.26 3.12 1.02 2.91† 0.81 1.04

Number of living children (ref=0) 

1-2 0.01*** 1.91* 0.40*** 0.92 0.13*** 0.55 3.96** 0.04* 2.13 0.26* 0.16***

3-4 0.01*** 1.05 0.33*** 0.59 0.05*** 0.47 1.87 0.03** 0.62 0.20* 0.13***

5+ 0.01** na 0.53* 0.59 0.04*** 0.43 na 0.02** 1.59 0.19* 0.13**

Weighted n 931 3339 3281 2646 1437 1082 580 878 228 2414 1899 

Notes: 

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

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods.

Discontinuation is defined as the interruption of contraceptive use for one month or longer.

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or no longer at risk of becoming pregnant (e.g. 

health concerns/side effects, method inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant of for other fertility-related reasons (e.g. 

infrequent sex/husband away, marital dissolution/separation, difficult to get pregnant).

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long as a method of contraception is being used 

continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded from this analysis. 

Data on religion was not collected in the Jordan 2012, Kyrgyz Republic 2012, or Tajikistan 2012 DHS surveys and are excluded from regression models for these 

countries. 

Christian is used as the reference group for religion in Honduras.

Women’s education is highly skewed toward secondary and higher education in the Kyrgyz Republic, therefore secondary education is used as the reference 

category. 

Data on employment status was not collected in the Jordan 2012 DHS and are excluded from the regression model.
87 

Appendix Tables: Sensitivity Analysis 

89 

Appendix Table 16. Sensitivity analysis: Proportion of women using contraception at the start of the 

12-month observation period by timing of experience of intimate partner violence 

Using any modern, 

temporary method 

Method type among those using 

modern, temporary methods 

Survey 

year No Yes 

pvalue Weighted 

n LARC

nonLARC pvalue Weighted 

n 

Cambodia 2014 * 

No IPV 70.3 29.7 2,154 16.5 83.5 640 

Ever IPV, but not last 12 

months 

58.1 41.9 231 22.2 77.8 97 

IPV in the last 12 months 67.2 32.8 592 15.8 84.2 194 

Total 68.7 31.3 2,977 17.0 83.0 931 

Egypt 2014 † 

No IPV 46.6 53.4 4,442 56.0 44.0 2,373 

Ever IPV, but not last 12 

months 

 42.4 57.6 666 55.9 44.1 384 

IPV in the last 12 months 49.4 50.6 1,164 52.4 47.6 589 

Total 46.7 53.3 6,272 55.4 44.6 3,345 

Honduras 2011-12 ** * 

No IPV 64.0 36.0 6,108 16.4 83.6 2,199 

Ever IPV, but not last 12 

months 

66.6 33.4 722 25.9 74.1 241 

IPV in the last 12 months 59.9 40.1 2,100 19.6 80.4 842 

Total 63.2 36.8 8,930 17.9 82.1 3,283 

Jordan 2012 † 

No IPV 61.8 38.2 4,656 53.9 46.1 1,780 

Ever IPV, but not last 12 

months 

 62.7 37.3 528 63.1 36.9 197 

IPV in the last 12 months 56.2 43.8 1,529 55.2 44.8 670 

Total 60.6 39.4 6,714 54.9 45.1 2,646 

Kenya 2014 * ** 

No IPV 59.6 40.4 1,897 17.9 82.1 766 

Ever IPV, but not last 12 

months 

57.8 42.2 347 29.3 70.7 147 

IPV in the last 12 months 52.7 47.3 1,108 26.5 73.5 525 

Total 57.1 42.9 3,352 22.2 77.8 1,437 

Kyrgyz Republic 2012 *** 

No IPV 74.4 25.6 2,859 70.5 29.5 732 

Ever IPV, but not last 12 

months 

 57.6 42.4 225 76.8 23.2 95 

IPV in the last 12 months 65.7 34.3 750 73.7 26.3 257 

Total 71.7 28.3 3,833 71.8 28.2 1,084 

Rwanda 2014-15 ** 

No IPV 62.0 38.0 884 19.7 80.3 336 

Ever IPV, but not last 12 

months 

54.9 45.1 141 25.8 74.2 64 

IPV in the last 12 months 52.5 47.5 390 20.9 79.1 185 

Total 58.7 41.3 1,415 20.7 79.3 585 

Tajikistan 2012 ** 

No IPV 78.4 21.6 2,913 74.2 25.8 629 

Ever IPV, but not last 12 

months 

 75.9 24.1 169 69.3 30.7 41 

IPV in the last 12 months 71.2 28.8 730 76.4 23.6 210 

Total 76.9 23.1 3,812 74.5 25.5 879 

Continued
90 

Appendix Table 16—Continued 

Using any modern, 

temporary method 

Method type among those using 

modern, temporary methods 

Survey 

year No Yes 

pvalue Weighted 

n LARC

nonLARC pvalue Weighted 

n 

Uganda 2011 † 

No IPV 81.7 18.3 538 11.8 88.2 99 

Ever IPV, but not last 12 

months 

76.7 23.3 155 5.6 94.4 36 

IPV in the last 12 months 84.8 15.2 614 9.6 90.4 93 

Total 82.6 17.4 1,307 9.9 90.1 228 

Zambia 2013-14 † 

No IPV 67.5 32.5 3,903 15.1 84.9 1,268 

Ever IPV, but not last 12 

months 

 64.6 35.4 893 18.3 81.7 316 

IPV in the last 12 months 64.3 35.7 2,349 18.3 81.7 838 

Total 66.1 33.9 7,145 16.6 83.4 2,422 

Zimbabwe 2010-11 

No IPV 54.6 45.4 2,389 4.3 95.7 1,084 

Ever IPV, but not last 12 

months 

49.0 51.0 196 1.8 98.2 100 

IPV in the last 12 months 52.6 47.4 1,509 3.0 97.0 716 

Total 53.6 46.4 4,094 3.6 96.4 1,899 

Notes: 

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

Modern, temporary contraceptive methods include: oral contraceptive pill, intrauterine device (IUD), injection, implants, 

male/female condom, lactational amenorrhea method (LAM), emergency contraception, standard days method, and 

vaginal methods like diaphragm, foam, and jelly. 

LARCs include IUDs and implants. Non-LARCs include injections, pills, condoms, and other modern methods. 
91 

Appendix Table 17. Sensitivity analysis: Unadjusted odds of multiple forms of intimate partner 

violence predicting discontinuation while still in need, discontinuation due to no further need, and 

total discontinuation in the 12 months prior to the survey among currently married women age 

15-49: Odds ratios from logistic regression models 

DWSIN 

Discontinuation due to 

no further need Total discontinuation 

OR 95% CI OR 95% CI OR 95% CI 

Multiple forms of IPV in last 12 months

Cambodia 2014 0.67 0.15,2.88 0.37 0.08,1.80 0.51 0.16,1.60 

Egypt 2014 1.88* 1.12,3.18 1.2 0.74,1.94 1.52* 1.05,2.19 

Honduras 2011-12 1.16 0.82,1.64 0.89 0.55,1.45 1.06 0.78,1.43 

Jordan 2012 1.88* 1.06,3.34 1.28 0.59,2.75 1.69* 1.08,2.62 

Kenya 2014 1.64 0.85,3.14 0.44† 0.17,1.11 1.05 0.61,1.81 

Kyrgyz Republic 2012 na na 0.18* 0.04,0.77 0.13** 0.03,0.53 

Rwanda 2014-15 0.56 0.25,1.27 0.78 0.35,1.73 0.64 0.35,1.14 

Tajikistan 2012 1.07 0.31,3.72 0.74 0.21,2.65 0.92 0.35,2.43 

Uganda 2011 0.84 0.36,1.97 1.20 0.40,3.65 0.93 0.44,1.96 

Zambia 2013-14 0.84 0.55,1.27 0.92 0.60,1.41 0.85 0.62,1.18 

Zimbabwe 2010-11 0.99 0.61,1.58 1.06 0.71,1.58 1.04 0.74,1.45 

Notes: 

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

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or 

no longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a more 

effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become pregnant 

of for other fertility-related reasons (e.g. infrequent sex/husband away, marital dissolution/separation, difficult to get 

pregnant). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long 

as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded 

from this analysis. 

 
92 

Appendix Table 18. Sensitivity Analysis: Unadjusted odds of the frequency of emotional, physical, 

sexual, and any intimate partner violence predicting discontinuation while still in need in the 12 

months prior to the survey among currently married women age 15-49: Odds ratios from logistic 

regression models 

Sometimes Often 

odds ratio p-value odds ratio p-value weighted n 

Emotional violence in last 12 months (ref=never ) 

Cambodia 2014 0.69 0.83 931 

Egypt 2014 1.88 * 1.19 3345 

Honduras 2011-12 1.19 1.60 † 3283 

Jordan 2012 1.11 1.75 2646 

Kenya 2014 1.61 1.81 1437 

Kyrgyz Republic 2012 0.37 1.00 1039 

Rwanda 2014-15 1.06 1.27 585 

Tajikistan 2012 1.23 0.95 879 

Uganda 2011 0.43 † 1.50 228 

Zambia 2013-14 0.69 0.71 2422 

Zimbabwe 2010-11 0.93 1.62 1899 

Physical violence in last 12 months (ref=never) 

Cambodia 2014 0.88 0.76 931 

Egypt 2014 1.37 2.09 3345 

Honduras 2011-12 1.20 0.79 3283 

Jordan 2012 1.51 0.50 2646 

Kenya 2014 1.29 0.34 1437 

Kyrgyz Republic 2012 0.38 0.69 1084 

Rwanda 2014-15 0.86 1.00 570 

Tajikistan 2012 1.15 1.00 872 

Uganda 2011 0.54 2.06 228 

Zambia 2013-14 0.74 1.56 2422 

Zimbabwe 2010-11 0.99 2.53 * 1899 

Sexual violence in last 12 months (ref=never) 

Cambodia 2014 1.97 1.00 931 

Egypt 2014 2.40 † 0.98 3345 

Honduras 2011-12 1.11 1.87 3283 

Jordan 2012 2.98 ** 0.77 2646 

Kenya 2014 2.19 † 0.48 1437 

Kyrgyz Republic 2012 0.57 1.00 1064 

Rwanda 2014-15 0.91 0.78 585 

Tajikistan 2012 1.00 0.59 854 

Uganda 2011 0.91 1.03 228 

Zambia 2013-14 1.42 1.21 2422 

Zimbabwe 2010-11 0.86 0.83 1899 

Continued
93 

Appendix Table 18—Continued

Sometimes Often 

odds ratio p-value odds ratio p-value weighted n 

Any IPV in last 12 months (ref=never) 

Cambodia 2014 0.79 0.75 931 

Egypt 2014 1.63 * 1.14 3345 

Honduras 2011-12 1.15 1.63 * 3283 

Jordan 2012 1.34 1.64 2646 

Kenya 2014 1.36 1.65 1437 

Kyrgyz Republic 2012 0.62 0.42 1084 

Rwanda 2014-15 0.92 1.01 585 

Tajikistan 2012 1.08 0.76 879 

Uganda 2011 0.39 * 1.27 228 

Zambia 2013-14 0.94 1.10 2422 

Zimbabwe 2010-11 0.94 1.22 1899 

Notes: 

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

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant or 

no longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a more 

effective method, cost, lack of access, or husband opposition). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long 

as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded 

from this analysis. 
94 

Appendix Table 19. Sensitivity Analysis: Unadjusted odds of emotional, physical, and 

sexual violence predicting discontinuation while still in need in the 12 months prior to the 

survey among currently married women age 15-49: Odds ratios from logistic regression 

models 

Specified form of violence 

only 

Violence other than specified form 

of violence 

odds ratio p-value odds ratio p-value N

Emotional violence (ref=no violence in last 12 months) 

Cambodia 2014 0.72 1.35 931 

Egypt 2014 1.67 * 1.13 3,345 

Honduras 2011-12 1.26 † 1.04 3,283 

Jordan 2012 1.36 1.69 2,646 

Kenya 2014 1.66 † 0.92 1,437 

Kyrgyz Republic 2012 0.23 † 0.86 1,084 

Rwanda 2014-15 1.07 0.69 585 

Tajikistan 2012 1.15 0.88 879 

Uganda 2011 0.75 0.64 228 

Zambia 2013-14 0.74 1.37 † 2,422 

Zimbabwe 2010-11 1.04 0.92 1,899 

Physical violence (ref=no violence in last 12 months) 

Cambodia 2014 0.84 0.73 931 

Egypt 2014 1.53 † 1.42 3,345 

Honduras 2011-12 1.18 1.30 3,283 

Jordan 2012 1.40 1.45 2,646 

Kenya 2014 1.30 1.71 1,437 

Kyrgyz Republic 2012 0.46 1.22 1,084 

Rwanda 2014-15 0.78 1.30 585 

Tajikistan 2012 1.08 0.91 879 

Uganda 2011 0.75 0.69 228 

Zambia 2013-14 0.86 1.21 2,422 

Zimbabwe 2010-11 1.11 0.86 1,899 

Sexual violence (ref=no violence in last 12 months) 

Cambodia 2014 1.67 0.63 931 

Egypt 2014 1.92 1.43 3,345 

Honduras 2011-12 1.40 1.22 3,283 

Jordan 2012 2.43 * 1.11 2,646 

Kenya 2014 1.89 1.23 1,437 

Kyrgyz Republic 2012 0.29 0.61 1,084 

Rwanda 2014-15 0.88 0.97 585 

Tajikistan 2012 0.09 * 1.20 879 

Uganda 2011 0.85 0.61 228 

Zambia 2013-14 1.28 0.76 2,422 

Zimbabwe 2010-11 0.87 1.09 1,899 

Notes: 

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

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become 

pregnant or no longer at risk of becoming pregnant (e.g. health concerns/side effects, method 

inconvenience, wanted a more effective method, cost, lack of access, or husband opposition). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this 

study so long as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) 

are excluded from this analysis. 
95 

Appendix Table 20. Sensitivity Analysis: Unadjusted odds of lifetime timing of emotional, 

physical, sexual, and any intimate partner violence predicting discontinuation while still in need 

in the 12 months prior to the survey among currently married women age 15-49: Odds ratios from 

logistic regression models 

Ever experienced, but not in 

last 12 months Experienced in last 12 months 

odds ratio p-value odds ratio p-value N 

Emotional violence (ref=never experienced) 

Cambodia 2014 0.77 0.70 931 

Egypt 2014 1.19 1.67 * 3,345 

Honduras 2011-12 1.20 1.28 † 3,283 

Jordan 2012 1.29 1.33 2,646 

Kenya 2014 0.81 1.65 † 1,437 

Kyrgyz Republic 2012 na 0.23 * 1,058 

Rwanda 2014-15 1.34 1.13 585 

Tajikistan 2012 na 1.16 879 

Uganda 2011 0.62 0.75 228 

Zambia 2013-14 1.06 0.70 † 2,422 

Zimbabwe 2010-11 2.77 † 1.09 1,899 

Physical violence (ref=never experienced) 

Cambodia 2014 0.21 * 0.80 931 

Egypt 2014 1.15 1.52 † 3,345 

Honduras 2011-12 1.05 1.13 3,283 

Jordan 2012 1.50 1.37 2,646 

Kenya 2014 0.78 1.12 1,437 

Kyrgyz Republic 2012 1.54 0.48 1,084 

Rwanda 2014-15 1.47 0.81 585 

Tajikistan 2012 0.29 † 1.03 879 

Uganda 2011 0.85 0.79 228 

Zambia 2013-14 1.54 * 0.92 2,422 

Zimbabwe 2010-11 0.84 1.13 1,899 

Sexual violence (ref=never experienced) 

Cambodia 2014 1.77 na 919 

Egypt 2014 1.79 na 3,328 

Honduras 2011-12 1.33 1.45 3,283 

Jordan 2012 2.35 * 0.47 2,646 

Kenya 2014 1.74 na 1,409 

Kyrgyz Republic 2012 0.32 na 1,076 

Rwanda 2014-15 0.88 na 580 

Tajikistan 2012 0.08 * na 874 

Uganda 2011 1.01 2.41 228 

Zambia 2013-14 1.35 0.53 2,422 

Zimbabwe 2010-11 0.86 1.36 1,899 

Continued
96 

Appendix Table 20—Continued 

Ever experienced, but not in 

last 12 months Experienced in last 12 months 

odds ratio p-value odds ratio p-value N 

Any IPV (ref=never experienced) 

Cambodia 2014 0.64 0.74 931 

Egypt 2014 1.02 1.50 † 3,345 

Honduras 2011-12 1.00 1.24 3,283 

Jordan 2012 1.48 1.49 † 2,646 

Kenya 2014 0.45 † 1.31 1,437 

Kyrgyz Republic 2012 1.48 0.59 1,084 

Rwanda 2014-15 1.31 0.98 585 

Tajikistan 2012 0.27 0.98 879 

Uganda 2011 0.64 0.64 228 

Zambia 2013-14 1.19 1.02 2,422 

Zimbabwe 2010-11 0.91 0.99 1,899 

Notes: 

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

Discontinuation is defined as the interruption of contraceptive use for one month or longer. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant 

or no longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a 

more effective method, cost, lack of access, or husband opposition). 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so 

long as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are 

excluded from this analysis. 
97 

Appendix Table 21. Sensitivity Analysis: Proportion of currently married women age 15-49 using 

contraception at 12 months prior to the survey who experienced interruption, by experience of 

intimate partner violence in the last 12 months 

Survey 

year Hiatus 

Abandonment 

discontinuation 

Total abandonment 

discontinuation Failure 

Any 

interruption

 no further 

need 

while still 

in need 

 % % % % % % 

Cambodia 2014 ns ns ns ns ns ns 

No IPV in the last 12 

months 

1.0 5.9 5.88 11.76 0.43 13.2 

IPV in the last 12 

months 

0.25 5.28 5.0 10.2 0.6 11.1 

Total 0.82 5.7 5.7 11.4 0.5 12.7 

Egypt 2014 ns ns ns ns ns ** 

No IPV in the last 12 

months 

 1.8 10.3 4.2 14.5 2.4 18. 8 

IPV in the last 12 

months 

 2.6 12.2 6.3 18.5 3.1 24.2 

Total 2.0 10.6 4.6 15.2 2.5 19.7 

Honduras 2011-12 ns ns * * ns * 

No IPV in the last 12 

months 

4.1 9.5 10.0 19.5 1.5 25.2 

IPV in the last 12 

months 

4.7 10.6 13.0 23.6 0.9 29.2 

Total 4.2 9.8 10.8 20.6 1.4 26.3 

Jordan 2012 ns ns * ns ns * 

No IPV in the last 12 

months 

 2.6 9.0 6.8 15.8 2.6 21.1 

IPV in the last 12 

months 

 1.9 9.6 10.9 20.5 4.7 27.1 

Total 2.5 9.2 7.9 17.0 3.1 22.6 

Kenya 2014 ns * ns ns ns ns 

No IPV in the last 12 

months 

1.0 7.5 6.4 13.9 1.8 16.7 

IPV in the last 12 

months 

1.1 4.3 8.9 13.2 3.3 17.6 

Total 1.0 6.3 7.3 13.7 2.4 17.0 

Kyrgyz Republic 2012 ns ns ns ns ns ns 

No IPV in the last 12 

months 

 0.7 8.0 2.6 10.5 2.4 13.6 

IPV in the last 12 

months 

 0.4 4.5 1.5 6.1 4.3 10.7 

Total 0.6 7.1 2.3 9.4 2.9 12.9 

Rwanda 2014-15 ns ns ns ns ns ns 

No IPV in the last 12 

months 

0.9 9.7 9.2 18.9 4.2 24.0 

IPV in the last 12 

months 

0.8 6.5 7.6 14.1 3.7 18.6 

Total 0.8 8.7 8.7 17.4 4.1 22.3 

Continued
98 

Appendix Table 21—Continued

Survey 

year Hiatus 

Abandonment 

discontinuation 

Total abandonment 

discontinuation Failure 

Any 

interruption

 no further 

need 

while still 

in need 

 % % % % % % 

Tajikistan 2012 ns ns ns ns * ns 

No IPV in the last 12 

months 

1.1 5.2 5.9 11.1 0.5 12.7 

IPV in the last 12 

months 

2.1 5.1 4.6 9.7 2.4 14.2 

Total 1.4 5.2 5.6 10.8 1.0 13.1 

Uganda 2011 ns ns ns ns ns ns 

No IPV in the last 12 

months 

 1.1 10.5 22.4 32.9 4.8 38.8 

IPV in the last 12 

months 

 1.7 11.0 20.4 31.5 4.0 37.2 

Total 1.3 10.7 21.6 32.4 4.5 38.2 

Zambia 2013-14 ns ns ns ns ns ns 

No IPV in the last 12 

months 

1.5 8.2 11.6 19.8 3.1 24.4 

IPV in the last 12 

months 

0.9 7.9 11.8 19.7 3.6 24.2 

Total 1.3 8.1 11.6 19.7 3.3 24.3 

Zimbabwe 2010-11 ns ns ns ns ns ns 

No IPV in the last 12 

months 

 1.2 13.3 5.6 18.9 3.5 23.6 

IPV in the last 12 

months 

 1.5 14.5 6.1 20.6 4.6 26.7 

Total 1.3 13.8 5.8 19.6 3.9 24.7 

Notes: 

ns=not significant, † p<0.10, * p<0.05, ** p<0.01, *** p<0.001 

Discontinuation is defined as the interruption of contraceptive use for one month or longer 

Abandonment discontinuation is defined as the interruption of contraceptive use without resumption of 

contraceptive use during the observation period. 

Hiatus is defined as the interruption of contraceptive use for one month or longer with resumption of contraceptive 

use during the observation period. 

Discontinuation while still in need is defined as discontinuing for reasons other than wanting to become pregnant 

or no longer at risk of becoming pregnant (e.g. health concerns/side effects, method inconvenience, wanted a 

more effective method, cost, lack of access, or husband opposition). 

Discontinuation due to no further need is defined as women who discontinue because they want to become 

pregnant of for other fertility-related reasons (e.g. infrequent sex/husband away, marital dissolution/separation, 

difficult to get pregnant). 

Only abandonment discontinuation is disaggregated into discontinuation while still in need and due to no further 

need. Too few women experienced a hiatus in contraceptive use to disaggregate this form of discontinuation 

further. 

Method switching is not considered to be an interruption to contraceptive use for the purposes of this study so long 

as a method of contraception is being used continuously. 

Women who experience contraceptive failure (became pregnant while using a contraceptive method) are excluded 

from this analysis.