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Domestic violence in India linked with higher rates of women seeking permanent sterilization

Indian man and woman holding hands

Women in India who experience domestic violence are significantly more likely to seek permanent sterilization as a means of birth control than women who are not victims of abuse, a recent study by Oregon State University found.

The probability of victims of domestic violence choosing sterilization — i.e. tubal ligation, or “tying the tubes” — is compounded by women’s upbringing and by the frequency with which they are abused. The more abuse they receive, the more likely they are to seek sterilization.

This is one of the only studies to look specifically at female sterilization as it relates to domestic violence in India, says Vaishali P. Patil, an author of the study and a Ph.D. student studying health policy in OSU’s College of Public Health and Human Sciences. India has the highest rate of female sterilization in the world at 39%, and more than 40% of those women are sterilized before age 25.

“The vast majority of studies say that when a woman experiences domestic violence, she cannot use any contraception, because her husband is not going to allow her to use it, and he won’t use it. Making the woman pregnant is one of the ways of controlling her,” Vaishali says.

However, when Vaishali further analyzed the women experiencing domestic violence who do report using contraception, female sterilization stood out as the most common form of birth control.

Vaishali’s study, published earlier this month in the Journal of Interpersonal Violence, used data from 2005-2006 nationwide survey conducted in India, which included a women-only domestic violence module for the first time in the survey’s history. It asked about specific forms of violence, including sexual violence, and health outcomes related to abuse, such as bruises and broken bones.

The study’s final sample included information from 69,704 women ages 15 to 49 who had been or were currently in heterosexual marriages.

Accounting for the frequency and severity of abuse women experienced, and whether they witnessed men abusing women in their family during their childhood, Vaishali found that victims of domestic violence were 18% more likely than non-victims to be sterilized.

Other factors such as level of education of both the woman and her partner, financial status, religion, employment, spousal alcohol use and location of residence within India also affect women’s likelihood of experiencing domestic violence.

“It’s not black and white. There are multiple things which are happening in the background, from when the woman is growing up, what community she’s going to marry into, what area she’s going to live in,” Vaishali says. “In India there are lots of cultural aspects. In a patriarchal society, marriage is a very important institution, and maintaining the sanctity of marriage … Women do not just break off and separate.”

With the social pressure placed on women in India to have children, especially sons, many become pregnant almost immediately after marriage, and may have multiple children with little or no spacing between pregnancies, Vaishali says. This creates health risks for both mothers and babies, including low birthweight and increased risk of complications in pregnancy.

“Abused women may prefer to go through the childbearing process quickly and then opt for permanent sterilization,” the study says. However, this also carries the risk of “sterilization regret,” particularly among women who were sterilized before age 25 or later lost a child and were unable to have another. Female sterilization is costly to reverse, and reversal procedures are not often successful.

Moving forward, Vaishali says women could be helped by health care providers in India being more aware of possible warning signs of abuse, and more proactive in asking female patients about their family life. Pregnancy is one of the few times in a woman’s life where she regularly goes to the doctor, and regularly has a chance to speak with the doctor alone, Vaishali says.

Vaishali is currently working on a study comparing the 2005-2006 survey response data with responses from the 2015 version. In the future, she also hopes to study domestic abuse among women who immigrate to the U.S. from India and are even more isolated by unfamiliarity and language barriers. 

Co-authors on the current paper were Jeff Luck, Jangho Yoon and Sunil K. Khanna, all faculty in Public Health at OSU.

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