Intimate partner violence and reproductive coercion against a clinic-based sample of low-income women in Mexico City: A latent class analysis

Male-perpetrated intimate partner violence (IPV) gravely impacts the lives of women, girls, and families. Approximately 25 to 40% of Mexican women who use health services have reported physical, sexual, and/or psychological IPV at some point during their life[1]. Recent research has positioned reproductive coercion, a behavior that interferes with women’s contraceptive and fertility choices, as a form of IPV [2]. While multiple acts of violence and coercion can occur in the same context (e.g., intimate relationship), it is important to assess heterogeneity in experiences of IPV and reproductive coercion among women in low- and middle-income countries [3] in order inform targeted interventions that are tailored to unique needs of subgroups of women as opposed to a “one fits all” intervention. The current study sought to identify patterns of physical and sexual IPV, and reproductive coercion among women residing in Mexico City.

The current study uses baseline data from a clinic-based, nurse-delivered IPV cluster randomized controlled trial with 950 low-income women seeking health services from 42 community health clinics in Mexico City [1]. Women who reported past-year physical and/or sexual IPV provided baseline data. Participants provided informed consent and completed a survey administered by a trained research assistant. The survey questions consisted of past year physical and sexual IPV, and reproductive coercion. Given the focus on reproductive coercion, current study analyses were restricted to a subset of 593 women who did not have a tubal ligation or whose male partner did not have a vasectomy. One in three (34.1%, n=202) women experienced reproductive coercion.

Latent class analyses were conducted to identify patterns of physical and sexual IPV, and reproductive coercion. All analyses were conducted using SAS 9.4. and latent class analysis was conducted using the PROC LCA/LTA. Three distinct latent classes emerged (Figure 1): High Physical/High Sexual IPV and High Reproductive Coercion class (16.4%), Low Physical/Low Sexual IPV and Low Reproductive Coercion class (69.8%), and High Physical/Low Sexual IPV, and Low Reproductive Coercion class (13.8%).

Figure 1.

Patterns of past-year intimate partner violence and reproductive coercion reported among 593 low-income women residing in Mexico City receiving healthcare services from community health clinics.

This study found that constraints on women’s reproductive choices and autonomy was a prevalent experience among a clinic-based sample of low-income women seeking healthcare services in Mexico City. Our findings suggests heterogeneity in women’s experiences of IPV and reproductive coercion. IPV can occur without concomitant reproductive coercion, but our findings suggest that reproductive coercion tends to co-occur with high frequencies of both physical and sexual IPV. Our research adds to the growing literature [1, 4] by identifying distinct typologies of IPV and reproductive coercion experiences, and underscores the importance of integrated, clinic-based interventions to address both IPV and reproductive coercion. Programmatic and policy initiatives could include safety planning and counseling, and screening for reproductive coercion. Future research should also extend the LCA analyses to understand perpetration and reproductive coercion among men.

Synopsis.

Community health clinics can have an active role in addressing IPV and reproductive coercion through policies and services in Mexico City.