Skip to main content
Download PDF

The intersection of intimate partner violence with sexual reproductive health in the Pacific: findings from a Kiribati population study

BMC Women's Health volume 25, Article number: 52 (2025) Cite this article

Abstract

Background

Women who experience intimate partner violence (IPV) are likely to experience reduced sexual and reproductive health (SRH). This paper aims to describe the prevalence of IPV and family planning use, and explore how IPV intersects with SRH among young Kiribati women; including met and unmet need for family planning, and use of contraception.

Methods

Data for this paper were drawn from the Kiribati Social Development Indicator Survey [1], conducted in 2018–2019. Chi-square tests for independence were conducted, with 95% confidence intervals to identify the strength of association. Associations were considered statistically significant at p < .05.

Results

Of the n = 3,106 women who had been intimately partnered or sexually active in the last year, 20% had unmet need for either spacing or limiting, the greatest unmet need being observed in women aged 15–24 years (28.8%). Half (51%) of ever-partnered Kiribati women experienced physical IPV from an ex/partner in their lifetime, one quarter experienced sexual IPV (24%) and 46% psychological IPV. Women aged 15–24 years reported higher rates of physical and/or sexual IPV over their lifetime and within the last year. Women who had experienced IPV from their partner in the last 12 months were significantly less likely to show unmet need for spacing or limiting (46.5%) than women who had not experienced any IPV (53.5%) and were more likely to be using a modern method of contraception (31%) than women who had not experienced IPV (26%). Women who experienced lifetime IPV were more also more likely to report met need for family planning.

Conclusions

This study shows women in Kiribati experience elevated rates of IPV and unmet need for family planning. Inclusion of young women (including single women) and rural women, especially women living with IPV must be prioritised as an international goal if the SRH needs are to be met for all. In order to overcome the difficulties faced by young women, women in remote areas and those experiencing IPV, health-care providers would benefit from further training and information on the issues around IPV.

Peer Review reports

Background

The young people of Kiribati show complex needs related to poverty, geographic isolation and difficulty accessing services [2, 3]. Sexual and reproductive health (SRH) is a critical area of health and wellbeing for a community that experiences a high prevalence of intimate partner violence (IPV) against a backdrop of complex service delivery challenges in a remote small developing island state.

Sexual reproductive health (SRH) is a fundamental human right [4], however the (2018) report of the Guttmacher-Lancet Commission into SRH found that almost 4.3 billion people worldwide have inadequate access to SRH services over the course of their reproductive lives. This includes more than 200 million women in developing nations like Kiribati who want to avoid pregnancy but are not using modern contraception [5]. Data from population surveys demonstrate that women living in poverty are less likely to access SRH services [6, 7], with young women being the least able to access health services [8]. Access to SRH services, information and education is essential for ensuring the wellbeing, autonomy and dignity of every person.

Geographic and demographic overview of Kiribati

Located in the central Pacific Ocean, Kiribati has a young population, with 55 per cent of the nation’s population aged under 25 years [9], making SRH issues for youth a priority. The country has a population of 119,000 people occupying just 811 square kilometres of inhabited land [10]. Many of the outer islands have limited opportunities for education and healthcare which leads to a highly mobile population with many young people moving to the main island of Tarawa. Kiribati’s main island, Tarawa, subsequently suffers from severe overcrowding [11, 12], and two thirds of the country’s population has been rated as poor or vulnerable, with population growth outpacing infrastructure and housing growth [2, 13]. The rapidly increasing population continues to put pressure on already-strained services. It is also one of the most geographically dispersed and remote countries in the world, with thirty-three atolls spread across 3.4 million square kilometres of ocean – with 3,900 km from the east to west. The provision of health services across this vast geographic area is challenging and expensive. Whilst the health status of the Kiribati population is improving over time, the country is yet to meet any of the Millennium Development Goals [14].

Sexual and reproductive health in Kiribati

Previous SRH assessment of Kiribati revealed high potential for risks of ‘unintended pregnancies, unsafe abortions, complications during pregnancy and delivery, especially for teenage girls and women in rural areas [15]. Discussion of sexuality is often viewed as taboo in the Pacific, meaning people can find it difficult to seek information on SRH services as a result [16]. When women have less than a primary education, they are also more likely to have higher fertility and adolescent birth-rates [1].

Qualitative interviews with women in Kiribati reveal that knowledge about contraception is mixed with some women receiving information about methods from a health practitioner, others hearing information from women in the community and many demonstrating no knowledge at all [16] p71. Further, women who were interviewed and wished to avoid pregnancies were also not using contraception [16]. Studies the Pacific Islands, as well as other developing nations that are predominantly Catholic, have revealed a lack of contraceptive use due to inadequate understanding of family planning methods, mixed feelings about conceiving, and adherence to religious beliefs prohibiting contraception [17,18,19,20].

Intimate partner violence in Kiribati

Women who experience IPV are also likely to experience significantly reduced general and reproductive health, and serious complications resulting in long-term decreased health and/or premature death [5, 21,22,23,24]. In Kiribati, studies show that rates of physical, sexual, and psychological violence against women are among the highest in the world [25]. Violence against women can include spousal violence (physical, sexual and/or psychological); sexual violence by persons other than a husband/partner, including other family members, friends, acquaintances, or strangers (i.e., non-partner sexual violence) [26, 27]. However, violence by a husband or male intimate partner (or other male family member) is the most pervasive form of violence against women globally [4, 28, 29]. Intimate partner violence is often a hidden form of violence, not reported to authorities and viewed as a private matter [30, 31]. Violence against women is more prevalent in areas where women and girls are less valued than men and contributes to the lack of empowerment of women and girls [31, 32].

The Kiribati Family Health and Support Study (2010) found that 68 per cent of ever-partnered Kiribati women aged 15–49 years reported having experienced at least one act of physical or sexual violence by an intimate partner across the course of their life [33,34,35]. This research resulted in a whole-of-government commitment to eliminate violence against women and girls, including the establishment of a dedicated Ministry for Women, Youth, Sports and Social Affairs (MWYSSA) in 2013 [36], p.5/33). The original prevalence findings have since been replicated with the Kiribati Social Development Indicator Survey 2018–2019 (KSDIS), which found that 67 per cent of ever-partnered women reported having experienced physical or sexual violence in their lifetime, with 53 per cent reporting experiencing violence in the last twelve months [1].

Intersection of intimate partner violence with sexual and reproductive health, and use of contraception

Use of SRH services, and specifically contraception, have been seen to be negatively impacted by the co-occurrence of IPV [37,38,39,40]. This is a global problem with significant impact on the health of women and girls, in addition to SRH [37, 41]. Existing literature reveals strong but heterogeneous relationships between IPV and the use of contraception, especially in developing countries, where both the occurrence of IPV and unmet demand for contraception are high [42,43,44,45]. Some evidence indicates that women who experience IPV are less likely to use modern contraceptive methods [46,47,48,49,50]. In contrast, other studies have found that women exposed to IPV are more likely to protect themselves from unwanted pregnancies [51,52,53,54]. These conflicting findings reinforce the need for further investigation of the complex relationships between IPV and contraception use [55].

Pregnancy has been particularly noted as a time where women are more at risk of IPV [23]. Traditional attitudes towards gender roles, such as the belief that men should control and dominate a relationship and household, or that women should perform domestic duties and be emotionally and physically available to men, are linked to perpetration of partner violence in pregnancy [56, 57]. On the other hand, studies have shown that women living with IPV are more likely to be using contraceptive methods to control pregnancy compared to those without [58], though partner refusal to use contraception was significantly more common among women who had ever experienced IPV [58, 59].

While national rates of IPV in Kiribati are becoming better known, we have less information about how it impacts on the lives of women, especially young women’s use of SRH services. The (2018) report of the Guttmacher-Lancet Commission into SRH determined that a more holistic view of SRH and adjacent issues, such as IPV and adolescent sexuality need to be addressed [5]. The recent KSDIS provides the opportunity to bringing together information about SRH needs in Kiribati alongside prevalence of IPV.

Aims

This paper aims to describe the prevalence of IPV, describe family planning use, and explore how IPV intersects with SRH among young Kiribati women, including met and unmet need for family planning and contraceptive use.

Methods

Data for this paper was drawn from the Kiribati Social Development Indicator Survey (KSDIS) [1], conducted in 2018–2019 as part of the Global Multiple Indicator Cluster Survey (MICS) Programme developed by UNICEF with the goal of generating internationally comparable data on women and children, covering a range of indicators including SRH, IPV and disability. Please consult the KSDIS [1] for further details on the modules within the MICS.

Research ethics to conduct this secondary analysis was obtained through the University of Melbourne research office (ethics ID 1647887.1).

Participants

The KSDIS sample of ever-partnered women aged 18–49 years was n = 3,106.

Measures

In order to explore SRH empowerment of women, we ask whether they have their contraceptive needs met, rather than merely whether they are using contraception:

Unmet need for family planning (spacing or limiting)

The measure of unmet need for family planning refers to fecund women who are not using any method of contraception, but who wish to postpone the next birth and have more space between births (spacing) or who wish to stop childbearing altogether and limit the number of children they have (limiting). Unmet need is identified in MICS (from which this data is drawn) by using a set of questions eliciting current behaviours and preferences pertaining to contraceptive use, fecundity, and fertility preferences [1](pp 89–90).

Met need for family planning (spacing or limiting)

Met need for limiting includes women who are using (or whose partner is using) a contraceptive method and who want no more children, are using male or female sterilisation or declare themselves as infecund.

Met need for spacing includes women who are using (or whose partner is using) a contraceptive method and who want to have another child or who are undecided whether to have another child. Summing the met need for spacing and limiting results in the total met need for contraception.

Use of contraception

We report on methods of contraception as defined in the MICS analysis as, including modern methods (oral contraceptive pills, injectables, implants, intra-uterine devices (IUDs), female or male sterilisation, vaginal barrier methods (diaphragm, sponge, cervical cap, spermicidal foam, jelly, cream and sponge), emergency contraction, lactational amenorrhea method (LAM)); or traditional methods (periodic abstinence, withdrawal, or post-partum amenorrhea). Traditional methods are generally not accepted to be effective methods of contraception [60]. Given that traditional methods are not effective, and that the sample of Kiribati women using only traditional methods was too small for cross-tabulation amongst groups, we combined traditional methods with no method as one group for analysis.

Analysis

In order to investigate associations between groups of women who experience violence and the types of contraceptive methods they choose, we used Chi-square tests for independence to analyse differences between groups of categorical variables, with p-values at the level < 0.05 reported as significant. Effect size (phi) was reported.

Findings

Demographics

The sample of women who had been intimately partnered or sexually active in the last year was 3,106, with a mean age of 32.36 years (SD = 8.32), and a median age of 32 years, the majority of whom lived in urban areas (57.3%) (Table 1). The age of a woman was not associated with whether she lived in an urban or rural area.

Table 1 Percentage of partnered/sexually active women in the last year, by area and age
Full size table

The Domestic Violence module was delivered to 2,548 women and of these women, 2,079 (81.6%) had been married or living with an intimate partner (ever-partnered). Analysis that includes IPV in this paper thus uses this sample of ever-partnered women.

Experience of intimate partner violence

Around half (51%) of ever-partnered Kiribati women experienced physical IPV from a current or former partner in their lifetime with one quarter experiencing sexual IPV (24%) and almost half (46%) psychological IPV over their lifetime. The women who experienced IPV were significantly more likely to have a lower level of education [psychological IPV χ2 (2, n = 2079) = 5.624, phi = 0.06, physical or sexual χ2 (2, n = 2079) = 15.761, p < .01, phi = 0.09, physical χ2 (2, n = 2079) = 17.912, p < .01, phi = 0.09, and sexual IPV χ2 (2, n = 2079) = 11.898, p = .003, phi = 0.08)] (Appendix Table 8), live in rural areas [physical and/or sexual IPV, χ2(2, n = 2079) = 9.910, p < .007, phi = 0.069] (Appendix Table 9, with 12 months rates available here), and be aged between 15 and 24 years (χ2(4, n = 2079) = 19.106, p < .001, phi = 0.096) (Appendix Tables 10 and 12 month rates also available here).

Family planning (use of contraception, met and unmet need)

For the analysis of need for family planning, we included women who had been either sexually active in the last year or were in a current intimate partner relationship. Need for family planning examines both the use of contraception and whether a woman’s need to manage her fertility are also being met.

Use of contraception

Just over half of sexually active Kiribati women in a current relationship were not using any form of contraception or were using traditional methods (59.5%). Significantly more sexually active women aged 15–24 years were using no method of contraception than other age groups (74.4%) χ2 (4, n = 1188) = 21.213, p < .01, phi = 0.13 (Table 2). There were no differences between rates for urban and rural areas.

Table 2 Contraceptive method categories used by sexually active women/women in a current relationship
Full size table

Women who experienced lifetime physical and/or sexual IPV were significantly more likely to be using a modern method of contraception (31%) than women who had not experienced lifetime IPV (26%), χ2 (4, n = 2076) = 9.498, p = .05, phi = 0.07 (Table 3). This pattern did not vary across age groups or area (Appendix Table 11).

Table 3 Percentage of ever-partnered women aged 18–49 who experienced physical/sexual IPV by method of contraception
Full size table

Unmet need

17% of all women in a current relationship had unmet need for either spacing or limiting, the greatest unmet need being observed in women 15–24 years (23%), χ2(4, n = 2,852) = 35.700, p < .001, phi = 0.11 (Table 4). This group also had the lowest levels of using contraception for spacing or limiting (25.7%) compared to above 30% in other age groups.

Table 4 Unmet need of women in a current relationship, and age group in years
Full size table

No difference was seen in rates between urban and rural areas.

Women who had experienced any type of IPV from their partner in the last 12 months were significantly less likely to show unmet need for spacing or limiting (46.5%) than women who had not experienced any IPV (53.5%) (χ2 (2, n = 2117) = 6.69, p < .05, phi = 0.06). *Please note that totals do not add up to 100% due to missing responses.

Met need for family planning

For this analysis, we selected women who had either been sexually active in the last year, or had a current partner, and did not want another child, or were pregnant and wish that they had delayed their pregnancy (n = 1,169). Forty-one per cent (40.5%) of Kiribati women reported that their needs for family planning were being met by use of modern methods of contraception, 7.4% by traditional methods, including the “no method” group.

Kiribati women who experienced IPV in their lifetime were more likely to report met need for family planning than women who have not experienced violence (Table 5) [physical IPV χ2 (2, n = 1,112) = 11.576, p < .003, phi = 0.102, sexual IPV χ2 (2, n = 1,113) = 8.131, p < .017, phi = 0.085, psychological violence, χ2 (2, n = 1,113) = 6.774, p < .034, phi = 0.078, physical or sexual IPV χ2 (2, n = 1,113) = 12.478, p < .002, phi = 0.106]. Rates of met need were not significantly different between women experiencing IPV in the last 12-months and those who had not.

Table 5 Women aged 18–49 who experienced physical/sexual IPV by met need for family planning
Full size table

IPV during pregnancy

Among Kiribati women who experienced violence, and had ever been pregnant, one in ten (10%) disclosed that violence had occurred during pregnancy. 88% of women who experienced physical violence during pregnancy reported that their current husband /partner or boyfriend perpetrated the violence. There were no significant differences between rates of rural and urban women experiencing physical IPV during pregnancy (Appendix Table 11). The sample of women was too small to report cross-tabulation of IPV during pregnancy by age, so we looked at age of marriage. Women who had married below the age of 18 were no more likely to experience IPV during pregnancy (Table 6). The mean age of childbearing in Kiribati was 31 years (2020) [61].

Table 6 Experience of IPV during pregnancy by age of marriage
Full size table

Contraception after birth

Women who had experienced IPV were more likely to be using current contraception after giving birth compared with women who had not experienced violence (χ2(2, n = 1921) = 6.694, p = .035, phi = 0.059) (Table 7).

Table 7 Experience of lifetime physical and/or sexual IPV by contraception after birth
Full size table

Discussion

This paper explored the intersection of intimate partner violence (IPV) and sexual and reproductive health (SRH), in particular, issues for young women and women in remote areas. Results suggests that IPV starts early for women in Kiribati and stays with them for many years. Overall, there was little difference in rates of lifetime IPV between age groups, but greater rates of IPV in the last 12 months for women younger than 35. Rates of IPV were higher for women living in rural areas and for women who had a lower level of education, consistent with previous literature [62,63,64,65]. Women living in rural/remote areas can be at higher risk of partner violence due to the lack of options for obtaining help or leaving an unsafe relationship [64]. Further, people living in small and close-knit communities may find it more difficult to ask for assistance due to shame and reputational risk [27].

Rates of unmet need for family planning were high, and significantly higher for women aged under 24 years. Kiribati rates for met need (40.5%) were low compared to global targets of met need being 77% (high met need) [66]. Global studies in low- and middle-income countries (LMICs) have shown positive association of women’s age, and economic wealth with met need for family planning and use of modern methods of contraception [67,68,69]. However, the current study found no disparities between rural (where economic wealth is lower in Kiribati) and urban areas for unmet and met need for family planning.

There are studies which show higher rates of unmet need and lower rates of modern contraceptive use in rural areas of other countries [70,71,72,73]. Malarcher, Shawn and WHO (2010) identified that being in rural areas can be a barrier to access family planning services either due to a lack of services or transport to medical services where they do exist, and potentially a reluctance to attend local services in small communities where women, especially adolescents, may be worried about their privacy [74]. In Kiribati, with the rising population and remoteness of many of Kiribati’s coral atolls, the on-going challenge to provide universal access to SRH services has been acknowledged by the Ministry for Health and Medical Services [15], in particular challenges around resources and under-staffing. Despite these challenges, our study did not observe a significant difference between met/unmet family planning needs and contraceptive use in rural areas compared to urban.

A study of contraceptive utilisation amongst adolescents in Zambia showed higher use of contraceptives in rural areas compared to urban [75]. The heterogeneity of these findings may indicate that demand for and use of family planning in rural versus urban areas is more complicated than physical access to resources. Relatively few women with an unmet need for family planning in developing countries cite cost or access as reasons for not using a contraceptive method, rather tending to cite fear of side effects, breastfeeding and attitudinal factors as their main reasons [76]. Health services themselves have also been shown as limiting access to services to young people, especially in places where culture and religion were cited as the main barriers to access by unmarried adolescents [65]. The explanations underlying these reasons are not currently understood and require further exploration [72], especially given that women living in rural areas face higher risks of unintended pregnancies, complications and death compared to other women [77, 78].

The current study found that women living with IPV were more likely to be using contraceptive methods to control pregnancy and have family planning needs met compared to women without lifetime IPV. While this is consistent with some literature [58, 59, 79] there is also contrasting research that shows women who have experienced IPV endure long-term impacts on their sexual and reproductive health and sometimes have limited access to health care due to living in a controlled environment [80,81,82,83].

Studies in sub-Saharan Africa [51], Bangladesh [52], New Zealand [59], Honduras [53], and India [54] have found a positive relationship between IPV and contraception use, suggesting that women who are exposed to IPV are more likely to protect themselves from unwanted pregnancies. Some studies have also shown that women who were exposed to sexual IPV were more than twice as likely to use modern contraceptive methods than those who did not face sexual IPV [42, 43]. Similarly for other forms of IPV, women’s experience of IPV were associated with a greater use of contraception [51, 52, 84, 85].

In contrast, a growing body of research has established the linkage between IPV and contraceptive discontinuation [86]. Studies conducted in India reported results where physical violence perpetrated by the husband was associated with a lower likelihood of modern contraceptive adoption [40, 45]. A multicountry study using Demographic Health Survey (DHS) data found inconsistent results in the association between various forms of IPV and contraceptive discontinuation [87].

These conflicting findings reinforce the need for further investigation of the complex relationships between IPV and contraception use. One possible explanation for these inconsistent results is that the influence of IPV on contraceptive use is not categorical [50]. Other factors, such as cultural, societal, and relational context play moderating roles in these relationships so it can be difficult to generalise findings. For example, men who want to limit the number of children they have would be unlikely to prevent their partner from accessing contraception. Forrest et al. (2018) found that, in the context of IPV, the desire for more children among men was one of the strongest correlates of whether their wives began using contraception, even after controlling for the wives’ desire for more children [50].

Studies have observed that women experiencing controlling and dominating behaviours by their husbands are more likely to report interference in the use of contraception than those women who do not experience controlling behaviours [88]. Further research on the role of husbands’ controlling behaviours as a moderating factor in the association between IPV and the use of contraception may improve our understanding between the interplay of IPV and SRH, in particular, the use of contraception.

Women who are pregnant are at risk of experiencing IPV [89,90,91,92], though the current study did not find this to be significantly different to the risk of IPV when not pregnant. Pregnancy has been identified as a time of greater autonomy and self-awareness for women and as such pregnancy may symbolise “autonomous control over her body and her independence from her partner” [56], p. 595. Since control is a significant aspect of IPV, violent or abusive men may find pregnancy threatening and seek to re-exert control over their partners [56, 93]. Given the inconsistency of the current finding with the literature, this may be an area for further exploration.

Our finding that women who had experienced lifetime IPV were more likely to use contraception after giving birth is consistent with findings from India, where women who had experienced physical and sexual violence were more likely to have postpartum contraceptive use [94]. In situations where women have little control over sex (i.e. experience forced sex), they may be more likely to use contraception compared to women not experiencing forced sex, suggesting that they may be using contraception to gain greater control of their reproductive health in the face of loss of control over sex [42, 95]. This previous study was not limited to contraception use during the postpartum period [43], which presents another area for further exploration.

Understanding of what is driving use of different forms of contraception is challenging among a population where the majority of women are not using a method of contraception. The relationship between contraceptive use and the experience of IPV is an important intersection to explore in Kiribati given both the high rates of IPV and unmet need for family planning. Future research on this issue could offer ways to increase support for women to have safe control over their childbearing.

Limitations

In any survey there will be respondents who opt not to disclose experiences that are asked about in the questionnaire. The more sensitive the questions are, the greater risk there is of low disclosure rates. Questions about SRH and IPV are two highly sensitive topics and we accept that any national survey will always be an underrepresentation of the true existence of the issues. Enhancing disclosure rates primarily relies on interviewer training, which can improve disclosure rates. The authors of this paper were involved in the interviewer training for the IPV module along with the Kiribati Women and Children’s Centre specialists. The training was shorter than recommended for an IPV survey but was the highest quality training possible in the time available. We accept the response rates as indicative of the issues with knowledge that they are likely underreports. Findings are limited by the cross-sectional and descriptive nature of the methodology, which prevents temporal or causal relationships from being inferred, though associative relationships were explored. These findings merit further investigation through qualitative research. Such research could delve into women’s motivations and choices regarding contraception, beyond the scope of family planning decision-making as addressed in the KSDIS questionnaire.

Conclusion

This study contributes to the expanding body of research about the association between women’s experience with IPV and contraceptive use, and the specific SRH issues for young women. According to the data from Kiribati, women who did not use modern means of contraception were more likely to be younger but no more likely to be living remotely. Younger women were also more likely to experience IPV. However, women who experienced IPV were more likely to have met need for contraception, regardless of their age or location.

Violence in all forms can have great impact on women’s sexual and reproductive health physically, emotionally and by restricting access to health care [96]. Inclusion of young women (including single women) and rural women, especially those experiencing IPV, must be prioritised as an international goal if the SRH needs are to be met for all. Appropriate contraceptive use is important to the health of women and children as it helps to prevent pregnancies that are too early or late, limits the total number of births as well as extends the time between births for recovery (spacing). The heterogeneity of findings relating to the intersection of IPV and SRH indicates a great need to further our understanding of this complex relationship.

In order to overcome the difficulties faced by young women, women in remote areas and those experiencing IPV, health-care providers require further training and information to understand the issues around IPV. Training to manage care, provide follow up and counselling should be included in pre-service curricula, as well as access to additional counselling and legal aid. Further, governments and partner agencies can make significant contributions to the reduction of violence against women, via the promotion of SRH and IPV services that improve these women’s access.

Data availability

The questionnaire, methodology and dataset are available through the Pacific Data Hub at the following link: https://pacificdata.org/data/dataset/spc_kir_2018_mics_v01_m_v01_a_puf#:~:text=The%202018%2D19%20Kiribati%20SDIS,collect%20disaggregated%20data%20for%20the.

References

  1. Office KNS. Kiribati Social Development Indicator Survey 2018–2019, Survey findings Report. National Statistics Office: South Tarawa, Kiribati; 2019.

  2. Storey D, Hunter S. Kiribati: an environmental ‘perfect storm’. Aust Geogr. 2010;41(2):167–81.

    Article  Google Scholar 

  3. Kidd S, Mackenzie U. Kiribati country case study. AusAID Pacific Social protection series: poverty, vulnerability and social protection in the Pacific March 2012. Australian Agency for International Development (AusAID): Canberra; 2012.

  4. WHO, Defining sexual health - Report of a Technical Consultation on Sexual Health 28–31 2002, in Sexual Health Document Series. 2006, World Health Organisation: Geneva.

  5. Accelerate progress—sexual and reproductive health and rights for all: report of the Guttmacher– Lancet Commission. The Lancet, 2018. 391(10140): pp. 2642–2692.

  6. Countdown 2008 Equity Analysis Group Boerma JT, Kinfu BJ, Axelson Y, Victora H. CG., Countdown 2008 Equity Analysis Group, Boerma JT, Bryce J, Kinfu Y, Axelson H, Victora CG. Mind the gap: equity and trends in coverage of maternal, newborn, and child health services in 54 Countdown countries. Lancet, 2008.

  7. Gwatkins DK, Rutstein S, Johnson K, Suliman E, Wagstaff A, Amouzou A. Socio-economic differences in health, nutrition, and population within developing countries. Nutrition and Population, and Poverty): Washington, D.C: The World Bank (Country Reports on Health; 2007.

    Google Scholar 

  8. Walters FP, Gray SH. Addressing sexual and reproductive health in adolescents and young adults with intellectual and developmental disabilities. Curr Opin Pediatr. 2018;30:451–8.

    Article  PubMed  Google Scholar 

  9. Office NS. Republic of Kiribati 2015 Population and Housing Census. 2016.

  10. Organisation FaA. Geography: Kiribati, Food and Agriculture Organisation. 2012; https://www.fao.org/forestry/country/18310/en/kir/

  11. Office NS. Republic of Kiribati 2020 population and housing: general report and results. Ministry of Finance; 2022.

  12. Kiribati Go. Kiribati development plan 2020–2023. A wealthy, healthy and peaceful nation. 2022.

  13. Organization WH. Kiribati–WHO Country Cooperation Strategy 2018–2022. World Health Organization, Western Pacific Region; 2017.

  14. WHO. Millennium Development Goals (MDGs). 2017 2024 [cited 2024 24.04.24]; https://www.who.int/news-room/fact-sheets/detail/millennium-development-goals-(mdgs).

  15. MHMS Kiribati, Kiribati sexual and Reproductive Health rights needs assessment. 2015, ministry for health and medical services with support from UNFPA, pacific sub-regional office and government of New Zealand.

  16. Spratt JM. A deeper silence: the unheard experiences of women with disabilities and their sexual and Reproductive Health experiences: Kiribati, the Solomon ilsands and Tonga. UNFPA: Fiji; 2013.

    Google Scholar 

  17. McMurray C. Culture, catholics and condoms:Population Planning in the Pacific. J Developing Soc. 2006;22(3):327–43.

    Article  Google Scholar 

  18. Natividad MDF. CATHOLICISM AND EVERYDAY MORALITY: Filipino women’s narratives on reproductive health. Glob Public Health. 2019;14(1):37–52.

    Article  PubMed  Google Scholar 

  19. Baigry MI, et al. Barriers and enablers to young people accessing sexual and reproductive health services in Pacific Island Countries and territories: a scoping review. PLoS ONE. 2023;18(1):e0280667.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Knill C, Preidel C, Nebel K. Brake rather than barrier: the impact of the Catholic Church on morality policies in Western Europe. West Eur Politics. 2014;5:845–66.

    Article  Google Scholar 

  21. Akyüz A, Yavan T, Şahiner G, Kılıç A. Domestic violence and woman’s reproductive health: a review of the literature. Aggress Violent Beh. 2012;17:514–8.

    Article  Google Scholar 

  22. Silverman JG, et al. Family Violence and Maltreatment of women during the Perinatal Period: associations with Infant Morbidity in Indian Slum communities. Matern Child Health J. 2016;20(1):149–57.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Lutgendorf MA. Intimate Partner Violence and Women’s Health. Volume 134. Obstetrics & Gynecology; 2019. 3.

  24. Sarkar NN. The impact of intimate partner violence on women’s reproductive health and pregnancy outcome. J Obstet Gynaecol. 2008;28(3):266–71.

    Article  CAS  PubMed  Google Scholar 

  25. Forster C. Ending domestic violence in Pacific Island countries: the critical role of law. Asian-Pacific Law Policy J. 2011;12:123–44.

    Google Scholar 

  26. Vives-Cases C, Hernández GI, Sanz-Barbero A, Gill B, Baldry AK. AC, expert opinions on improving femicide data collection across Europe: a concept mapping study. PLoS ONE 2016;11(2).

  27. Weil JM, Lee HH. Cultural considerations in understanding family violence among Asian American Pacific Islander families. J Commun Health Nurs. 2004;21:217–27.

    Article  Google Scholar 

  28. Krug EG, et al. The world report on violence and health. Lancet. 2002;360(9339):1083–8.

    Article  PubMed  Google Scholar 

  29. Sciortino R. Sexual and reproductive health and rights for all in Southeast Asia: more than SDGs aspirations. Volume 22. Health & Sexuality; 2020. pp. 744–61. 7Culture.

  30. Farran S. Gender, equality and Pacific Island Countries with particular focus on domestic violence. J South Pac Law. 2015;2:A1-A23, ISSN 1684–5307.

  31. Weil S, Consuelo C, Marceline N. Femicide across Europe:Theory, research and prevention. 2018.

  32. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls. Lancet. 2015;385(9977):1580–9.

    Article  PubMed  Google Scholar 

  33. Community SotP. Kiribati Family Health and Support Study: a study on violence against women and children. Noumea, New Caledonia: SPC and Government of Kiribati, Statistics Division; 2010.

    Google Scholar 

  34. Community SotP. Kiribati Family Health and Support Study: a study on violence against women and children. SPC and Government of Kiribati: Kiribati; 2010.

    Google Scholar 

  35. Community SotP. Kiribati Family health and support study a study on violence against women and children. S.a.G.o.: Kiribati, Editor.; 2010.

    Google Scholar 

  36. Kiribati Go. Combined initial, 2nd and 3rd periodic reports submitted by Kiribati under article 18 of the Convention, due in 2005: Convention on the Elimination of All Forms of Discrimination against Women CEDAW/C/KIR/1–3., U. Nations, Editor. 2019: New York.

  37. Campbell K. Legal memories: sexual assault, memory, and International Humanitarian Law. Signs. 2002;28(1):149–78.

    Article  Google Scholar 

  38. Pallitto G-M, Jansen, Heise, Ellsberg, Watts. Global and regional estimates of violence against women: prevalence and health effects of intimate partner violence and non-partner sexual violence. World Health Organization; 2013.

  39. Bergmann JN, Stockman JK. How does intimate partner violence affect condom and oral contraceptive use in the United States? A systematic review of the literature. Contraception. 2015;91(6):438–55.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Stephenson R, Koenig MA, Acharya R, Roy TK. Domestic violence, contraceptive use, and unwanted pregnancy in rural India. Stud Fam Plann. 2008;39:177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ruiz-Pérez I, Plazaola-Castaño J, del Rio-Lozano M. Physical health consequences of intimate partner violence in Spanish women. Eur J Pub Health. 2007;17:437–43.

    Article  Google Scholar 

  42. Raj A, McDougal L. Associations of intimate partner violence with unintended pregnancy and pre-pregnancy contraceptive use in South Asia. Contraception. 2015;91:456–63.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Raj A, McDougal L, Reed E, Silverman JG. Associations of marital violence with different forms of contraception: cross-sectional findings from South Asia. Int J Gynecol Obstet. 2015;133:e56–61.

    Google Scholar 

  44. Silverman JG et al. Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. eClinicalMedicine. 2020;22.

  45. Stephenson R, Jadhav A, Hindin M. Physical domestic violence and subsequent contraceptive adoption among women in rural India. J Interpers Violence. 2013;28:1020–39.

    Article  PubMed  Google Scholar 

  46. Intimate partner violence and condom and diagphram nonadherence among women in an HIV prevention trial in southern Africa. Journal of Acquired Immune Deficiency Syndromes, 2013. 64(4): pp. 400–408.

  47. Maxwell L, et al. Intimate partner violence and pregnancy spacing: results from a meta-analysis of individual participant time-to-event data from 29 low-and-middle-income countries. BMJ Global Health. 2018;3(1):pe000304.

    Article  Google Scholar 

  48. Kabir R, Kordowicz M. Exploring the relationship between intimate partner violence and contraception use by Tanzanian women. Health Care Women Int. 2021;42(10):1220–33.

    Article  PubMed  Google Scholar 

  49. Chen GL et al. A cross-sectional analysis of intimate partner violence and family planning use in rural India. eClinicalMedicine, 2020;21.

  50. Forrest W, Arunachalam D, Navaneetham K. Intimate partner violence and contraceptive use in India: The moderating influence of conflicting fertility preferences and contraceptive intentions. J Biosoc Sci. 2018;50(2):212–26.

    Article  PubMed  Google Scholar 

  51. Alio AP, Daley EM, Nana PN, Duan J, Salihu HM. Intimate partner violence and contraception use among women in sub-saharan Africa. Int J Gynecol Obstet. 2009;107:35–8.

    Article  Google Scholar 

  52. Dalal K, A.J., Dawad S. Contraception use and associations with intimate partner violence among women in Bangladesh. J Biosoc Sci. 2012;44:83–94.

    Article  PubMed  Google Scholar 

  53. Kuhlmann AS, Shato T, Fu Q, Sierra M. Intimate partner violence, pregnancy intention and contraceptive use in Honduras. Contaception. 2019;100:137–41.

    Article  Google Scholar 

  54. Reed E, Saggurti N, Donta B, Ritter J, Dasgupta A, Ghule M, Battala M, Nair S, Silverman JG, Jadhav A, Palaye P, Raj A. Intimate partner violence among married couples in India and contraceptive use reported by women but not husbands. Int J Gynecol Obstet. 2016;133:22–5.

    Article  Google Scholar 

  55. Paul P, Mondal D. Association between Intimate Partner Violence and Contraceptive Use in India: exploring the moderating role of Husband’s Controlling behaviors. J Interpers Violence. 2022;37(17–18):NP15405–33.

    Article  PubMed  Google Scholar 

  56. Bacchus L, Mezey G, Bewley S. A qualitative exploration of the nature of domestic violence in pregnancy. Violence against Women. 2006;12(6):588–604.

    Article  PubMed  Google Scholar 

  57. Brownridge DA, et al. Pregnancy and intimate Partner violence: risk factors, severity, and Health effects. Violence against Women. 2011;17(7):858–81.

    Article  PubMed  Google Scholar 

  58. Mundhra R, et al. Intimate Partner violence: Associated factors and acceptability of Contraception among the women. Indian J Community Med. 2016;41(3):203–7.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Fanslow J, et al. Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women. Aust N Z J Obstet Gynaecol. 2008;48(1):83–9.

    Article  PubMed  Google Scholar 

  60. Collumbien M, Gerressu M, Cleland J. Non-use and use of ineffective methods of contraception. JSTOR; 2004. pp. 1255–320.

  61. Atlas WD. Kiribati age of childbearing, 1950–2022. [Webpage] 2023; https://knoema.com/atlas/Kiribati/topics/Demographics/Fertility/Age-of-childbearing

  62. Nabaggala MS, Reddy T, Manda S. Effects of rural–urban residence and education on intimate partner violence among women in Sub-saharan Africa: a meta-analysis of health survey data. BMC Womens Health. 2021;21(1):149.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Hatcher AM, et al. Intimate partner violence among rural South African men: alcohol use, sexual decision-making, and partner communication. Cult Health Sex. 2014;16(9/10):1023–39.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Lanier C, Maume MO. Intimate Partner violence and Social Isolation across the Rural/Urban Divide. Violence against Women. 2009;15(11):1311–30.

    Article  PubMed  Google Scholar 

  65. Harrington RB, Harvey N, Larkins S, Redman-MacLaren M. Family planning in Pacific Island Coutnries and Territories (PICTS): A scoping review. PLoS One, 2021. 16(e0255080).

  66. United, Nations. D.o.E.a.S.A., Population Division, Model-based Estimates and Projections of Family Planning Indicators 2022. 2022.

  67. Do M, Kurimoto N. Women’s empowerment and choice of contraceptive methods in selected African Countries. Int Perspect Sex Reproductive Health. 2012;38q(1):23–33.

    Article  Google Scholar 

  68. Yaya S, et al. Women empowerment as an enabling factor of contraceptive use in sub-saharan Africa: a multilevel analysis of cross-sectional surveys of 32 countries. Reproductive Health. 2018;15(1):214.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Hameed W, Azmat SK, Ali M, Sh eikh MI, Abbas G, Temmerman M, Avan BI. Women’s empowerment and contraceptive use: the role of independent versus couples’ decision-making, from a lower middle income country perspective. PLoS ONE, 2014. 9(8).

  70. Thomas C, et al. Disparities in utilisation of combined oral contraceptives in Aotearoa New Zealand: a cross-sectional whole-of-population study. Aust N Z J Obstet Gynaecol. 2023;63(3):441–7.

    Article  PubMed  Google Scholar 

  71. White JS, Speizer IS. Can family planning outreach bridge the urban-rural divide in Zambia? BMC Health Serv Res. 2007;7(1):143.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Staveteig S. Fear, opposition, ambivalence, and omission: results from a follow-up study on unmet need for family planning in Ghana. PLoS ONE. 2017;12(7):e0182076.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Crombach LGA, Smits J. Understanding the urban-rural fertility divide in sub-saharan Africa: the critical role of social isolation. Population Space Place; 2023.

  74. Malarcher S, World Health O. Social determinants of sexual and reproductive health: informing future research and programme implementation / edited by Shawn Malarcher. World Health Organization: Geneva; 2010.

    Google Scholar 

  75. Sserwanja Q, et al. Rural-urban correlates of modern contraceptives utilization among adolescents in Zambia: a national cross-sectional survey. BMC Womens Health. 2022;22(1):324.

    Article  PubMed  PubMed Central  Google Scholar 

  76. Sedgh G, Hussain R. Reasons for contraceptive nonuse among women having Unmet need for Contraception in developing countries. Stud Fam Plann. 2014;45(2):151–69.

    Article  PubMed  Google Scholar 

  77. Kennedy EC, et al. Be kind to young people so they feel at home: a qualitative study of adolescents’ and service providers’ perceptions of youth-friendly sexual and reproductive health services in Vanuatu. BMC Health Serv Res. 2013;13(1):455.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Raman S, et al. Identifying and overcoming barriers to adolescent sexual and reproductive health: perspectives and practices of health, education and welfare workers. Pac J Reproductive Health. 2015;1:4–13.

    Google Scholar 

  79. Fanslow J, et al. Pregnancy outcomes and intimate partner violence in New Zealand. Aust N Z J Obstet Gynaecol. 2008;48(4):391–7.

    Article  PubMed  Google Scholar 

  80. Stöckl H, et al. Intimate partner violence among adolescents and young women: prevalence and associated factors in nine countries: a cross-sectional study. BMC Public Health. 2014;14(1):751.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Dhar D, et al. Associations between intimate partner violence and reproductive and maternal health outcomes in Bihar, India: a cross-sectional study. Reproductive Health. 2018;15(1):109.

    Article  PubMed  PubMed Central  Google Scholar 

  82. Rahman M, et al. Intimate partner violence and use of reproductive health services among married women: evidence from a national Bangladeshi sample. BMC Public Health. 2012;12(1):913.

    Article  PubMed  PubMed Central  Google Scholar 

  83. Ononokpono DN, Azfredrick EC. Intimate Partner Violence and the Utilization of Maternal Health Care Services in Nigeria. Health Care Women Int. 2014;35(7–9):973–89.

    Article  PubMed  Google Scholar 

  84. Okenwa L, Lawoko S, Jansson B. Contraception, reproductive health and pregnancy outcomes among women exposed to intimate partner violence in Nigeria. Eur J Contracept Reproductive Health Care. 2011;16(1):18–25.

    Article  Google Scholar 

  85. Fanslow J, Whitehead A, Silva M, Robinson E. Contraceptive use and associations with intimate partner violence among a population-based sample of New Zealand women. Aust N Z J Obstet Gynaecol. 2008;48:83–9.

    Article  PubMed  Google Scholar 

  86. Kupoluyi JA. Intimate partner violence as a factor in contraceptive discontinuation among sexually active married women in Nigeria. BMC Womens Health. 2020;20(1):128.

    Article  PubMed  PubMed Central  Google Scholar 

  87. MacQuarrie KLD, Mallick L, Kishor S. Intimate partner violence and discontinuation of contraceptive use. in Population Association of America annual meetings. 2017. Maryland, USA.

  88. Clark CJ, Silverman J, Khalaf IA, Abu Ra’ad B, Abu Al Sha’ar Z, Abu Al Ata A, Batieha A. Intimate partner violence and interference with women’s efforts to avoid pregnancy in Jordan. Stud Fam Plann. 2008;39:p123–32.

    Article  Google Scholar 

  89. Campo M. Domestic and family violence in pregnancy and early parenthood. Australia: Australian Institue of Family Studies; 2015.

    Google Scholar 

  90. Almeida FSJ, et al. Domestic violence in pregnancy: prevalence and characteristics of the pregnant woman. J Clin Nurs. 2017;26(15–16):2417–25.

    Article  PubMed  Google Scholar 

  91. Organization WH. In: Organization WH, editor. Multi-country study on women’s health and domestic violence against women. Initial results on prevalence, health outcomes and women’s responses. Editor: Geneva; 2005.

    Google Scholar 

  92. Finnbogadóttir H, Dykes A-K, Wann-Hansson C. Prevalence and incidence of domestic violence during pregnancy and associated risk factors: a longitudinal cohort study in the south of Sweden. BMC Pregnancy Childbirth. 2016;16(1):228.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Jasinski JL. Pregnancy and domestic violence: a review of the literature. Trauma Violence Abuse. 2004;5(1):47–64.

    Article  PubMed  Google Scholar 

  94. Boyce SC, et al. Associations of intimate partner violence with postnatal health practices in Bihar, India. BMC Pregnancy Childbirth. 2017;17(1):398.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Mody SK, et al. Postpartum contraception utilization among low-income women seeking immunization for infants in Mumbai, India. Contraception. 2014;89(6):516–20.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Organization WH. Primary health care on the road to universal health coverage: 2019 global monitoring report., W.H. Organization, Editor. 2020.

Download references

Acknowledgements

We acknowledge the women of Kiribati who shared their experiences of access to sexual and reproductive health support, and intimate partner violence with the enumerators from the Kiribati National Statistics Office.

Funding

This research was funded by the Spotlight Foundation through the Pacific Regional Office of the United Nations Fund for Population.

Author information

Authors and Affiliations

  1. Department of Social Work, Melbourne School of Health Sciences, University of Melbourne, Melbourne, VIC, Australia

    Anneliese Spiteri-Staines, Luz Viviana Sastre Gomez, Jess Letch, Anna Bornemisza & Kristin Diemer

  2. Ministry of Science and Technology, Government of Colombia, Bogota, Colombia

    Luz Viviana Sastre Gomez

Authors
  1. Anneliese Spiteri-Staines
    View author publications

    You can also search for this author inPubMed Google Scholar

  2. Luz Viviana Sastre Gomez
    View author publications

    You can also search for this author inPubMed Google Scholar

  3. Jess Letch
    View author publications

    You can also search for this author inPubMed Google Scholar

  4. Anna Bornemisza
    View author publications

    You can also search for this author inPubMed Google Scholar

  5. Kristin Diemer
    View author publications

    You can also search for this author inPubMed Google Scholar

Contributions

AS wrote the main manuscript. VS conducted statistical analyses and prepared tables. AB conducted statistical analyses and provided editing input. JLcontributed to writing the introduction and discussion and reviewed main findings. KD provided project management of the project, and contributed to the writing of all parts of the manuscript and data analysis. All authors reviewed the manuscript.

Corresponding author

Correspondence to Anneliese Spiteri-Staines.

Ethics declarations

Ethics approval and consent to participate

Research ethics to conduct this secondary analysis was obtained through the University of Melbourne research office (ethics ID 1647887.1), and conducted in accordance with the Australian Code for Responsible Conduct of Research. Data for this paper was drawn from the Kiribati Social Development Indicator Survey (KSDIS) [1], conducted in 2018–2019 as part of the Global Multiple Indicator Cluster Survey (MICS) Programme developed by UNICEF with the goal of generating internationally comparable data on women and children, covering a range of indicators including SRH, IPV and disability. Consent was gained by participants prior to completing the questionnaire. Parents or legal guardians provided consent for persons under the age of 16 to participate in the interview. The KSDIS [1] outlines procedures used to gain consent should more detail be required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary Material 1

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spiteri-Staines, A., Gomez, L.V.S., Letch, J. et al. The intersection of intimate partner violence with sexual reproductive health in the Pacific: findings from a Kiribati population study. BMC Women's Health 25, 52 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-024-03484-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12905-024-03484-3

Keywords

BMC Women's Health

ISSN: 1472-6874

Contact us