Productive reproductive work requires violence-free household environment and meeting family planning needs. The prevalence of domestic violence and unmet needs of family planning often put women at risk of unwanted pregnancies. The objective of present study is to improve productive reproductive work of women in slum communities through developing better marital communication thereby the prevalence of domestic violence is reduced and choosing of family planning services is increased. A community-based intervention was initiated in two selected slum communities in Mumbai, taking a sample of 901 women. The pre and post intervention data revealed the significant effect of intervention on reducing domestic violence and adoption of family planning methods for improved reproductive health of the women. These changes have ultimately contributed to the betterment of reproductive work.

1. Influence of marital communication on the
productive reproductive work: A community
based intervention findings from Maharashtra
Ajeesh Sebastian
Shahina Begum, DD Naik, Prashant Tapase, Balaiah Donta
Dept. of Biostatistics, National Institute for Research in Reproductive Health
(ICMR), Mumbai, Maharashtra

2. Introduction
 Productive reproductive work requires violence-free household
environment and meeting family planning needs
 In Maharashtra, the percentage of ever-married women who
have ever experienced spousal violence in urban and rural
areas is 16.4 and 26.2 respectively (NFHS 4)
 Prevalence of domestic violence is more reported among low
socioeconomic household settings due to their risk factors such
as their age, socioeconomic status, education level, nonworking
status, the unhealthy habits of partner
 There is an association between intimate partner violence and
unmet need of family planning
 This association leads to problem such as unintended/
unwanted pregnancies, gynaecological issues , abortions,
physical injuries, STDs, mental health problems, and maternal
and newborn morbidity and mortality

3. Objectives
 To study the changes in unmet needs for family planning
among women from low socioeconomic profile in association
with improved marital communication intervention
Methodology
 Study design: Community based intervention study
 Study population: 1136 women (aged 18-39 year) from two
slum communities in Mumbai, having unmet needs for family
planning
 Endline: 901 women

4. Intervention
Sample population experiencing
DV
Sample population not
experiencing DV
• Individual session on family
planning with woman
• Individual session on family
planning with woman
• Individual session on domestic
violence and marital
communication
• Group session on family planning
with husbands
• Couple session on marital
communication
• Individual session on domestic
violence and marital
communication
• Group session on family planning
with husbands

5. Demographic characteristics
Number Percent
age
Number Percent
age
Age of
women
Education of
women
<20 21 2.33 Attended school
20-24 283 31.40 Yes 775 86.0
25-29 353 39.17 No 126 14.0
30-34 173 19.20 Highest
standard that
have completed
35-39 71 7.88 <4 years 43 4.77
Religion 5-10 years 571 63.37
Hindu 598 66.37 >11 years 160 17.75
Muslim
255
28.30 Education of
partner
Buddhist 39 4.32 Literate 832 92.34
Others 9 0.99 Illiterate 69 7.65

6. Social group Highest standard that
have completed
SC 196 21.75 No schooling 69 7.65
ST 14 1.55 <4 years of schooling 35 3.88
OBC 285 31.63 5-10 years of schooling 544 60.37
Other 406 45.06 >11 253 28.07
Age at
marriage
Husband’s occupation
<13 45 4.99 Skilled worker 112 12.43
14-18 386 42.84 unskilled worker 562 62.37
19-22 338 37.51 White collar 102 11.32
>22 132 14.65 Business 125 13.87
Duration of
the marriage
Number of children
given birth and are alive
<5 years 348 38.62 1 352 39.06
6-10 years 325 36.07 2 307 34.07
>11 years 228 25.30 3 147 16.31
>4 94 10.43

7. Status of unmet needs: Baseline
Total number and unmet need for spacing and limiting:
Baseline data
Not using
contraceptive
Percentage
Want to have
another child
426 47.28
Don’t want any
more child
448 49.72
undecided 27 3
Total 901 100

8. Maternal health indicators: Endline

9. Status of unmet needs: Endline
Would you like to have (a/another) child? * Currently using any
contraceptive method? Cross tabulation
Currently using any contraceptive
method?
TotalYes No NA
Would you like
to have
(a/another)
child?
Want to
have child 198 87 53 426
No more
child
325 111 12 448
undecided 12 12 3 27
Total
535 (59.3%) 298 68 901

10. Current use of contraception:
endline

11. Discussion about FP methods:
Pre-post status

12. Reasons for not using contraceptives:
Endline

13. Prevalence of any domestic
violence: pre-post data

14. Domestic violence and contraceptive use

15. Discussion
 35% of women were having unmet need for family
planning at baseline and during the study period
 Significant decrease in unmet need for family
planning (59.3%)
 Improved marital communication on FP methods
(from 54.2% to 71.03%).
 Decrease in violence from 31.80% to 8.70%
 Increased contraceptive use among Domestic
Violence reported sample population (0% to 61.6%).

16. Thank you

17. References
 Begum S, Donta B, Nair S et al. 2015. Socio-demographic factors associated with domestic violence in
urban slums, Mumbai, Maharashtra, India. Indian J Med Res. 141(6): 783–788.
 Kaur S, PatidarAB, Meenakshi et al. 2014. Domestic Violence and Its Contributory Factors among
Married Women in selected slums of Ludhiana, Punjab. Nursing and Midwifery Research Journal,
10(1): 30-35.
 Vachher AS, Sharma AK. 2010. Domestic violence against women and their mental health status in a
colony Delhi. Indian journal of Community medicine; 35(3):403-5.
 Sinha A, Mallik S, Sanyal D, Dasgupta S, Pal D, Mukherjee A. 2012.Domestic violence among ever
married women of reproductive age group in a slum area of Kolkata. Indian J Public Health. 56:31–6.
 Ruikar MM, Pratinidhi AK. 2008. Physical wife abuse in an urban slum of Pune, Maharashtra. Indian J
Public Health.52:215–7.
 Babu BV, Kar SK. 2009. Domestic violence against women in eastern India: a population-based study
on prevalence and related issues. BMC Public Health. 9:129.
 Koenig MA, Stephenson R, Ahmed S etal. 2006. Individual and contextual determinants of domestic
violence in North India. Am J Public Health. 96:132–8.
 Kaneda T, Smith R. 2015. Intimate partner violence and unmet need for family planning: Findings
among women of different ages from six sub-Saharan African countries. Available at
http://www.prb.org/pdf15/packard-unmet-need-researchbrief.pdf.
 Meiksin R, Meekers D, Thompson S et al. 2015. Domestic violence, marital control, and family
planning, maternal, and birth outcomes in Timor-Leste. Maternal and Child Health Journal, 19(6), 1338-
1347.
 Stephenson R, Koenig MA, Acharya R, et al. 2008. Domestic violence, contraceptive use, and
unwanted pregnancy in rural India. Stud Fam Plann. 39:177–86.
 Stephenson R, Koenig MA, Ahmed S. 2006. Domestic violence and contraceptive adoption in Uttar
Pradesh, India. Stud Fam Plann. 37:75–86.
 Donta B, Nair S, Begum S et al. 2015. Association of Domestic Violence From Husband and Women
Empowerment in Slum Community, Mumbai. Journal of Interpersonal Violence. 31(12): 2227 – 2239.

18.  Dasgupta A. 2015. Understanding intimate partner violence and associated
challenges to family planning among married women in Maharashtra, India. UC San
Diego: PublHlth(GlobalHlth) JtDocSDSU. Available at
http://escholarship.org/uc/item/0jr396wk
 Begum S, Dwivedi, Pandey A, et al. 2010. Association between domestic violence and
unintended pregnancies in India: findings from the National Family Health Survey-2
data. Natl Med J India. 23(4): 198-200.
 Golding, J.M and D. L.Taylor.1996. Sexual Assault History and Premenstrual Distress
in two General Population Samples. Journal of Women’s Health 5(2): 143-152.
 Díaz-Olavarrieta C, Wilson KS, García SG.2009. The co-occurrence of intimate
partner violence and syphilis among pregnant women in Bolivia. J Womens Health
(Larchmt). 18(12):2077-86.
 Decker RD, Seage GR, Hemenway D et al. 2009. Intimate Partner Violence Functions
as both a Risk Marker and Risk Factor for Women’s HIV Infection: Findings from
Indian Husband-Wife Dyads. J Acquir Immune Defic Syndr 51(5): 593–600.
 Wu V, Huff H, Bhandari M. 2010. Pattern of physical injury associated with intimate
partner violence in women presenting to the emergency department: a systematic
review and meta-analysis. Trauma Violence Abuse. 11(2): 71-82.
 Starbird E, Norton M, MarcusaR. 2016. Investing in Family Planning: Key to Achieving
the Sustainable Development Goals. Glob Health Sci Pract 4(2): 191-210.
 United Nations Children’s Fund (Unicef). 2000. Domestic Violence against Women
and Girls. Innocenti Digest Number 6. Innocenti Research Centre, Florence, Italy.
 Halperin DT, Stover J, Reynolds HW. 2009. Benefits and costs of expanding access to
family planning programs to women living with HIV. AIDS. 23 (Suppl 1):S123-S130.
 Shah PS, Balkhair T, Ohlsson A, et al. 2011. Intention to become pregnant and low
birth weight and preterm birth: a systematic review. Matern Child Health J. 15(2): 205-
16.
 Varghese S, Prasad JH, Jacob KS. 2013. Domestic violence as a risk factor for infant
and child mortality: A community-based case–control study from southern India. Natl
Med J India. 26: 142–6.