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The Center for Health and Gender Equity (CHANGE) is a research and advocacy organization that seeks to integrate concern for gender equity and social justice into international health policy and practice. CHANGE staff can be reached by e-mail at change@genderhealth.org or at http://www.genderhealth.org.

As a 40-year old woman in Uttar Pradesh said, “What can I do to protect myself from these unwanted pregnancies unless he agrees to do something? Once when I gathered the courage and told him I wanted to avoid sex with him, he said, 'What else have I married you for?' He beats me for the smallest reasons and has sex whenever he wants” (248).

Not surprisingly, many women acquiesce to having sex even if they do not want it. For example, in the Western Visayas region of the Philippines, 43% of the married women of reproductive age who were surveyed said they were afraid to refuse their husbands' sexual advances, often because refusal might cause their husbands to beat them (103).

Many studies have found that violence toward women is more common in families with many children (103, 130, 233, 268, 288, 318, 386, 436). Researchers have long assumed that having many children increases women's risk of being abused, perhaps by increasing levels of stress within the family or provoking more marital disagreements. Recent research in Nicaragua, however, suggests that the relationship may be the reverse, with domestic violence increasing the likelihood that a woman will have many children. The study found that abused women were twice as likely as other women to have four or more children. But 50% of all physical abuse began within the first two years of the relationship, and 80% began within four years (131). The fact that abuse preceded having many children suggests that violence is a risk factor for having many children, rather than a consequence.

A large-scale survey among married men in Uttar Pradesh, India, demonstrates directly that forced sex can lead to unintended pregnancies. Men who admitted having forced their wives to have sex were 2.6 times more likely than other men to have caused an unplanned pregnancy (288).

Contraceptive use. Many women are afraid to raise the issue of contraception for fear that their partners might respond violently (23, 33, 84, 135, 157, 158, 411). In some cultures husbands may react negatively because they think that protection against pregnancy would encourage their wives to be unfaithful. Where having many children is a sign of virility, a husband may interpret his wife's desire to use family planning as an affront to his masculinity (411). In Kenya some men say that they oppose the use of contraception because they fear it will weaken their control over their wives (32, 463).

JHU/CCP

In this scene from the Egyptian television series "And the Nile Flows On," a husband slaps his wife when he discovers that she has been using contraceptive pills without his knowledge and consent. Many women are afraid even to raise the issue of family planning for fear their partners might disapprove and respond angrily and violently.

Women often use contraception clandestinely because they fear being beaten or abandoned if they do so openly. If a woman is caught in covert use of contraception, the consequences of undermining male authority can besevere. In Ghana 51% of women and 43% of men agreed that a husband is justified in beating his wife when she uses a family planning method without his knowledge (23).

When asked what happens if a woman practices family planning without her husband's consent, men interviewed in Ghana gave such replies as, “It is fitting enough to beat her for not consulting you earlier before going ahead to practice family planning,” and “It is not good for you to keep such a woman since she did so without first consulting with you” (135). In Cape Town, South Africa, young women described how their partners beat them and tore up their clinic contraceptive cards (475).

For women living with men who are violent, the fear of a negative reaction is often enough to cut off discussion of contraception. As one woman said of her husband, “Whenever he hears people discussing family planning over the radio, he fumes and shouts.... If he can threaten a wireless, what would he do to me if I open the topic?” (23).

Fortunately, not all women who fear a negative response are necessarily at risk of abuse. Studies suggest that many husbands are more open to family planning than their wives may think (117). Communication within marriage about sex is often so limited, however, that spouses often do not know their partners' views of family planning. Wives whose husbands actually favor family planning may assume that their husbands' attitudes mirror cultural norms that disapprove of it. In Uganda, for example, 24% of women thought their husbands disapproved of contraception when in fact their husbands approved (33).