Reproductive Health Outcomes Associated With Domestic Violence Among Iranian Women During the COVID‐19 Pandemic: A Cross‐Sectional Study

Background and Aims: Domestic violence (DV) is a major public health concern that negatively affects women's reproductive health. The COVID-19 pandemic and related lockdowns may have exacerbated DV and its consequences. This study aimed to assess reproductive health outcomes associated with DV among married women in Iran during the COVID-19 lockdown. Methods: A cross-sectional study was conducted between November 2020 and September 2021, including 5317 married women attending healthcare centers across Iran. Data were collected on socio-demographic characteristics, fertility-related factors, and experiences of DV using the revised Conflict Tactics Scales (CTS2). Multivariate logistic regression models were applied to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between DV and reproductive health outcomes, adjusting for potential confounders. Results: Women who experienced DV were significantly more likely not to use contraceptives (AOR = 2.08; 95% CI, 1.61-2.70). DV was also associated with reduced likelihood of exclusive breastfeeding (AOR = 1.59; 95% CI, 1.21-2.10), lower participation in Pap smear screening (AOR = 1.43; 95% CI, 1.09-1.87), and higher risk of sexually transmitted infections (STIs) (AOR = 2.41; 95% CI, 1.33-4.38). These associations remained significant after adjusting for age, education, employment, and parity. Conclusion: DV during the COVID-19 pandemic is strongly associated with adverse reproductive health outcomes among Iranian women, including unsafe contraceptive practices, inadequate breastfeeding, missed cervical cancer screening, and increased STI risk. These findings underscore the urgent need for public health interventions, including enhanced social and healthcare support, safety measures, and accessible reproductive health services for women experiencing DV, particularly during pandemics or periods of social restriction.