Association between intimate partner violence on unintended pregnancy in India: A population-based mediation analysis

Unintended pregnancy remains a major public health concern in India, where intimate partner violence (IPV) is widespread. This study examines the association between IPV and unintended pregnancy among currently pregnant women aged 18-49 years using nationally representative National Family Health Survey-5 (2019-21) data. The analysis included 3,022 women selected into the domestic violence module who provided complete information on pregnancy intention and IPV exposure. Descriptive statistics and Poisson regression with robust error variance estimated adjusted prevalence ratios. An exploratory multiple-mediator framework using generalized structural equation modeling assessed statistical pathways involving partner controlling behavior and parity. Overall, 22 percent of women experienced IPV in the past year, and 10.7 percent reported an unintended pregnancy. Sexual violence was significantly associated with unintended pregnancy (aPR: 1.27; 95 percent CI: 1.05-1.49). Higher parity, partner's alcohol use, and partner controlling behavior were also significantly associated with unintended pregnancy. Exploratory pathway analysis indicated direct and indirect statistical associations between IPV and unintended pregnancy through partner controlling behavior and parity, with approximately 50 percent of the total association statistically accounted for by these pathways. Given the cross-sectional design, these pathways should not be interpreted causally. Findings support policy efforts addressing IPV prevention, reproductive autonomy, and access to reproductive health and contraceptive services.