Women who had controlling husbands and had experienced intimate partner violence in their married life are more at risk of developing sexually transmitted infection (STI) or reproductive tract infection (RTI) than women who do not report facing control or intimate partner violence (IPV) in their marriage, a new study reveals.

The study analyses data obtained from a sample size of 73,895 women in National Family Health Survey-5 (2019-2021) and was conducted by researchers in School of Health Systems Studies in Mumbai-based Tata Institute of Social Sciences and Centre for Study of Regional Development in JNU. 

One in nearly every twelve married women in the age group of 15-49 years in India had experienced at least one sexually transmitted infection or reproductive tract infection over a period of one year, the study states.

To gauge if women had experienced STI/RTI, those who reported being sexually active, were asked whether they had a disease through sexual contact, a bad-smelling abnormal genital discharge, and a genital sore or ulcer in the last 12 months preceding the survey.

The study analyses in detail questions posed to women in NFHS-5 pertaining to sexual autonomy — if a wife knows her husband has a sexually transmitted disease, is she justified in asking use of a condom when they have sex; if a wife knows her husband has sex with other women, is she justified in refusing to have sex with him; and can a wife say no to her husband when she does not want to have sexual intercourse with him.

The study reveals that a majority — 73% women of the total sample size claimed that they had sexual autonomy. A third of the same sample size (31%) had faced intimate partner violence be it physical which included husband pushing the wife, kicking her, dragging or punching her and so on, sexual which includes husband forcing wife to have sex with him or emotional where husband has humiliated or threatened to hurt the wife or someone close to her or insulted her. Also, 46% of the same sample size said that they faced controlling attitudes of their husbands, which included husband being jealous if wife talked to other men, frequently accusing wife of being unfaithful, not permitting wife from meeting female friends, trying to limit wife’s contact with her core family, insisting on knowing where she is at all times, and not trusting her with money. 

“The study reveals that STI/RTI infection was substantially higher among women who experienced intimate partner violence (18.4%) as compared to those women who did not (9.7%). Also 15.9% women who face controlling attitudes of the husband also reported STI/RTI as compared to 9.4% women who reported STI/RTI but had not faced control from husband,” said Pintu Paul, co-author of the study. 

Women who had no sexual autonomy and were exposed to intimate partner violence were 2.3 times more likely to have STI/RTI than those who had sexual autonomy and were not exposed to intimate partner violence. Similarly, women without sexual autonomy and whose husbands endorsed controlling attitudes were over twice more likely to be exposed to RTI than those who had sexual autonomy and had not experienced their husband’s controlling attitudes.

Mr. Paul further said, women who had sexual autonomy and freedom of physical mobility were 24% less likely to experience RTI compared to those who did not. Women’s freedom of movement is measured by their ability to go to the market, the health centre and places outside the village or community.

However, the influence of household decision-making was found to be greater than physical mobility in reducing the risk of RTI among women. “Women who had sexual autonomy and decision-making autonomy had a 36% decreased likelihood of having RTI infection than those who had not,” Mr. Paul emphasised. A woman’s household decision-making ability is assessed in terms of whether she can take decisions about her own health care, make large purchases for the household and visit family or relatives. 

Mr. Paul also said, “After controlling for sociodemographic factors in the full model, women with sexual autonomy were associated with a 12% lower likelihood of having STI/RTI than those without sexual autonomy.”

“This may be because sexually autonomous women may have greater self-efficacy and bargaining power in their marital relationships, enabling them to make decisions about their sexual and reproductive health,” the study states. 

Also, the prevalence of STI/RTI was higher among younger women aged 15 to 24 years (13%) and 25 to 34 years (13.2%) as compared to older women aged 35 to 49years (11.6%).

“Our findings call for policy-level interventions to prevent child marriage and domestic violence against women and change regressive social norms that curb women’s decision-making ability and freedom of movement,” Mr. Paul added.