Does Proximity to Conflict Zones Moderate Associations Between Girl Child Marriage, Intimate Partner Violence, and Contraception in Postconflict Sri Lanka?

Abstract

Women’s primary contraceptive method type is impacted by the gender inequities of girl child marriage and intimate partner violence (IPV). Outside of South Asia, proximity to conflict zones has been found to impact contraceptive use, girl child marriage, and IPV, possibly moderating associations between these variables. We created multinomial regression models using the 2016 Demographic and Health Survey data from postconflict Sri Lanka to study associations between primary contraceptive method type (modern spacing methods, sterilization, and traditional methods compared to no method) and the gender inequities of girl child marriage and past year sexual, physical, and emotional IPV and to assess whether and how these associations were moderated by proximity to conflict. We found that proximity to conflict moderated the relationships between girl child marriage, past year physical and emotional IPV, and primary contraceptive method type. Girl child marriage was associated with increased relative risk (RR) of modern spacing methods (adjusted RR ratio/aRRR: 1.81–2.21) across all levels of proximity to conflict. In districts distal to conflict, past year physical IPV was associated with decreased RR of sterilization (aRRR: 0.67) and traditional methods (aRRR: 0.63), and past year emotional IPV was associated with decreased RR of traditional methods (aRRR: 0.71). In districts central to conflict, past year emotional IPV was associated with increased RR of modern spacing methods (aRRR: 1.50). Our findings suggest that policymakers and providers who seek to improve reproductive health in Sri Lanka must consider the moderating impact of proximity to conflict on the relationship between contraceptive use and the gender inequities of girl child marriage and IPV.