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Atreyee Sinha and Aparajita Chattopadhyay

in the North (Bauer, Rodriguez, Quiroga et al., 2000; Chandrasekaran, Krupp, George et al., 2007;
Hughes, 2004). In such cases, the victims do not perceive themselves to be victimised and tend to
accept violence as a justified action by husbands (Heise, Ellsberg and Gottmoeller, 2002). Given this
attitude towards domestic violence from the victims themselves, it is not surprising that nearly 51%
of the married men and 54% of married women think that beating of wives is acceptable for certain
specific reasons, particularly if she disrespects her in-laws (IIPS and Macro International, 2007).
This type of attitude is more in the Northern part of the country than the South. On the other hand,
when incidence of violence is less in society (as in the South states), women tend to feel more victi-
mised and isolated and thus the impact of such violence becomes manifold, as we observed in the
South Indian states. Consequently we see that the effect of violence on lowering MCH care utiliza-
tion is more serious among the victims in the South rather than in the North.
One potential drawback, that needs to be taken into account, is that the present study used cross-
sectional data. Due to the nature of data, the major limitation of the analysis was our inability to un-
derstand the exact temporal relationship between occurrence of violence and the utilization of
MCH care. We were unable to determine whether the violence occurred before or after the
MCH care utilization. However, women’s age was restricted to 15–30 years in order to take care of
this temporality issue. In India, at older age groups, i.e., above 30 years, incidence of violence re-
duces gradually. The chances of pregnancy also decline significantly as the women grow older (IIPS
and Macro international, 2007). The median age at marriage in India is less than 20 years and the
first onset of spousal violence is within first 2 years of marriage (IIPS and Macro International,
2007). Thus, by considering young married women we tried to capture recent episodes of spousal
violence as well as recent pregnancy.
The present study highlighted the constraining effects of spousal violence on the uptake of mater-
nal and child health care services among young married women in India and thus the issue of spous-
al violence calls for attention from the policy makers and stakeholders on priority basis. First and
foremost the reproductive and child health programs should address spousal violence in order to im-
prove health and well-being of women coming to the facilities for treatment. Integration of violence
screening with the MCH care programs could be helpful in identifying the victims, providing prop-
er care and support to them and thus improving the coverage of health care services simultaneously.
Promoting women’s empowerment by specifically improving female education is a key to combat
incidence of violence as well as increase the awareness and utilization of health care services in the
long run. Since education and media exposure have a very strong association with health care utili-
zation across the regions, it is necessary for the national level policies to use print and digital media
and target educational institutes in order to create awareness about MCH programs among women.
Along with focusing on the victims, policies should also focus on the perpetrators of violence. In-
volvement of men in the reproductive and child health programs and counselling them can also be a
key in reducing intimate partner violence. Policies aiming at gender sensitization at early ages, i.e.,
among school students, during marriages and in health centres are also imperative. Promoting exist-
ing policies and laws of violence prevention through media, advertising the importance of MCH care
services with its short and long term implications, encouraging men to be a part of the MCH care
programs and above all strengthening women's voice against spousal violence are the need of the
hour.
Conflict of Interest and Funding

No conflict of interest was reported by all authors. The analysis described in this paper was based on
secondary data obtained from publicly available sources and no funding was obtained from any ex-
ternal sources to prepare this article.

Acknowledgements

We express thanks to the editor and the two anonymous reviewers of this journal for their useful

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