Short interpregnancy interval following reproductive coercion: A prospective cohort study of pregnant Ethiopian women.

BACKGROUND: Short interpregnancy intervals (IPIs) (< 12 months) remain a public health concern in low- and middle-income countries due to their association with adverse maternal and neonatal outcomes. Reproductive coercion (RC), which involves intimate partner behaviors that interfere with women's reproductive decisions, undermines autonomy, and increases the risk of unintended pregnancy. This exploratory study examines the relationship between RC and short IPIs. METHODS: Data come from a prospective cohort (2019-2021) of pregnant Ethiopian women aged 15-49, followed up to 1 year postpartum (N = 1935). Kaplan-Meier estimators and survival-time models assessed relationships between RC-experienced before the index pregnancy, measured dichotomously (yes/no) and by severity (none, less severe, more severe)-and having an IPI < 12 months following a live birth. FINDINGS: Overall, 27.3% of women experienced RC before their index pregnancy, and 4.4% had a subsequent pregnancy within 12 months of giving birth (IPI range: 3-12 months). Among women who experienced any RC, less severe RC, or more severe RC, 5.8%, 5.5%, and 6.2%, respectively, had short IPIs, compared to 3.8% of those who did not experience RC. Any RC was associated with a marginally higher risk of short IPI compared to no RC (HR: 1.55, 95% CI: 0.97-2.48, p = 0.07). Disaggregating by RC severity, there was a small, non-significant increase in risk among women who experienced less severe RC (HR: 1.44, 95% CI: 0.80-2.59; p = 0.23), and a marginally higher risk of short IPI among women who experienced more severe RC behaviors (HR: 1.72, 95% CI 0.97-3.04, p = 0.06) compared to women who did not experience RC. INTERPRETATION: Women who experience more severe RC may face an elevated risk of short IPI. The observed dose-response trend between RC severity and short IPI warrants further investigation to better understand how RC may impact pregnancy spacing. Clarifying the role of RC in short IPIs could help identify factors that limit women's reproductive autonomy.