Impact of Spousal Violence on Short Birth Intervals in India: A Propensity Score Matching and Decomposition Analysis

Spousal violence remains a critical public health and human rights issue in India and limited evidence exists on its relationship with short birth intervals (SBI). This study investigates the effect of spousal violence on SBI among Indian women using data from the latest National Family Health Survey. This cross-sectional study utilized a nationally representative sample of 394,571 ever-married women aged 15 to 49 years with at least two live births. The primary outcome variable was SBI, defined as <33 months between two successive live births. The key exposure variable was experience of spousal violence (emotional, physical, or sexual). Multivariable logistic regression, Propensity Score Matching (PSM), and Fairlie decomposition analyses were performed to assess the impact of spousal violence on SBI, adjusting for key socio-demographic and reproductive health covariates. Approximately 26.7% of women reported experiencing spousal violence, and 50.7% had a SBI. Logistic regression revealed that women who experienced spousal violence had 11% higher odds of SBI (OR = 1.11, p < .001) than those who did not. PSM results indicated a 2.2 percentage point higher risk of SBI among women exposed to violence (Average Treatment Effect = 0.022, p < .001). Fairlie decomposition showed that 27% of the SBI gap between exposed and unexposed groups was explained by observed covariates, with women's low education and rural residence being the largest contributors. This study highlights spousal violence as a significant correlate of SBI in India, emphasizing the urgent need for targeted policy interventions that integrate reproductive health services with domestic violence prevention. Strengthening legal enforcement, raising awareness through digital platforms, and promoting women's education and autonomy are critical strategies to reduce adverse reproductive outcomes linked to intimate partner violence.