ORIGINAL ARTICLE Intimate partner violence and chronic undernutrition among married Bangladeshi women of reproductive age: are the poor uniquely disadvantaged? M Rahman 1 , K Nakamura 1 , K Seino 1 and M Kizuki 2 BACKGROUND/OBJECTIVES: To investigate (i) associations of intimate partner violence (IPV) and chronic undernutrition among women of reproductive age and (ii) whether women who experience both poverty and IPV are unique in their nutritional disadvantages. SUBJECTS/METHODS: This study used the data from the 2007 Bangladesh Demographic Health Survey, a cross-sectional, nationally representative study. Analyses were based on the responses of 3861 currently married, non-pregnant women. Exposure was determined from maternal reports of physical and sexual IPV. Chronic undernutrition among women was the main outcome variable of interest. Descriptive statistics and multivariate logistic regression methods were employed in the analysis. RESULTS: Over 53% of married Bangladeshi women experienced physical and/or sexual violence from their husbands. Experience of physical IPV (adjusted odds ratio (AOR) ¼ 1.22; 95% confidence interval (CI) ¼ 1.02–1.46) and both physical and sexual IPV (AOR ¼ 1.24; 95% CI ¼ 1.04–1.58) was associated with an increased risk of chronic undernutrition among women. A magnitude of three or more types of physical IPV appeared to have more profound consequences on women’s undernutrition. Findings also revealed that women who are poor and have experienced IPV are unique in their nutritional disadvantages. CONCLUSIONS: Experience of IPV is an important risk marker for the increased risk of chronic undernutrition among women of reproductive age in Bangladesh. Women experiencing IPV need help irrespective of the socioeconomic status they belong to. Targeted intervention at IPV among the poor may help improve nutritional status among women of reproductive age. European Journal of Clinical Nutrition (2013) 67, 301–307; doi:10.1038/ejcn.2012.202; published online 12 December 2012 Keywords: chronic undernutrition; intimate partner violence; wealth index; BMI; Bangladesh INTRODUCTION There has been little progress over the past decade in reducing chronic undernutrition among women of reproductive age, and Bangladesh continues to have one of the highest rates in the world. In 2007, 30% of Bangladeshi women of reproductive age were suffering from chronic undernutrition. 1 To date, the major determinants of undernutrition among women in poorer settings are assumed to be related to women’s reproductive history and to overall socioeconomic changes in the household and society. 2–5 However, the role that psychosocial factors play in women’s nutritional status is less understood. Intimate partner violence (IPV), which consists of a range of physical or sexual coercive acts, or both, perpetrated against women by a current or former male intimate is considered to be one of the main psychosocial risk factors that might influence women’s nutritional status. 6 IPV can place stress on women, and stress in turn can increases oxidative stress 7–9 and metabolic levels, 10 risk factors for undernutrition. IPV against women can initiate immediate and long-lasting psychological symptoms, which may affect her eating practices. These include loss of appetite, abdominal pain, diarrhea or constipation, sleep disturbances, disordered eating, activity levels and general healthcare practices. 11,12 Besides, experiencing IPV also is associated with more frequent physical inactivity and disabilities that prevent work. 13,14 More directly, IPV can increase the risk of poor nutritional status among women through familial circumstances, such as the withholding of food by abusive husbands. 15 A growing literature has shown the linkage between IPV and various aspects of women’s mental, physical and reproductive health consequences. 16–20 However, the literature on conse- quences of IPV on women’s nutritional patterns is limited. A recent investigation in India indicates an association between physical IPV measured via only a single global question and the risk of chronic undernutrition among women. 21 There is a clear need to use behaviorally specific questions and nationally representative data to better understand whether physical and sexual IPV are associated with undernutrition among women. Moreover, the validity of this relationship between IPV and undernutrition needs to be carefully examined because adverse nutritional outcomes of women are more likely in poverty-stricken settings, 22,23 and such settings have also been associated with an increased risk of IPV. 16,24 Abused women of low economic status may be at a distinct disadvantage because of an increased level of IPV 16,25 and impaired resources that can restrict quality education, employment opportunities, adequate housing, sanitation and food sufficiency. These can be coupled with a higher level of 1 International Health Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan and 2 Health Promotion, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan. Correspondence: Dr M Rahman, International Health, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo, Tokyo 113-8519, Japan. E-mail: rahman.ith@tmd.ac.jp Received 11 July 2012; revised 15 November 2012; accepted 16 November 2012; published online 12 December 2012 European Journal of Clinical Nutrition (2013) 67, 301–307 & 2013 Macmillan Publishers Limited All rights reserved 0954-3007/13 www.nature.com/ejcn