Power over parity: intimate partner violence and issues of fertility control

doi:10.1016/j.ajog.2009.04.048

American Journal of Obstetrics and Gynecology

Volume 201, Issue 2, August 2009, Pages 148.e1-148.e7

https://doi.org/10.1016/j.ajog.2009.04.048 Get rights and content

Objective

The purpose of this study was to examine the association between intimate partner violence (IPV), abortion, parity, and contraception use.

Study Design

We recruited 1463 women for this written questionnaire study of IPV. Patient demographics, contraceptive history, and reproductive history were obtained in the waiting room from patients presenting for gynecologic care.

Results

Seventy percent of those eligible participated. Twenty-one percent reported a history of IPV. Partner unwillingness to use birth control, partner desirous of conception, partner creating difficulty for subject's use of birth control, and subjects expressing inability to afford contraception were all positively associated with report of IPV. Each additional pregnancy was associated with 10% greater odds of IPV (95% confidence interval, 1.03-1.17).

Conclusion

Contraception is more difficult to navigate for women experiencing IPV. Providers should consider prescribing contraceptive methods for IPV victims that are not partner dependent.

Section snippets

Materials and Methods

We surveyed women at the Philadelphia centers of Planned Parenthood Southeastern Pennsylvania in 2 sites: a surgical abortion clinic and a general gynecologic clinic. Planned Parenthood was chosen, because it is the only high-volume provider of abortion services and gynecologic care in the city of Philadelphia.

We developed a 31-item questionnaire asking about IPV, contraceptive knowledge and use, reproductive health history, and demographics. For questions on violence, we used the CDC's

Results

Of the 2103 women 18 years and older who were seen in the clinic during the study, 1463 (70%) completed the survey. The response rates were greater in the general gynecology clinic (488/602; 81%) than the abortion clinic (975/1501; 65%) (P < .0001). We excluded 33 women who completed questionnaires and were less than 18 years of age and another 76 women who did not answer the IPV questions, leaving 1354 questionnaires for evaluation in our final analysis.

A history of IPV was reported by 291

Comment

We hypothesized that practicing contraception would be significantly more difficult for women with a history of violence, because of partner unwillingness to use contraception. We found that agreeing with the statements: my partner makes it difficult for me to use birth control and I had sex without using birth control, because my partner didn't want to use it or wanted me to get pregnant, was highly predictive of violence. In addition, these women were more likely to have used after-the-fact

Acknowledgments

We thank the Robert Wood Johnson Clinical Scholars Program, the Pennsylvania Department of Health, and the Institute for Translational Medicine and Therapeutics at the University of Pennsylvania for funding support, and Taleen Khoury for her assistance with data collection. We also thank the staff of the Philadelphia centers of Planned Parenthood Southeastern Pennsylvania for their generosity in allowing us to use their site.

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Intimate partner violence (IPV) is a public health problem of epidemic proportions. IPV often starts early in adolescence and continues throughout an individual’s lifespan. IPV is defined as abuse or aggression occurring in the context of a romantic relationship that is perpetrated by a current or former partner. IPV victims often experience severe psychological trauma, physical injury, and even death. The direct recipient of the violence is often not the only individual impacted. Children are often peripheral victims of IPV. It is vital that pediatric health care providers, including pediatric nurse practitioners, recognize that IPV is indeed a pediatric health care crisis requiring strategies for both identification and intervention. This continuing education article will discuss IPV and its impact on children from conception to adolescence while exploring implications for practice.
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Female sexual activity and, accordingly, birth rates tend to decline in times of stress, such as a pandemic. In addition, when resources are scarce or exogenous conditions are threatening, some women may engage in sexual activity primarily to maintain socioeconomic security. Having unwanted sex may indicate sexual activity in exchange for economic security.
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The proportion of women who were sexually active early in the pandemic (51%) was about the same as in the 12 months before the pandemic (52%), although 7% of women became active, and 7% of women became inactive. Overall, 11% of sexually active women were having unwanted sex in the early pandemic. The rates of anxiety, depression, traumatic stress symptoms, and each of the 5 health-related socioeconomic risk factors assessed were about 2 times higher among women having unwanted sex than other women (P<.001). Women having unwanted sex were also 5 times more likely than other women to report an increased frequency of sex since the pandemic (65% vs 13%; P<.001) and 6 times more likely to be using emergency contraception (18% vs 3%; P<.001). Women reporting unwanted sex commonly described decreased libido or interest in sex related to mood changes since the pandemic, having “more sex,” fear or worry about the transmission of the virus because of sex, and having sex to meet the partner’s needs. Among sexually active women, the odds of unwanted sex (adjusting for demographic, reproductive, and health factors) were higher among women with 1 prepandemic health-related socioeconomic risk factor (adjusted odds ratio, 2.0; 95% confidence interval, 1.1–3.8) and 2 or more prepandemic health-related socioeconomic risk factors (adjusted odds ratio, 6.0; 95% confidence interval, 3.4–10.6). Among sexually active women with any prepandemic health-related socioeconomic risk factor, those with new or worsening transportation difficulties early in the pandemic were particularly vulnerable to unwanted sex (adjusted odds ratio, 2.7; 95% confidence interval, 1.7–4.3).
More than 1 in 10 sexually active US women was having unwanted sex early in the COVID-19 pandemic. Socioeconomically vulnerable women, especially those with new or worsening transportation problems because of the pandemic, were more likely than others to engage in unwanted sex. Pandemic response and recovery efforts should seek to mitigate unwanted sexual activity and related health and social risks among women.
Integrating anti-violence efforts into sexual and reproductive health: Reproductive coercion as a case example
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Integration of anti-oppression approaches into clinical practice, including sexual and reproductive health, is needed. Reproductive coercion is a common form of violence that directly impacts sexual and reproductive health. Person-centered harm reduction strategies for reproductive coercion can be integrated readily into routine care utilizing clinicians’ existing skill set. Interventions for reproductive coercion may serve as a proof of concept for the incorporation of anti-violence and healing justice efforts within medical care.
Unfit for purpose: A situational analysis of abortion care and gender-based violence
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Citation Excerpt :
These barriers can delay care, reduce abortion options, increase the need to travel for more complex care and increase the cost of the procedure (Upadhyay, 2017; World Health Oraganization, 2012). Furthermore, barriers disproportionately affect marginalised people (Upadhyay, 2017) such as those affected by gender-based violence (GBV) who are more likely to seek out abortions, request multiple abortions or present for late-term abortions (Aston & Bewley, 2009; Gee, Mitra, Wan, Chavkin, & Long, 2009; Hall, Chappell, Parnell, Seed, & Bewley, 2014; Taft & Watson, 2007). In Australia, one-in-four women will have an abortion in their lifetime and are up to three times more likely to have experienced GBV, specifically domestic violence, than women who continue with their pregnancies (Taft & Watson, 2007).
Timely access to comprehensive abortion care is fundamental to reproductive autonomy; however, factors such as geographical location, politics, and religious influences create obstacles to this goal and may have distressing consequences for people seeking abortions in the context of gender-based violence.
To investigate the broader situational elements of the Australian healthcare environment that affect abortion care for victims of gender-based violence.
Situational Analysis was used to conduct this study. The lead author interviewed 18 clinicians about their experiences of providing abortion care in the context of gender-based violence. Transcripts were analysed using situational maps, identifying the human and non-human elements affecting clinical care.
Participants believed that patients were “mostly uncatered for.” They described a workforce unprepared to provide abortion care, generally, and gender-based violence interventions more specifically. Clinicians found that their pro-life colleagues centred their own needs, and many revealed that the workplace environments placed clinicians’ and patients’ safety at risk.
While abortion is a safe and straightforward procedure, the interconnectedness of time sensitivity, stigma, shifting legal landscapes, and high rates of gender-based violence mean that it is probably more complex than the current work models plan for. A trauma-informed integrated approach that protects the safety and wellbeing of patients and staff is needed.
Healthcare services should implement streamlined evidence-based and trauma-informed abortion pathways that take full advantage of nurses' and midwives' skills, knowledge, and potential. As a priority, healthcare services should also introduce security measures and protocols to keep staff and patients safe.
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Research on adverse childhood experiences (ACEs) and use of modern contraception is limited in Honduras. The government has made substantial gains in promoting modern contraception. Young adults experience high rates of violence. The aim of this study was to assess the relationship between ACEs and contraceptive behaviors among young women and men.
We used data from 810 women and 753 men aged 18–24 years from the 2017 Honduras Violence against Children Survey, a cross-sectional, nationally representative household survey of childhood adversity. We assessed associations between ACEs and three contraceptive use outcomes: use versus nonuse of modern contraceptives; use of methods requiring medium/high or low programmatic support among current contraceptive users; and frequent versus infrequent condom use.
Exposure to physical or emotional abuse and witnessing violence in the home was not significantly associated with the three contraceptive use outcomes for men or women. Sexual abuse and parental separation reduced odds of contraceptive use among women (Odds Ratio (OR) < 0.60) but not among men. In contrast, orphan status increased odds of modern contraception use among men (OR 1.93) and frequent condom use among women (OR 2.22).
The inconsistent direction and magnitude of associations between ACEs and modern contraceptive use among young men and women suggests divergent relationships between ACEs and sexual and reproductive health behaviors. Results may highlight the strength of norms around contraceptive use and/or widespread access to community-based family planning programs and comprehensive sexuality education, irrespective of exposure to ACEs in Honduras.
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View all citing articles on Scopus

: This study was supported by the Robert Wood Johnson Clinical Scholars Program and the Institute for Translational Medicine and Therapeutics, both at the University of Pennsylvania and under a Grant from the Pennsylvania Department of Health. The Department specifically disclaims responsibility for any analysis, interpretations, or conclusions.

: Cite this article as: Gee RE, Mitra N, Wan F, et al. Power over parity: intimate partner violence and issues of fertility control. Am J Obstet Gynecol 2009;201:148.e1-7.

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ResearchGeneral gynecologyPower over parity: intimate partner violence and issues of fertility control

Objective

Study Design

Results

Conclusion

Section snippets

Materials and Methods

Results

Comment

Acknowledgments

Lancet

Contraception

Internat J Gynecol Obstet

J Obstet Gynecol Canada

Women's Health Issues

Obstet Gynecol

Am J Prev Med

Am J Obstet Gynecol

Am J Prev Med

Adverse health conditions and health risk behaviors associated with intimate partner violence—United States, 2005

MMWR Morb Mortal Wkly Rep

Prevalence of family violence amongst women attending an abortion clinic in New Zealand

Aust N Z J Obstet Gynaecol

Characteristics of women undergoing repeat induced abortion

JAMC

Research
General gynecology
Power over parity: intimate partner violence and issues of fertility control