Clinical OpinionObstetricsReproductive coercion: uncloaking an imbalance of social power
Section snippets
Definitions
Birth control sabotage involves any deliberate act that interferes with or inhibits a woman’s ability to obtain contraception. This includes hiding or destroying oral contraceptive pills; removing vaginal rings, contraceptive patches, or intrauterine devices (IUDs) without a partner’s permission; removing or intentionally breaking condoms; or not withdrawing when that was the agreed-upon method of contraception.1, 2, 9, 10
Pregnancy pressure refers to pressuring a female partner to become
Women, domestic
In 2010, Miller et al3 reported the prevalence of RC in the United States. In this cross-sectional survey of more than 1200 female clients aged 16–29 years in 5 Northern California family-planning clinics, 15% reported birth control sabotage and 19% reported pregnancy coercion.3 Three quarters of women who reported a history of RC also acknowledged suffering from IPV.3 The prevalence of IPV in this sample was higher (53%) compared with the national average of 24% reported by the Centers for
Lesbian, gay, bisexual, and transgender (LGBT)
Few studies of RC include same-sex couples or bisexual individuals; however, higher rates of assault and victimization are reported in females who endorse same-sex relationships than those solely in heterosexual relationships. In an analysis of the multistate Youth Risk Behavior Survey, adolescents who reported same-sex sexual encounters experienced twice the rate of physical and sexual violence than their peers with opposite-sex partners, although the mechanism of this increased risk is not
Clinical implications
Unintended pregnancy, abortion (both elective and forced), and STIs/HIV all may result from the inability to negotiate sex and contraception.8, 9, 25, 26, 27, 28 Pregnancy-related birth outcomes may suffer when initiation and continuation of pregnancy is undesired but coerced. Infants of women with mistimed pregnancies (ie, pregnancies that may have been desired at a later time) and unwanted pregnancies (ie, pregnancies that are unwanted at that time or in the future) may be more likely to
Strategies for intervention
Increasing awareness of RC and its impact on women’s health is a critical step. Providers may be aware of RC but may be unaware of the different forms it can take. Training and education to those in positions to screen and identify at-risk women (ie, health care workers, social workers, mental health therapists) will help increase this awareness.1
The American Congress of Obstetricians and Gynecologists (ACOG), in conjunction with Futures Without Violence, a US-based organization aimed at ending
Conclusion
RC is a form of partner violence that is prevalent in adolescents and adults, in heterosexual and same-sex relationships, and in those with or without a history of physical or sexual violence. Birth control sabotage, pregnancy pressure, and pregnancy coercion can lead to severe reproductive health consequences and may be debilitating to a woman’s mental health. Providers have an obligation to educate themselves and their staff regarding RC as well as to provide a safe, supportive, and
References (34)
- et al.
Pregnancy coercion, intimate partner violence and unintended pregnancy
Contraception
(2010) - et al.
Power over parity: intimate partner violence and issues of fertility control
Am J Obstet Gynecol
(2009) - et al.
Reproductive coercion and cooccurring intimate partner violence in obstetrics and gynecology patients
Am J Obstet Gynecol
(2014) - et al.
Recent reproductive coercion and unintended pregnancy among female family planning clients
Contraception
(2014) - et al.
A family planning clinic partner violence intervention to reduce the risk associated with reproductive coercion
Contraception
(2011) - et al.
Male reproductive control of women who have experienced intimate partner violence in the United States
Soc Sci Med
(2010) - et al.
Male partner pregnancy-promoting behaviors and adolescent partner violence: findings from a qualitative study with adolescent females
Ambul Pediatr
(2007) - et al.
A systematic review of interventions for preventing adolescent intimate partner violence
J Adolesc Health
(2014) - et al.
From work with men and boys to changes of social norms and reduction of inequities in gender relations: a conceptual shift in prevention of violence against women and girls
Lancet
(2015) - et al.
d’Oliveira AF, Koziol-McLain J, Colombini M, Feder G. The health-systems response to violence against women
Lancet
(2015)
Reproductive and sexual coercion. ACOG Committee opinion no. 554
Obstet Gynecol
Adolescent relationship abuse and reproductive and sexual coercion among teens
Curr Opin Obstet Gynecol
Reproductive coercion and partner violence: implications for clinical assessment of unintended pregnancy
Expert Rev Obstet Gynecol
Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12—youth risk behavior surveillance, selected sites, United States, 2001–2009
MMWR Surveill Summ
Cited by (0)
J.P. received research funding from the Global Women’s Health Fellowship at the University of Illinois, Chicago.
The authors report no conflict of interest.