Clinical Opinion
Obstetrics
Reproductive coercion: uncloaking an imbalance of social power

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Reproductive coercion involves behavior that interferes with contraceptive and pregnancy choices of women and occasionally men. This includes birth control sabotage (intentional destruction of a woman’s chosen method of contraception), pregnancy pressure (behaviors to coerce pregnancy against one’s wishes), and pregnancy coercion (threats to direct the outcome of a pregnancy). All are associated with serious reproductive consequences including unintended pregnancy, abortion, sexually transmitted infections, poor pregnancy outcomes, and psychological trauma. This article presents an overview of the recent literature surrounding reproductive coercion and how it relates to the reproductive health outcomes of women, adolescents, and the lesbian, gay, bisexual, and transgender community. Men’s experience with reproductive coercion will also be discussed. Clinical implications and evidence-based strategies for assessment and intervention will be identified.

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

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    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.

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