Original research articlePregnancy coercion, intimate partner violence and unintended pregnancy☆
Introduction
Nearly one in four women in the United States report experiencing violence by a current or former spouse or boyfriend at some point in her life [1], with adolescents and young adults at highest risk for intimate partner violence [2], [3], [4], [5]. Studies have highlighted the association between partner violence and unintended pregnancy [6], [7], [8], [9], [10], [11], [12], [13], [14]. Recent evidence suggests these associations co-occur with reproductive control, i.e., male partners' attempts to control a woman's reproductive choices. Abused women face compromised decision-making regarding, or limited ability to enact, contraceptive use and family planning, including fear of condom negotiation [9], [15], [16], [17], [18], [19], [20]. Women's lack of control over her reproductive health is increasingly recognized as a critical mechanism underlying abused women's elevated risk for unintended pregnancy [21], [22].
One specific element of abusive men's control that may, in part, explain the association of partner violence with unintended pregnancy is overt pregnancy coercion and direct interference with contraception. Some males use verbal demands, threats and physical violence to pressure their female partners to become pregnant [12], [23], [24]. Reproductive control may also take the form of direct acts that ensure a woman cannot use contraception — birth control sabotage — including flushing birth control pills down the toilet, intentional breaking of condoms and removing contraceptive rings or patches [23], [24]. The extent to which reproductive control and the elements of pregnancy coercion and birth control sabotage are associated with physical and/or sexual violence in intimate relationships is not known.
Family planning clinics provide an important venue for examination of these phenomena, as family planning clients are known to experience a higher prevalence of partner violence than the general population [25], [26] and are frequently seeking care for pregnancy-related issues, providing opportunities for intervention. This study examines: (1) the prevalence of pregnancy coercion and birth control sabotage, (2) associations of such reproductive control with partner violence, (3) whether such reproductive control is associated with unintended pregnancy and (4) whether such associations are affected by the co-occurrence of partner violence, among clients seeking reproductive health services at family planning clinics.
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Materials and methods
The current study was conducted via a cross-sectional survey of English- and Spanish-speaking females ages 16–29 years seeking care in five family planning clinics in California that served as baseline data for an intervention study. Clients were recruited from August 2008 to March 2009. Upon arrival to a clinic, females seeking any health services were screened for age eligibility by trained research staff. Eligible women interested in participating were escorted to a private area in the
Results
Seventy-six percent of the sample were 24 years of age or younger. Consistent with the location of family planning clinics in neighborhoods serving communities of color, over three quarters of the sample identified themselves as non-White, with 16% not born in the United States. Sixty-five percent reported being in a serious relationship, married or cohabiting (Table 1).
Over half of the sample (53.4%) reported having experienced physical or sexual violence from an intimate partner. Pregnancy
Discussion
The current study documents a high prevalence of partner violence, pregnancy coercion and birth control sabotage among young women attending family planning clinics. To our knowledge, this is the first quantitative description of reproductive control (pregnancy coercion and birth control sabotage) in the family planning and domestic violence literature. These under-recognized behaviors are likely to increase risk for unintended pregnancy. Moreover, associations of intimate partner violence with
Acknowledgments
We gratefully acknowledge the staff of Planned Parenthood Shasta Diablo Affiliate for their invaluable support with this study, specifically the clinics located in the Richmond, Vallejo, Antioch and Fairfield communities. Heather Anderson, Jenna Burton, Shadi Hajizadeh, Marian Parsons and Alicia Riley provided invaluable research assistance. In addition, we wish to thank Lisa James, Director of Health, Family Violence Prevention Fund, and Yali Bair, Vice President Planned Parenthood Affiliates
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Funding sources for this study are the National Institute of Child Health and Human Development (R21 HD057814-02 to Miller and Silverman); UC Davis Health System Research Award to Miller; and Building Interdisciplinary Research Careers in Women's Health award to Miller (BIRCWH, K12 HD051958; National Institute of Child Health and Human Development, Office of Research on Women's Health, Office of Dietary Supplements, National Institute of Aging).