Elsevier

Contraception

Volume 83, Issue 3, March 2011, Pages 274-280
Contraception

Original research article
A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

https://doi.org/10.1016/j.contraception.2010.07.013Get rights and content

Abstract

Background

This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion.

Study Design

Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16–29 years (N=906) completed audio computer-assisted surveys prior to a clinic visit and 12–24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion.

Results

Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio=1.63; 95% confidence interval=1.01–2.63).

Conclusions

Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.

Introduction

The extent and health impact of intimate partner violence (IPV) worldwide have prompted recommendations for screening in clinical settings to identify and assist victims [1], [2], [3]. Young adult women utilizing family planning clinics report higher rates of IPV as compared to their same-age peers [4], [5], [6], underscoring the potential of family planning clinics to provide intervention and to serve as a bridge to further services for a large number of women affected by IPV.

The consistent associations of IPV with increased risk for unintended pregnancy, abortion and sexually transmitted infection (STI) [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21] are increasingly considered to be a result of male coercive behaviors related to sex and contraception [22], [23], [24], [25], [26]. “Reproductive coercion” spans both pregnancy coercion (e.g., male partners' verbal pressure to get women pregnant) and birth control sabotage (e.g., condom manipulation and other active interference with contraceptive methods) and results in women's compromised decision-making regarding, or limited ability to enact, the use of condom and other contraceptives [4]. The likely role of reproductive coercion in elevating abused women's risk for unintended pregnancy [4], [27], [28] and other sexual and reproductive health concerns strongly suggests that clinic-based IPV assessments may benefit from addressing reproductive coercion directly.

Moreover, prior research indicates that clinic-based IPV assessment can be the first step in recognizing partner violence [29], [30]; thus, discussion of the specific elements of reproductive coercion in the clinical context, such as pressure not to use contraception or fear of condom negotiation, may similarly provide a unique opportunity to enhance women's ability to identify and address such abuse. Expanding IPV screening to include reproductive coercion also provides a context to introduce harm reduction behaviors to assist women in resisting and minimizing the potential impact of such coercion on their health and safety. Currently, family planning counselors and clinicians are urged to assess for IPV among their patient population; however, these protocols do not include assessment tools to identify reproductive coercion, or guidance on counseling patients to reduce their risk for unintended pregnancy based on IPV and reproductive coercion.

Clinical interventions that facilitate awareness of male partner reproductive coercion, as well as strategies for overcoming such coercion, may be critical tools in reducing unintended pregnancy and related abortions. To our knowledge, the currently described and evaluated intervention offers the first harm reduction protocol that assesses for reproductive coercion and focuses on reducing women's risk for unintended pregnancy in the context of IPV. Of note, this reproductive coercion intervention enhances existing standard-of-care practice and does not require additional structures or personnel, maximizing potential sustainability.

The current study evaluates this family-planning-clinic-based intervention using a randomized controlled design, comparing changes in reports of reproductive coercion, IPV, awareness and utilization of IPV-related resources, and relationship status among participants in intervention and control clinics.

Section snippets

Brief description of intervention and control conditions

The intervention was developed collaboratively by a team of community-based practitioners, IPV advocates and researchers. Delivered by trained paraprofessional reproductive health specialists (RHS; aka family planning counselors), the intervention constitutes an enhanced IPV screening, which focuses first on educating clients about reproductive coercion and the many forms of IPV, specifically ways in which IPV can affect sexual and reproductive health with respect to control of reproductive

Demographic characteristics and attrition analyses

Seventy-six percent of the entire sample (across all four clinics) were 24 years of age or younger. These family planning clinics were located in urban neighborhoods predominantly serving communities of color; thus, more than three quarters of the participants identified themselves as non-White. The intervention clinics had more Hispanic/Latina participants, while the control clinics had significantly more African-American participants. More intervention clinic participants were born outside of

Discussion

Exposure to this brief and sustainable intervention to reduce male partner reproductive coercion was associated with a large reduction in pregnancy coercion among women who had recently experienced IPV. Post hoc analyses suggest that intervention exposure was also associated with leaving a relationship because it was unhealthy or because the woman felt unsafe, perhaps partially explaining the observed reduction in reproductive coercion experiences. While intervention participants reported

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.

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    Funding for this study was provided by the National Institute of Child Health and Human Development (R21 HD057814-02 to E. Miller and J.G. Silverman), UC Davis Health System Research Award to E. Miller and Building Interdisciplinary Research Careers in Women's Health award to E. 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).

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