What Is Reproductive Coercion?

Home , Reproductive coercion

REPRODUCTIVE COERCION What is Reproductive Coercion? REPRODUCTIVE COERCION OCCURS PRIMARILY IN HETEROSEXUAL RELATIONSHIPS where the male partner attempts to take away or influence the female partner’s decision-making when it comes to her reproductive health.

UNDERSTANDING REPRODUCTIVE COERCION The most common forms of reproductive coercion include birth control sabotage, pregnancy pressure and pregnancy coercion. • Birth control sabotage: active interference with female contraceptive use to promote pregnancy. Examples of birth control sabotage include destroying or withholding contraception, preventing the female partner from going to a doctor or clinic to get contraception, poking holes in a condom on purpose, removing a condom during sex to promote a pregnancy and forcibly removing vaginal rings, contraceptive patches, or intrauterine devices (IUDs) (American Congress of Obstetricians and Gynecologists [ACOG], 2013). • Pregnancy pressure : coercive behaviors used to HOW COMMON IS REPRODUCTION promote pregnancy including threats of violence or COERCION? actual violence if a woman does not comply with her Reproductive coercion is common, particularly partner’s wishes to become pregnant (ACOG, 2013). among women who have also experienced physical or • Pregnancy coercion: coercive behaviors used to sexual intimate partner violence (Miller et al., 2010). In control the outcome of a pregnancy. Examples of one study of women seeking services at family planning pregnancy coercion include forcing a woman to carry clinics, 15% of women had experienced birth control a pregnancy to term against her wishes, forcing a sabotage and 19% of women had experienced pregnancy woman to terminate a pregnancy against her wishes, coercion or pressure (Miller et al., 2010). or injuring a female partner to cause a miscarriage More than one third of women in that study (ACOG, 2013). with histories of intimate partner violence had also experienced some form of reproductive coercion. A recent nationally representative survey found that an estimated

PENNSYLVANIA COALITION AGAINST RAPE REPRODUCTIVE COERCION REPRODUCTIVE COERCION

10.3 million U.S. women had expereienced their THE LINK BETWEEN PARTNER partner pressuring them to get pregnant when they VIOLENCE, REPRODUCTIVE did not want to or had a sexual partner refuse to use COERCION AND HEALTH a condom indicating that reproductive coercion is a problem for many women of reproductive age (Black Several decades of research has indicated that et al., 2011). physical and sexual intimate partner violence is associated Evidence from global settings has found with poor reproductive health in women (ACOG, 2013). that women may also experience pressure to get For example, unintended pregnancy - defined broadly pregnant and control around pregnancy outcomes as pregnancy that was not planned, was unexpected or from others in their social network, including parents mistimed, or not wanted by a woman - is at least two and in-laws (Gupta et al., 2012). Female partners times more likely among women with histories of intimate may also deceive their male sexual partners by telling partner violence compared to those women who have them they are taking birth control when they are never been in an abusive relationship (Gazmararian et al., actually not and encourage unprotected intercourse 2000; Pallitto, Campbel, & O’Campo, 2005). Forced sex, in order to get pregnant (Black et al., 2011). More fear of negotiating condom and contraceptive use, and research is needed to understand the types of inconsistent condom use all influence risk for unintended reproductive coercion experienced by males and the pregnancy among women in unhealthy or abusive associated health impacts. This document focuses relationships. Reproductive coercion is now recognized by on the impact of reproductive coercion by male leading health organizations as an additional mechanism partners in heterosexual relationships on women’s for the association between intimate partner violence and reproductive decision making. unintended pregnancy (ACOG, 2013).

STRATEGIES FOR INTERVENTION “The first couple of times, the condom Women experiencing reproductive coercion seemed to break every time. You may not necessarily recognize such coercive behaviors know what I mean, and it was just as unhealthy or abusive, especially if there is no history kind of funny, like, the first six times of physical or other forms of sexual violence in their the condom broke. Six condoms, that’s relationship. Health care providers are in a unique kind of rare. I could understand one position to increase awareness among their female but six times? Then after that when I patients about the impact of unhealthy relationships got on the birth control, he was just on their health, including pregnancy risk associated like always saying, like you should with reproductive coercion. The American Congress of have my baby, you should have my Obstetricians and Gynecologists (2013) has recommended daughter, you should have my kid.” that all reproductive health care providers assess for reproductive coercion in their patients. Providers are – 17-year-old female who started Depo- instructed to have a conversation with clients about their Provera without partner’s knowledge reproductive health needs in the context of healthy and (Miller et al., 2007) unhealthy relationships, gauge partner influence over their contraceptive use and condom use, and discuss strategies women can employ to have control in their reproductive health decision making, such as using longer acting reversible contraceptives that their partner cannot control.

PENNSYLVANIA COALITION AGAINST RAPE 2 REPRODUCTIVE COERCION REPRODUCTIVE COERCION

A key component of this clinical intervention includes their organization. Clinicians should know their local connecting women with community resources that have advocate partners on a first name basis, and vice versa. expertise in domestic and sexual violence. Because Advocates can emphasize that clinicians do not have to women experiencing reproductive coercion may not be the experts on reproductive coercion and other forms self-identify as abused, and thus, may not seek services of abuse. Rather, a strong partnership with the rape crisis on their own, a strong collaboration between advocates center and domestic violence agency may help clinicians in the sexual assault and domestic violence fields, and feel supported to discuss reproductive coercion with local health care providers is critical. Advocates and their patients because they know and are comfortable clinicians, alike, will feel more comfortable referring to working closely with the advocates to keep their clients their community partners if they are familiar with the safe. Such dialogue between clinics and advocates should scope of services provided as well as the names of staff ideally happen on a regular basis in the event of refresher and management of their community partners. trainings or new hires to the clinic.

Training to facilitate supported referrals to Creating referral resources for clinics community partners Advocates can also help their clinical partners by creating When clinics decide to implement training on a referral list of other local resources in the community reproductive coercion, it is most effective for advocates that may be useful to a woman in an abusive relationship. to be an active part of the process. It is recommended In addition to contact information for the local domestic that advocates meet with clinic staff, discuss the services violence shelter, these resources may include local legal that are offered by the local agency, and walk providers aid organizations, food pantries, and national and local through what will happen when a referral is made to hotline numbers.

PENNSYLVANIA COALITION AGAINST RAPE 3 REPRODUCTIVE COERCION REPRODUCTIVE COERCION

ABOUT THE AUTHOR Gupta, J., Falb, K., Kpebo, D., & Annan, J. (2012). Abuse Heather McCauley, ScD, ScM is a from in-laws and associations with attempts to control Postdoctoral Fellow in the Department reproductive decisions among rural women in Cote d’Ivoire: of Pediatrics, University of Pittsburgh A cross sectional study. British Journal of Obstetrics School of Medicine Division of Adolescent and Gynecology, (119/9), 1058-66. Medicine at the Children’s Hospital of Pittsburgh of UPMC. Miller, E., Decker, M.R., Reed, E., Raj, A., Hathaway, J.E., & Silverman, J.G. (2007). Male partner pregnancy-promoting ADDITIONAL RESOURCES behaviors and adolescent partner violence: Findings from a Futures Without Violence: qualitative study with adolescent females. Ambulatory http://www.futureswithoutviolence.org Pediatrics, (7/5), 360-6.

REFERENCES Miller, E, Decker, MR, McCauley, HL, Tancredi, D.J., Levenson, R.R., Waldman, J., Schoenwald, P., Silverman, J.. American Congress of Obstetricians and Gynecologists. (2010). Pregnancy coercion, intimate partner violence, and (2013). Reproductive and sexual coercion unintended pregnancy. Contraception. (81/4): 316-322. (Committee Opinion No. 554). Obstetrics & Gynecology. Retrieved from http://www.acog.org/ Pallitto, C.C., Campbel, J.C., & O’Campo, P. (2005). Is Resources%20And%20Publications/Committee%20 intimate partner violence associated with unintended Opinions/Committee%20on%20Health%20Care%20 pregnancy? A review of the literature. Trauma, for%20Underserved%20Women/Reproductive%20 Violence, & Abuse, (6/3), 217-235. and%20Sexual%20Coercion.aspx

Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011).The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 summary report. Atlanta, GA: National Center for Injury Prevention and Control, Center for Disease Control and Prevention. Retrieved from http://www.cdc. gov/violenceprevention/pdf/nisvs_report2010-a.pdf

Gazmararian, J.A., Petersen, R., Spitz, A.M., Goodwin, M.M., Saltzman, L.E., & Marks, J.S. (2000). Violence and reproductive health: Current knowledge and future research directions. Maternal and Child Health Journal, (4/2), 79-84.

PENNSYLVANIA COALITION AGAINST RAPE 4 REPRODUCTIVE COERCION