Reproductive coercion

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Reproductive coercion (also called coerced reproduction, reproductive control or reproductive abuse) is a collection of behaviors that interfere with decision-making related to reproductive health. [1] These behaviors are meant to maintain power and control related to reproductive health by a current, former, or hopeful intimate or romantic partner, [2] [3] but they can also be perpetrated by parents or in-laws. [4] Coercive behaviors infringe on individuals' reproductive rights and reduce their reproductive autonomy. [5]

Contents

There are three forms of reproductive coercion, including pregnancy coercion, birth control sabotage, and controlling the outcome of a pregnancy. [1] [6]

Reproductive coercion and intimate partner violence are strongly correlated; however, reproductive coercion can occur in relationships in which physical and sexual violence are not reported. [1] Reproductive coercion and unintended pregnancy are strongly associated, and this association is stronger in individuals who have experienced intimate partner violence. [1] While research remains fragmentary, women in abusive relationships are at higher risk of reproductive coercion and unintended pregnancies. [7] Reproductive coercion is considered a serious public health issue. [2] [3]

Forms

Pregnancy coercion

Pregnancy coercion includes any behaviors intended to coerce or pressure a partner to become or not become pregnant, or to coerce or pressure a partner to impregnate them. [1] [6] [8] Pregnancy coercion involves various tactics, including verbal threats related to impregnation, coerced sex, refusal to use or interference with male-controlled contraception (i.e., condoms, withdrawal), interference with or pressure not to use or to use female controlled contraception (i.e., hormonal methods), monitoring menstrual cycles or gynecological visits, pressure for or against sterilization or other medical related methods, and monitoring of ovulation. [1] Threatened or completed physical violence may also be perpetrated against a partner to coerce them to become pregnant or coerce a partner to impregnate them. [3] [8]

Birth control sabotage

Birth control sabotage involves tampering with contraception or interfering with the use of contraception. [1] [6] Birth control sabotage includes removing a condom after agreeing to wear one (also called stealthing), damaging a condom, removing or lying about the use of contraception (including vaginal rings, intrauterine devices (IUDs), and contraceptive patches), or throwing away or lying about the consumption of oral contraceptive pills. [1] [2] [3] [8] Other methods of birth control sabotage include preventing a partner from obtaining or refilling contraceptive prescriptions, refusing to wear a condom, stating that a condom is being worn when one is not, not withdrawing after agreeing to do so, exaggerating the risks of hormonal contraceptives, not informing a partner after ceasing the use of female-controlled contraception or removing contraceptive devices, [8] and not telling a partner if a condom broke or fell off. [1] [3]

Gender and sexual power dynamics and coercion associated with sexual power dynamics are both linked to condom nonuse. [9] Even women with high sexually transmitted infection knowledge are more likely to use condoms inconsistently than women with low STI knowledge when there is a high level of fear for abuse. [2]

Controlling the outcome of a pregnancy

Controlling the outcome of a pregnancy is an attempt to influence a partner to continue or terminate a pregnancy. [1] [6] This can include abortion coercion, or pressuring, threatening, or forcing a partner to have an abortion or not. [1] A Guttmacher Institute policy analysis states that forcing a woman to terminate a pregnancy she wants or to continue a pregnancy she does not want violates the basic human right of reproductive health. [10]

Prevalence

United States

Reproductive coercion in October 2018 was reported by 5-14% of women in family planning clinic settings [1] [5] and lifetime experience has been reported by 8-30% of women in a range of settings in the US. [1] [5]

The US Centers for Disease Control and Prevention's survey on domestic violence includes questions regarding control of reproductive health, specifically pregnancy pressure and birth control sabotage. [11] The 2011 study found that:

In a sample of urban women aged 18–44, 16% reported experiencing reproductive coercion. [1] In a family planning clinic setting in California, 13% of patients reported experiencing reproductive coercion in October 2018. [1] Among California girls aged 14–19 seeking school-based health services, 12.4% reported experiencing reproductive coercion. [1] Among women aged 16–29 seeking family planning in California, 19.1% reported experiencing pregnancy coercion in their lifetime. [1] 15.0% of women in California, aged 16–29, seeking family planning reported experiencing birth control sabotage. [1] In a sample of college-aged women in the northeastern United States, 8% reported experiencing reproductive coercion in their lifetime; 3.9% reported experiencing birth control sabotage in their lifetime, and 6.8% reported experiencing pregnancy coercion in their lifetime. [1] In a Texas sample, 1% of non-pregnant women aged 16–40 reported experiencing pregnancy coercion in their lifetime. [1] Among Pennsylvania family planning clinic patients, reproductive coercion was reported at 5% in October 2018. [1] In a sample of adolescents aged 14–20 in Boston, 20% had been coerced into having sex without a condom. [1]

Among women seeking an abortion in the United States, between 0.1% and 2.0% are coerced to have an abortion by an intimate partner. [1] Furthermore, one study of males between the age of 18-35 who had ever had sex found that 4.1% had attempted to compel a partner to have an abortion and 8.0% attempted to prevent a partner from having an abortion. [1]

Teenage girls in physically violent relationships are 3.5 times more likely to become pregnant and are 2.8 times more likely to fear the possible consequences of negotiating condom use than non-abused girls. They are also half as likely to use condoms consistently compared to non-abused girls, and teenage boys perpetrating dating violence are also less likely to use condoms. [2] Teenage mothers are nearly twice as likely to have a repeat pregnancy within 2 years if they experienced abuse within three months after delivery. [2] 26% of abused teenage girls reported that their boyfriends were trying to get them pregnant. [2]

Other countries

In Bangladesh, 10% of married women experiencing intimate partner violence reported that their male partner disagreed with them about using contraception. [4] Additionally, 10.4% of women who did not report intimate partner violence reported that their male partner disagreed with them about using contraception. [4]

Among women seeking abortions in Northern China, 2.1% reported that they were being forced to have an abortion by their partner. [4]

Among women in Côte d'Ivoire over the age of 18 with a male partner, lifetime prevalence rates of reproductive coercion perpetrated by an in-law of 5.5% and 6.0% have been reported. [4] Lifetime prevalence of reproductive coercion among women in Côte d'Ivoire over the age of 18 perpetrated by a male partner is 18.5%. [4] Reproductive coercion by in-laws was reported by 15.9% of women who were maltreated by their in-laws, versus 2.8% who were not maltreated. [4] Additionally, reproductive coercion by in-laws was reported by 16.3% of women who experienced physical violence by their in-laws, versus 5.9% who did not report violence. [4]

Among women who had abortions in Italy, 2% of those who did not experience intimate partner violence, 7% who experienced psychological violence, and 13% who experienced physical or sexual violence stated that they become pregnant because their partner wanted them to be pregnant. [4] Furthermore, 4.5% of those who did not experience intimate partner violence, 3.6% who experienced psychological violence, and 21.7% who experienced physical or sexual violence stated they had an abortion because their partner wanted a child but they did not. [4]

Among married women aged 15–49 in Jordan, 13% reported that a parent or in-law tried to stop them from using contraception, including their mother-in-law (36%), mother (27%), or sister-in-law (11%). [4] Furthermore, 11% reported that their husband refused to use contraception or tried to stop them from using contraception, and 89% reported their husband had expressed disapproval of contraception. [4] In total, 20% of ever-married Jordanian women report that their husband or someone else has interfered with their attempts to prevent pregnancy. [4]

In Nigeria, coercion by husband was more commonly a reason for IUD removal in younger women (74.2%) than older women (25.8%), and in less educated women (46.7%) than more educated women (33.3%). [4]

In India, a study conducted in the state of Uttar Pradesh reported that about 1 out of 8 women (12%) were subjected to Reproductive Coercion by their current husbands or in-laws. Additionally, 36% of the women facing Reproductive Coercion reported that their current pregnancy was unintended.

Clinical practice and unintended pregnancy prevention

The American College of Obstetricians and Gynecologists recommends that physicians should screen patients for reproductive coercion periodically, including at annual examinations, during prenatal and postpartum care, and at new patient visits. [3] According to the American College of Obstetricians and Gynecologists and Futures Without Violence recommendations, providers should assess for reproductive coercion as part of routine family planning care and before discussing contraceptive options. [2] [3]

Suggested screening questions in health settings for assessing potential reproductive coercion include: [2] [3]

Family planning clinicians can use strategies to help prevent adverse reproductive health outcomes among women who experience reproductive coercion. [2] Strategies include educating patients on the reproductive health impacts of reproductive coercion, counseling on harm reduction strategies, preventing unintended pregnancies by offering discrete, effective birth control methods that may not be detectable by a partner (such as IUDs, emergency contraception, contraceptive implants, or contraceptive injections), and assessing their patient's safety prior to notifying partners about sexually transmitted infections. [2] [3] Interventions that provide awareness of reproductive coercion and provide harm reduction strategies to address reproductive coercion have been found to reduce pregnancy coercion by 71% among women experiencing intimate partner violence. [2]

Emergency contraception can be used after sex without contraception in order to prevent an unwanted pregnancy. [12] In the United States, levonorgestrel (LNG) Plan B One Step and other generics (the morning after pill or emergency contraception) can be acquired by persons of any age. [12] When taken within 72 hours of sex without contraception, Plan B and generics can help prevent an unwanted pregnancy. [12] Other options for emergency contraception in the United States include ulipristal acetate (available with a prescription) taken within five days of sex without contraception, and the insertion of a copper IUD within five days of sex without contraception. [12]

See also

Related Research Articles

Coitus interruptus, also known as withdrawal, pulling out or the pull-out method, is a method of birth control during penetrative sexual intercourse, whereby the penis is withdrawn from a vagina prior to ejaculation so that the ejaculate (semen) may be directed away from the vagina in an effort to avoid insemination.

<span class="mw-page-title-main">Emergency contraception</span> Birth control measures taken after sexual intercourse

Emergency contraception (EC) is a birth control measure, used after sexual intercourse to prevent pregnancy.

<span class="mw-page-title-main">Teenage pregnancy</span> Childbirth in human females under the age of 20

Teenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female adolescent or young adult under the age of 20. Worldwide, pregnancy complications are the leading cause of death for women and girls 15 to 19 years old. The definition of teenage pregnancy includes those who are legally considered adults in their country. The WHO defines adolescence as the period between the ages of 10 and 19 years. Pregnancy can occur with sexual intercourse after the start of ovulation, which can happen before the first menstrual period (menarche). In healthy, well-nourished girls, the first period usually takes place between the ages of 12 and 13.

<span class="mw-page-title-main">Family planning</span> Planning when to have children

Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Reproductive rights are legal rights and freedoms relating to reproduction and reproductive health that vary amongst countries around the world. The World Health Organization defines reproductive rights as follows:

Reproductive rights rest on the recognition of the basic right of all couples and individuals to decide freely and responsibly the number, spacing and timing of their children and to have the information and means to do so, and the right to attain the highest standard of sexual and reproductive health. They also include the right of all to make decisions concerning reproduction free of discrimination, coercion and violence.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life.

<span class="mw-page-title-main">Comparison of birth control methods</span>

There are many methods of birth control that vary in requirements, side effects, and effectiveness. As the technology, education, and awareness about contraception has evolved, new contraception methods have been theorized and put in application. Although no method of birth control is ideal for every user, some methods remain more effective, affordable or intrusive than others. Outlined here are the different types of barrier methods, hormonal methods, various methods including spermicides, emergency contraceptives, and surgical methods and a comparison between them.

Contraceptive security is an individual's ability to reliably choose, obtain, and use quality contraceptives for family planning and the prevention of sexually transmitted diseases. The term refers primarily to efforts undertaken in low and middle-income countries to ensure contraceptive availability as an integral part of family planning programs. Even though there is a consistent increase in the use of contraceptives in low, middle, and high-income countries, the actual contraceptive use varies in different regions of the world. The World Health Organization recognizes the importance of contraception and describes all choices regarding family planning as human rights. Subsidized products, particularly condoms and oral contraceptives, may be provided to increase accessibility for low-income people. Measures taken to provide contraceptive security may include strengthening contraceptive supply chains, forming contraceptive security committees, product quality assurance, promoting supportive policy environments, and examining financing options.

Long-acting reversible contraceptives (LARC) are methods of birth control that provide effective contraception for an extended period without requiring user action. They include injections, intrauterine devices (IUDs), and subdermal contraceptive implants. They are the most effective reversible methods of contraception because their efficacy is not reliant on patient compliance. The typical use failure rates of IUDs and implants, less than 1% per year, are about the same as perfect use failure rates.

Intimate partner sexual violence (IPSV) deals with sexual violence within the context of domestic violence. Intimate partner sexual violence is defined by any unwanted sexual contact or activity by an intimate partner in order to control an individual through fear, threats, or violence. Women are the primary victims of this type of violence.

<span class="mw-page-title-main">Contraceptive implant</span> Implantable medical device used for birth control

A contraceptive implant is an implantable medical device used for the purpose of birth control. The implant may depend on the timed release of hormones to hinder ovulation or sperm development, the ability of copper to act as a natural spermicide within the uterus, or it may work using a non-hormonal, physical blocking mechanism. As with other contraceptives, a contraceptive implant is designed to prevent pregnancy, but it does not protect against sexually transmitted infections.

<span class="mw-page-title-main">Birth control</span> Method of preventing human pregnancy

Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

Unintended pregnancies are pregnancies that are mistimed, unplanned or unwanted at the time of conception.

<span class="mw-page-title-main">Intrauterine device</span> Form of birth control involving a device placed in the uterus

An intrauterine device (IUD), also known as intrauterine contraceptive device or coil, is a small, often T-shaped birth control device that is inserted into the uterus to prevent pregnancy. IUDs are one form of long-acting reversible birth control (LARC). One study found that female family planning providers choose LARC methods more often (41.7%) than the general public (12.1%). Among birth control methods, IUDs, along with other contraceptive implants, result in the greatest satisfaction among users.

Pregnancy when coupled with domestic violence is a form of intimate partner violence (IPV) where health risks may be amplified. Abuse during pregnancy, whether physical, verbal or emotional, produces many adverse physical and psychological effects for both the mother and fetus. Domestic violence during pregnancy is categorized as abusive behavior towards a pregnant woman, where the pattern of abuse can often change in terms of severity and frequency of violence. Abuse may be a long-standing problem in a relationship that continues after a woman becomes pregnant or it may commence in pregnancy. Although female-to-male partner violence occurs in these settings, the overwhelming form of domestic violence is perpetrated by men against women. Pregnancy provides a unique opportunity for healthcare workers to screen women for domestic violence though a recent review found that the best way in which to do this is unclear. Reducing domestic violence in pregnancy should improve outcomes for mothers and babies though more good quality studies are needed to work out effective ways of screening pregnant women.

<span class="mw-page-title-main">Birth control in the United States</span> History of birth control in the United States

Birth control in the United States is available in many forms. Some of the forms available at drugstores and some retail stores are male condoms, female condoms, sponges, spermicides, and over-the-counter emergency contraception. Forms available at pharmacies with a doctor's prescription or at doctor's offices are oral contraceptive pills, patches, vaginal rings, diaphragms, shots/injections, cervical caps, implantable rods, and intrauterine devices (IUDs). Sterilization procedures, including tubal ligations and vasectomies, are also performed.

<span class="mw-page-title-main">Birth control in Africa</span>

Access to safe and adequate sexual and reproductive healthcare constitutes part of the Universal Declaration of Human Rights, as upheld by the United Nations.

<span class="mw-page-title-main">Reproductive rights in Latin America</span>

Latin America is home to some of the few countries of the world with a complete ban on abortion and minimal policies on reproductive rights, but it also contains some of the most progressive reproductive rights movements in the world. With roots in indigenous groups, the issues of reproductive rights include abortion, sexual autonomy, reproductive healthcare, and access to contraceptive measures. Modern reproductive rights movements most notably include Marea Verde, which has led to much reproductive legislation reform. Cuba has acted as a trail-blazer towards more liberal reproductive laws for the rest of Latin America, while other countries like El Salvador and Honduras have tightened restrictions on reproductive rights.

Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

There are many types of contraceptive methods available in France. All contraceptives are obtained by medical prescription after a visit to a family planning specialist, a gynecologist or a midwife. An exception to this is emergency contraception, which does not require a prescription and can be obtained directly in a pharmacy.

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Grace KT, Anderson JC (October 2018). "Reproductive Coercion: A Systematic Review". Trauma, Violence & Abuse. 19 (4): 371–390. doi:10.1177/1524838016663935. PMC   5577387 . PMID   27535921.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 Chamberlain L (2010). "Reproductive Health and Partner Violence Guidelines: An Integrated Response to Intimate Partner Violence and Reproductive Coercion" (PDF). Futures Without Violence.
  3. 1 2 3 4 5 6 7 8 9 American College of Obstetricians Gynecologists (February 2013). "ACOG Committee opinion no. 554: reproductive and sexual coercion". Obstetrics and Gynecology. LWW. 121 (2 Pt 1): 411–5. doi:10.1097/01.AOG.0000426427.79586.3b. PMID   23344307.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Grace KT, Fleming C (December 2016). "A Systematic Review of Reproductive Coercion in International Settings". World Medical & Health Policy. 8 (4): 382–408. doi:10.1002/wmh3.209. PMC   5423714 . PMID   28503353.
  5. 1 2 3 Walker, Susan; Rowlands, Sam (2019-01-01). "Reproductive control by others: means, perpetrators and effects". BMJ Sexual & Reproductive Health. 45 (1): 61–67. doi:10.1136/bmjsrh-2018-200156. ISSN   2515-1991. PMID   30622127. S2CID   58546639.
  6. 1 2 3 4 Miller E, Silverman JG (September 2010). "Reproductive coercion and partner violence: implications for clinical assessment of unintended pregnancy". Expert Review of Obstetrics & Gynecology. 5 (5): 511–515. doi:10.1586/eog.10.44. PMC   3282154 . PMID   22355296.
  7. ↑ Paterno MT, Jordan ET (March 2012). "A review of factors associated with unprotected sex among adult women in the United States". Journal of Obstetric, Gynecologic, and Neonatal Nursing. 41 (2): 258–274. doi:10.1111/j.1552-6909.2011.01334.x. PMID   22376055.
  8. 1 2 3 4 Park, J., Nordstrom, S. K., Weber, K. M., & Irwin, T. (2016). Reproductive coercion: uncloaking an imbalance of social power. In American Journal of Obstetrics and Gynecology (Vol. 214, Issue 1, pp. 74–78). Elsevier BV. https://doi.org/10.1016/j.ajog.2015.08.045
  9. ↑ Hendriksen ES, Pettifor A, Lee SJ, Coates TJ, Rees HV (July 2007). "Predictors of condom use among young adults in South Africa: the Reproductive Health and HIV Research Unit National Youth Survey". American Journal of Public Health. 97 (7): 1241–8. doi:10.2105/AJPH.2006.086009. PMC   1913066 . PMID   17538062.
  10. ↑ Barot S (Fall 2012). "Governmental coercion in reproductive decision making: see it both ways". Guttmacher Policy Review . Guttmacher Institute. 15 (4).
  11. ↑ Black MC, Basile KC, Breiding MJ, Smith SG, Walters ML, Merrick MT, Chen J, Stevens MR (2011). The National Intimate Partner and Sexual Violence Survey (NISVS) (PDF). Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention: 48.
  12. 1 2 3 4 Haeger KO, Lamme J, Cleland K (2018). "State of emergency contraception in the U.S., 2018". Contraception and Reproductive Medicine. 3: 20. doi: 10.1186/s40834-018-0067-8 . PMC   6123910 . PMID   30202545.
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