Reproductive Coercion and Partner Violence: Implications for Clinical Assessment of Unintended Pregnancy

Elizabeth Miller; Jay G Silverman

Disclosures

Expert Rev of Obstet Gynecol. 2010;5(5):511-515. 

In This Article

Reproductive Coercion Defined

Unintended pregnancy (defined broadly as pregnancy that was not planned, was unexpected or mistimed, or not wanted by a woman) is common and disproportionately affects younger women.[1] Physical and sexual violence victimization by an intimate partner is associated with poor reproductive health, including unplanned pregnancies, poor pregnancy outcomes and sexually transmitted infections.[2–10] Unintended pregnancies are two- to three-times more likely to be associated with intimate partner violence (IPV) than planned pregnancies.[6,7,11–15] Forced sex, fear of negotiating condom and contraceptive use, inconsistent condom use and partner interference with access to healthcare all contribute to this association between unintended pregnancy and IPV.[16–21]

In addition to these mechanisms, a growing body of literature on male partner influences on contraception and pregnancy decision-making has identified a range of male partner pregnancy-controlling behaviors which we have termed reproductive coercion. Male partner reproductive coercion (to be distinguished from the range of state control of women's reproductive health across the globe, including forced sterilization) is defined as male partners' attempts to promote pregnancy in their female partners through verbal pressure and threats to become pregnant (pregnancy coercion), direct interference with contraception (birth-control sabotage), and threats and coercion related to pregnancy continuation or termination (control of pregnancy outcomes). Abusive male partners have been found to actively promote pregnancy via behaviors spanning verbal pressure to become pregnant, condom manipulation, threats or actual violence in response to condom requests and direct acts of birth-control sabotage (e.g., removing a vaginal ring, throwing out birth-control pills and blocking women from seeking access to contraception). In addition, once their female partner is pregnant, abusive male partners may enact behaviors to control the outcomes of the pregnancy including violent acts to attempt to induce miscarriage and coercion to either continue or terminate the pregnancy. While women may also attempt to become pregnant or control the outcome of a pregnancy without their partner's knowledge, the focus here is on how male partner abusive behaviors may be connected to unintended pregnancy (i.e., pregnancy that is mistimed, unplanned or unwanted from the woman's perspective). This article reviews recent studies on male partner reproductive coercion, examining further evidence of the link between unintended pregnancy and IPV and highlighting future directions for research as well as implications for clinical practice.

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