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

Literature Review of Male Partner Reproductive Coercion

The following studies focus specifically on male partner attempts to promote pregnancy and control pregnancy outcomes, and were found by reviewing the literature broadly for evidence of the association between IPV and unintended pregnancy. A study of teen mothers receiving public assistance, for example, reported that almost half of the young women had experienced verbal pressure from their male partners not to use birth control (e.g., "You would have my baby if you loved me") as well as 14% reporting their partners' interference with her use of contraception (e.g., "My boyfriend won't let me use family planning").[101]

Another in-depth qualitative study among 53 ethnically diverse young women, sexually active females aged 15–20 years with known histories of partner violence, found that a quarter of participants had experienced explicit attempts by their male partners to promote pregnancy, including verbal pressure, birth-control sabotage and forced sex without condoms. The male partners of those reporting such coercion to get pregnant were on average 4 years older than their female partners, and these relationships were longer term (lasting more than a year) relative to young women who did not report reproductive coercion.[22] A related quantitative study among young women (aged 14–20 years) attending teen health centers produced similar findings; over two-fifths of the sample (45%) had experienced IPV (further indicating the need for providers to address this issue) and those experiencing IPV were more likely to report being afraid to ask their male partner to use a condom, negative consequences of making such a request, and being coerced into not using a condom compared with girls not reporting IPV (adjusted odds ratios: 2.9–5.3).[19]

These findings among adolescents are paralleled in studies involving adult women. A recent qualitative study among a diverse sample of adult women (aged 19–57 years) residing in domestic violence shelters revealed a high prevalence of birth control sabotage, forced sex and partner interference with access to healthcare. Of note, among the younger cohort (aged 19–32 years), 77% reported experiencing birth-control sabotage at the hands of their abusive partner. Among those females reporting birth-control sabotage, 80% had also experienced forced sex (compared with 48% with no history of birth-control sabotage), underscoring the association of birth-control sabotage with sexual violence. This study also identified multiple strategies that women utilize to resist male partner attempts to control their reproduction, including hiding birth control and seeking clinical care for intrauterine contraceptive placement.[23]

Similar findings emerged from another qualitative study among 71 adult females (aged 18–49 years) with histories of IPV recruited from reproductive health clinics (family planning and abortion clinics) as well as a domestic violence shelter; 74% reported male partners' attempts to get them pregnant (i.e., pregnancy-promoting behaviors) as well as abusive behaviors related to controlling the outcomes of a pregnancy (either termination or continuation, following the male partner's wishes). Of note, these examples of the male partner's control of their female partner's reproductive autonomy (described in detail in this article) occurred in both physically violent as well as nonviolent relationships.[24]

A quantitative study of adult men attending urban community health centers supports these findings of associations between IPV and pregnancy-controlling behaviors; men who reported IPV perpetration against a female partner were significantly more likely to have attempted to coerce a pregnant partner to either terminate or continue a pregnancy, and to have been involved in multiple pregnancies ending in abortions (i.e., unwanted pregnancies).[25]

A survey conducted among 1463 adult female patients seeking gynecologic care found that partner unwillingness to use contraception, partner desires that she become pregnant and partner interference with contraception were all positively associated with IPV.[26] Specifically, compared with women without histories of IPV, women with histories of IPV were 2.3-times more likely to report that their partner didn't want to use contraception or wanted her to get pregnant, and almost three-times more likely to report that their partner made it difficult to use birth control.

Our research team also conducted a quantitative study in 2009 among over 1200 young adult sexually active female users of free-standing reproductive health clinics (aged 16–29 years), seeking care for a variety of reasons including complete physicals, pregnancy testing and contraceptive counseling. Via a survey collected on a laptop computer using audio computer-assisted self-interviewing software, one-quarter reported ever experiencing reproductive coercion, which included both experiences of birth control sabotage (active interference with contraceptive methods) as well as pregnancy coercion (threats to promote a pregnancy).[27] Over one-third of women with histories of IPV also reported reproductive coercion. Reproductive coercion increased the risk for unintended pregnancy twofold in the presence of IPV, suggesting that reproductive coercion may partially explain the link between IPV and unintended pregnancy.

These studies all highlight the phenomenon of male partner reproductive coercion that has not been well characterized in previous reproductive health or violence literature. Future research should be conducted that is population based to more definitively assess the prevalence of forms of reproductive coercion and associations with IPV. Similarly, beyond cross-sectional studies, prospective work to examine how reproductive coercion, IPV and unintended pregnancy are inter-related, including specifying the relevant chronologies and patterns, is needed to inform the design of targeted interventions to reduce both the risk for unintended pregnancy as well as IPV victimization.

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