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

Implications for Clinical Assessment of Unintended Pregnancy

Given this body of evidence, male partner reproductive coercion may be one explanation for contraceptive nonadherence, a key behavior associated with unintended pregnancy. Where providers may have traditionally assumed that certain individual-level factors explain contraceptive nonadherence (such as lack of knowledge, carelessness or ambivalence about becoming pregnant), the addition of this lens of reproductive coercion as a potential explanation for contraceptive nonadherence offers an opportunity for providers to ask about the possibility of pregnancy-promoting behaviors by their patient's partner, and to assess a patient's safety. Specifically, providers should first assess for a woman's pregnancy intentions, followed by specific assessment for reproductive coercion and IPV. In addition to routine assessments, inconsistent or no contraceptive use, frequent requests for emergency contraception and frequent visits for pregnancy and sexually transmitted infection testing may all be clinical red flags for underlying reproductive coercion and IPV. Providers should know their local violence victimization resources (including on-site social workers if available) and how to access supports for women who are currently experiencing abusive and unsafe situations.

Women experiencing reproductive coercion may not necessarily recognize such coercive behaviors as unhealthy or abusive, especially if there is no history of physical or sexual violence in the relationship. Thus, reproductive health providers are in a unique position to increase awareness among their female patients about the impact of unhealthy relationships on their health, including pregnancy risk associated with reproductive coercion. In the clinical setting, offering verbal information as well as educational materials about reproductive coercion may facilitate women's recognition of IPV as well as provide an opportunity to introduce harm-reduction behaviors. Those harm reduction behaviors may include intrauterine device placement (a contraceptive method that is less likely to be sabotaged), longer-acting injectable contraceptives and access to emergency contraception. Providers also have an opportunity to speak directly with their patients about how to negotiate condom use in a safe way.

Finally, in addition to assessing for pregnancy-promoting behaviors and educating clients about reproductive coercion, providers also have an obligation to assess women's safety once a pregnancy is diagnosed. A straightforward question such as "How might the person who got you pregnant react if he were to know about your positive pregnancy test?" may reveal not only conflict around how to resolve the pregnancy, but may also inform how the provider will counsel about options available to their female patient. In an abusive relationship, a positive pregnancy test could lead to escalation of violence in order to terminate the pregnancy, forced continuation of the pregnancy or threats to kill her if she doesn't comply with his wishes regarding the pregnancy. Thus, options counseling with women regarding their desires related to a recently diagnosed pregnancy should also include a frank discussion (in private) with the woman about whether she has experienced reproductive coercion and how her partner might react were he to learn of her pregnancy diagnosis. As disclosures are likely to increase, providers should ensure that they know who the violence prevention advocates are who are available to support them within their clinical setting (such as social workers and victim advocates) and in their community (domestic violence agencies, shelters, rape crisis centers and child protective services).

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