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

Expert Commentary

The associations between IPV and poor reproductive health outcomes have been well established in the women's health and violence literature. More recent studies have also identified that unintended pregnancy is more likely to occur in the context of abusive relationships than when the pregnancy is planned. Unintended pregnancy is linked to multiple adverse health outcomes in pregnancy, poor care-seeking among pregnant women, and poor infant and child health. Elucidation of the etiologies of unintended pregnancy and concrete programmatic and policy initiatives are needed urgently to improve maternal and child health. Abuse in relationships can include forced sex, violent intercourse, angry responses to requests for condom use, as well as fear and safety concerns which constrain a woman's ability to negotiate contraceptive and condom use with an abusive male partner. This new concept of male partner reproductive coercion described in this article represents another mechanism to consider in understanding connections between IPV and unintended pregnancy. Reproductive coercion emerges as a phenomenon that is both associated with and distinct from IPV. Thus, providers of women's health should receive training to assess for both reproductive coercion and IPV. With this new information about how male partners may actively try to promote a pregnancy that the female partner does not want and may attempt to control the outcomes of a pregnancy, pregnancy test counseling and options counseling for a pregnancy diagnosis should include assessments for reproductive coercion and IPV. This concept of reproductive coercion shifts the frame from a focus on individual factors (such as a woman's ambivalence about pregnancy) to the contribution of relationship factors that have a clear impact on a woman's ability to prevent an unwanted pregnancy. State- and national-level policies pertinent to women's health should include provider training on reproductive coercion and IPV, incorporate education about such coercion and partner violence into pregnancy prevention education, and ensure that women have access to violence-related support services when seeking health services.

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