October 31, 2013 — Summary of "Reproductive Coercion and Co-Occurring Intimate Partner Violence in Obstetrics and Gynecology Patients," Clark et al., American Journal of Obstetrics & Gynecology, October 2013.
"Reproductive coercion may lead to unprotected intercourse and thus could have significant implications for health care providers' efforts to promote reproductive health and family planning," according to Lindsay Clark and colleagues at Brown University's Warren Alpert Medical School Department of Obstetrics and Gynecology.
The researchers defined reproductive coercion as any "male behavior to control contraception and pregnancy outcomes of female partners," including pregnancy coercion, such as threatening a woman physically or psychologically if she does not become pregnant, and birth control sabotage, such as intentionally breaking a condom. They added that reproductive coercion is often linked with intimate partner violence, including physical injury, psychological abuse, sexual assault and other actions.
The study aimed to "estimate the prevalence of reproductive coercion in a large obstetrics and gynecology clinic located within a[n] urban, university-based medical center," as well as "[assess] the prevalence of intimate partner violence specifically in relationships where reproductive coercion occurred."
The researchers offered an anonymous survey to women presenting for routine obstetrics and gynecology care at a large clinic. Clark and colleagues excluded women who were not ages 18 through 44, did not speak or read English, or presented for surgical or subspecialty care.
The survey included 14 questions assessing reproductive coercion, 10 demographic questions and three questions regarding co-occurring intimate partner violence. The 14 questions on reproductive coercion were equally divided into questions on pregnancy coercion and birth control sabotage; women had to answer at least one of the 14 questions to be included in the study.
The researchers considered a woman to have been coerced or to have experienced intimate partner violence if she answered affirmatively to any of the questions on those subjects.
The survey also asked women who indicated that they had experienced reproductive coercion how their health care providers could have helped them navigate their situation.
Of the 737 women approached to participate in the study, 641 (87%) completed the requisite one reproductive coercion question to be included in the analysis. Overall, 42% identified as Latina, 16% black, 27% white and 15% as "another or mixed race," while almost half of the group (46%) said they had obtained an associate's degree, attended some college or received a four-year college degree.
The majority of the participants (70%) said they were married or in a committed relationship, while another 28% said they were single or in a dating relationship. In addition, 94% said they had been pregnant at one point in their lives, while 58% were currently pregnant. Seventy-four percent of the women said they were receiving health care coverage under Medicaid.
The researchers determined that 16% of women said they had experienced birth control sabotage, pregnancy coercion or both within their lifetime, while 11% reported only pregnancy coercion and 9% reported only birth control sabotage.
Women who said they had experienced either one or both forms of coercion were more likely to be single or in a dating relationship; more likely to be black, multiracial or an "other" race; and more likely to be receiving no-cost care, uninsured or unaware of their insurance status. Specifically, women who said they were single were twice as likely as those in committed relationships to report reproductive coercion, while women uncertain of their relationship status were almost six times more likely to report coercion. Women who said they were pregnant were less likely to report coercion.
The study also found that among the 103 women who reported reproductive coercion, 32% also screened positive for intimate partner violence. Specifically, 46.6% of women who reported birth control sabotage indicated they experienced co-occurring intimate partner violence, while 34% of those who reported pregnancy coercion reported such violence.
In addition, 20% of women who reported reproductive coercion said it would have been helpful if their "health care providers had discussed hidden forms of birth control with them," the researchers wrote. Fourteen percent said it would have been helpful if their health care providers had asked them about feeling pressured to become pregnant, while another 3% said it would have been helpful to be asked if their partner had interfered with their birth control.
"This study affirms findings of previous investigations that reproductive coercion is common among reproductive-aged women and is associated with a history of intimate partner violence," the researchers wrote, adding that it also advances "current knowledge by assessing the prevalence of reproductive coercion among a broader female patient population and addressing the prevalence of intimate partner violence specifically in relationships where reproductive coercion has occurred."
They added that the findings should inform routine clinical practice, especially with regard to contraceptive counseling and family planning because ob-gyns are "well placed to identify this phenomenon and lessen its impact on the health and well-being of patients and their families."
They concluded, "With improved understanding, [ob-gyns] will be better equipped to identify affected female patients and offer them options to help interrupt the cycle of birth control sabotage, male power over pregnancy decision making, and unwanted pregnancies."