Reproductive coercion

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Not to be confused with Sexual coercion.

Reproductive coercion (also called coerced reproduction) are threats or acts of violence against a partner's reproductive health or reproductive decision-making and is a collection of behaviors intended to pressure or coerce a partner into becoming a parent or ending a pregnancy.[1] Reproductive coercion is a form of domestic violence, also known as intimate partner violence, where behavior concerning reproductive health is used to maintain power, control, and domination within a relationship and over a partner through an unwanted pregnancy. It is considered a serious public health issue.[1][2] This reproductive control is highly correlated to unintended pregnancy.[3]

The three forms of reproductive coercion are pregnancy pressure, birth control sabotage, and pregnancy coercion; they can exist independently or occur simultaneously. If a woman does not comply with her partner's wishes, her partner may act out violently against her, which is a common response.[1]

Around 10% of U.S. men reported ever having an intimate partner who tried to get pregnant when they did not want to or stopped them from using birth control.[4]

Relationship to domestic violence[edit]

Domestic violence, also called "intimate partner violence", is monitored by the US Centers for Disease Control and Prevention (CDC). Their survey on domestic violence measures five types of domestic violence, including control of reproductive health, citing pregnancy pressure and birth control sabotage specifically.[4]

While research remains fragmentary, women in abusive relationships appear to be at higher risk of reproductive coercion and unintended pregnancies.[5]

Pregnancy pressure[edit]

Pregnancy pressure is enacted by a woman's sexual partner when he pressures her into terminating a pregnancy, or into having unprotected sex in order to become pregnant.[1] Ways in which this occurs are through verbal demands, verbal threats, and physical violence.

Examples of verbal pressure are:

  • "If you have a baby, you will never have to worry about me leaving you. I will always be around."
  • "You would have my baby if you really loved me."
  • "I'll leave you if you don't get pregnant."
  • "I'll hurt you if you don't agree to become pregnant."
  • "I'll have a baby with someone else if you don't become pregnant."[2]

Birth control sabotage[edit]

Birth control sabotage is frequently associated with physical or sexual violence, and is a contributor to high pregnancy rates—especially teenage pregnancy rates—among abused, disadvantaged women and teenagers.[2]

Reproductive coercion can take the form of birth control sabotage, either as verbal sabotage or behavioral sabotage, and acts as an active interference with contraceptive methods. Direct actions are taken to ensure the failure of birth control (such as poking holes in or breaking condoms) or complete removal of contraception (such as flushing birth control pills down the toilet or removing contraceptive rings or patches from the body). Partners can also forbid women from using family planning or force them to have sex without protection.[1][2]

Studies on the birth control sabotage performed by males against female partners have indicated a strong correlation between domestic violence and birth control sabotage. These studies have identified two main classes of the phenomenon:[6]

  • Verbal sabotage—verbal or emotional pressure not to use birth control or to become pregnant.
  • Behavioral sabotage—the use of force to have unprotected sexual intercourse or not to use birth control.

14% of surveyed young mothers reported undergoing birth control sabotage.[6] A separate study found that 66% of teen mothers on public assistance who had recently experienced intimate partner violence disclosed birth control sabotage by a dating partner. When women did try to negotiate condom use with their abusive partners, 32% said they were verbally threatened, 21% reported physical abuse, and 14% said their partners threatened abandonment.[2]

Gender and sexual power dynamics and coercion associated with sexual power dynamics are both linked to condom nonuse.[7] Even women with high STI knowledge are more likely to use condoms inconsistently than women with low STI knowledge when there is a high level of fear for abuse.[2]

Pregnancy coercion[edit]

Pregnancy coercion is the act of controlling the outcome of a pregnancy - to either force the continuation or termination of the pregnancy - by threats or acts of violence if the woman does not comply with the perpetrator's demands or wishes.[2][8] Reproductive coercion behaviors may result in several unintended pregnancies that are then followed by multiple coerced abortions.

Women who seek abortions are nearly 3 times as likely to have experienced reproductive coercion by a partner in the past year, compared to women continuing their pregnancies.[2]

A Guttmacher Institute policy analysis states that forcing a woman to terminate a pregnancy she wants or to continue a pregnancy she does not want violates the basic human right of her reproductive health.[9]

Teen pregnancy[edit]

Teenage girls in physically violent relationships are 3.5 times more likely to become pregnant and are 2.8 times more likely to fear the possible consequences of negotiating condom use than non-abused girls. They are also half as likely to use condoms consistently compared to non-abused girls, and teenage boys perpetrating dating violence are also less likely to use condoms.[2]

Teenage mothers are nearly twice as likely to have a repeat pregnancy within 2 years if they experienced abuse within three months after delivery.[2]

26% of abused teenage girls reported that their boyfriends were trying to get them pregnant.[10]

Prevalence[edit]

The Center for Disease Control found that:[4]

  • approximately 8.6% (or an estimated 10.3 million) of women in the United States reported ever having an intimate partner who tried to get them pregnant when they did not want to, or refused to use a condom, with 4.8% having had an intimate partner who tried to get them pregnant when they did not want to, and 6.7% having had an intimate partner who refused to wear a condom;
  • approximately 10.4% (or an estimated 11.7 million) of men in the United States reported ever having an intimate partner who tried to get pregnant when they did not want to or tried to stop them from using birth control, with 8.7% having had an intimate partner who tried to get pregnant when they did not want to or tried to stop them from using birth control and 3.8% having had an intimate partner who refused to wear a condom.

Law[edit]

Reproductive coercion is not criminalized in the United States, but at least one form is criminalized in Sweden: namely, "sex by surprise," or inseminating a woman without her consent.[11]

In Canada, at least one case of a male partner sabotaging condoms leading to pregnancy has caused charges of sexual assault to be brought upon the man. The victim agreed only to sex with an intact condom and clearly did not want to get pregnant, so her boyfriend lacked informed consent for intercourse, the Nova Scotia Court of Appeal said in a 4-1 decision. Without consent, sex is considered assault under the Criminal Code.[12]

In Mexico, the government permits abortion, which is otherwise illegal, for women who have been coerced into pregnancy.[11]

Assessment and intervention[edit]

A typical assessment of women's reproductive health includes the following questions:[2]

  • Has a current or former partner not let you use birth control, destroyed your birth control, or refused to wear a condom?
  • Has your partner ever tried to get you pregnant when you didn't want to be?
  • Has your partner ever forced you to have an abortion or caused you to have a miscarriage?
  • Has your partner ever purposely given you an STD?
  • Are you worried you might be pregnant?[2]

Due to the findings related to reproductive coercion and its prevalence, the American College of Obstetricians and Gynecologists has called for its members to be vigilant for reproductive coercion.[1] Clinical implications discovered through case studies are the following: to assess for reproductive coercion as a part of a routine family planning care; to assess reproductive coercion before discussing contraceptive options; to offer discreet birth control methods; and to assess safety.[2] Some believe that all reproductive health care settings should have a written protocol for identifying and responding to domestic violence that includes reproductive coercion, and agencies that already have a protocol should be reviewed and expanded to address reproductive coercion.[2]

See also[edit]

References[edit]

  1. ^ a b c d e f Committee on Health Care for Underserved Women. American College of Obstetricians and Gynecologists. February 2013 Committee Opinion No. 554: Reproductive and Sexual Coercion Obstet Gynecol 2013;121:411–5. PMID 23344307
  2. ^ a b c d e f g h i j k l m n Chamberlain, Linda, and Rebecca Levenson. Reproductive Health and Partner Violence Guidelines: An Integrated Response to Intimate Partner Violence and Reproductive Coercion. San Francisco: Family Violence Prevention Fund, 2010.
  3. ^ Coker AL. Does physical intimate partner violence affect sexual health? A systematic review. Trauma Violence Abuse. 2007 Apr;8(2):149-77. PMID 17545572
  4. ^ a b c Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS). Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention: 48
  5. ^ Paterno MT, Jordan ET. A review of factors associated with unprotected sex among adult women in the United States.J Obstet Gynecol Neonatal Nurs. 2012 Mar;41(2):258-74. doi: 10.1111/j.1552-6909.2011.01334.x. Epub 2012 Feb 29. PMID 22376055
  6. ^ a b Domestic Violence and Birth Control Sabotage: A Report from the Teen Parent Project. Chicago: Center for Impact Research, 2000.
  7. ^ Hendriksen, Ellen Setsuko, Audrey Pettifor, Sung-Jae Lee, Thomas J. Coates, and Helen V. Rees. "Predictors of Condom Use Among Young Adults in South Africa: The Reproductive Health and HIV Research Unit National Youth Survey." American Journal of Public Health 97.7 (2007): 1241-248. PMID 17538062
  8. ^ Presentation by Alexandra Sueda, MD. Department of Ob/Gyn, Kaiser Permanente. Contraceptive Coercion'
  9. ^ Sneha Barot Governmental Coercion in Reproductive Decision Making: See It Both Ways Guttmacher Policy Review Fall 2012, Volume 15, Number 4
  10. ^ Futures Without Violence. Feb 27, 2012 Teen Dating Violence and Reproductive Coercion: Innovative Opportunities for Programs and Partnerships
  11. ^ a b Carmen M. Cusack, Consensual Insemination, An Analysis of Social Deviance within Gender, Family, or the Home Journal of Law & Social Deviance, Vol. 2, p. 158, (2011)
  12. ^ [1]

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