January 30, 2013

Doctors Need To Be On the Lookout For Reproductive Coercion

According to new recommendations from the American College of Obstetricians and Gynecologists, doctors should be aware of and screen for reproductive coercion.

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Birth control pills

Birth control pills

I often blog about issues surrounding sexual assault and reproductive rights; sometimes they go hand in hand (e.g., remember all the political turmoil prior to the 2012 elections in which new terminology such as “legitimate rape” was added to our discourse?). For example, we see the blurring of these two issues in the case of reproductive coercion. Recently the American College of Obstetricians and Gynecologists (ACOG) published recommendations that doctors, especially OB-GYNs, be on the lookout for signs of “reproductive coercion.” As a sexuality researcher, this concept was not entirely new to me, but certainly not something I was all that familiar with. This concerned me because I wondered how many others would be familiar with reproductive coercion.

What is reproductive coercion?

According to an article published in 2010 in Contraception, reproductive coercion can be defined as threats or acts of violence against a person’s reproductive health or reproductive decision-making. The term is often used to describe a set of behaviors which infringe on women’s reproductive rights such as pressuring or coercing a woman to become pregnant or have an abortion, or birth control sabotage. The National Domestic Violence Hotline describes reproductive coercion as a form of domestic or intimate partner violence. Like other forms of domestic violence, women are more likely than men to experience reproductive coercion (i.e., approximately 86% of victims of reproductive coercion are women).

What motivates reproductive coercion?

Ultimately, much like other forms of sexual or domestic violence, reproductive coercion is about control. For example, according to Ann Moore and her research team at the Guttmacher Institute: “men coerced women to become pregnant and then denied paternity or men refused to use contraception and then demanded the woman have an abortion…It’s not necessarily about the outcome, but about the control.” The National Domestic Violence Hotline says that reproductive coercion occurs for many reasons. For example, a woman may be coerced or forced into pregnancy because her partner wants to ensure that she will be in his life forever. Additionally some men force or coerce their partner into pregnancy because they want to leave a legacy. Alternatively, some women may experience force or coercion to end a pregnancy. A man may use threats, physical force/abuse or deception to force or coerce a woman into a pregnancy or abortion. And if a woman does not comply with her partner’s demands, he may act out violently and/or verbally/emotionally abuse her. Another form of reproductive coercion is birth control sabotage. In cases of birth control sabotage, a woman’s birth control method is tampered with which reduces its effectiveness or could possibly render it completely ineffective. Again, the result is the same—a woman is forced or deceived into a situation she does not want.

Although an overwhelming majority of reproductive coercion victims are women, men can also be victims as well. For example, a woman may lie about or misrepresent her contraceptive usage or need. She may do this in order to maintain a relationship with her partner or ensure that he will be a part of her life in the future.

What are the outcomes associated with reproductive coercion?

Unfortunately, there is very little research examining reproductive coercion. However, reproductive coercion has been linked to unintended pregnancy which in turn is linked to a myriad of other negative health-related outcomes for both the woman and infant.  Reproductive coercion can (although it does not always) occur in conjunction with physical or sexual violence which again is linked to numerous sexual and reproductive health issues. Given the rates of unintended pregnancy in the United States, researchers should continue to examine reproductive coercion, especially in regard to other forms of violence, unintended pregnancy and other negative health outcomes.

What to do now?

At this point in time, it is important to be aware of reproductive coercion and inform others about it. It is also paramount that doctors, especially those who regularly see women patients about reproductive health issues, be aware of the recommendations from the ACOG and be on the lookout for reproductive coercion.