According to the nation’s leading obstetricians and gynecologists, “reproductive and sexual coercion” — behavior intended to maintain power and control in a sexual relationship — is, sadly, not uncommon.
While homicide is one of the leading causes of death for pregnant women, The American College of Obstetricians and Gynecologists (ACOG) reports that many abused adolescent girls and women are also the subject of another, lesser-known form of abuse: “contraception sabotage,” the most common form of reproductive coercion.
In a just-released committee opinion ACOG notes that victims of such abuse have “male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections, or force them into having unwanted pregnancies or abortions.” This type of “reproductive coercion” says ACOG, can even go as far as male partners “forcefully remove intrauterine devices (IUDs) and vaginal rings, poke holes in condoms, or destroy birth control pills.”
Sexual coercion includes a range of behavior that a partner may use related to sexual decision making to pressure or coerce a person to have sex without using physical force. This behavior includes repeatedly pressuring a partner to have sex, threatening to end a relationship if the person does not have sex, forcing sex without a condom or not allowing other prophylaxis use, intentionally exposing a partner to a sexually transmitted infection, including human immunodeficiency virus (HIV), or threatening retaliation if notified of a positive STI test result.
One quarter of adolescent females reported that their abusive male partners were trying to get them pregnant through interference with planned contraception, forcing the female partners to hide their contraceptive methods. In one study of family planning clinic patients, 15% of women experiencing physical violence also reported birth control sabotage. Among adolescent mothers on public assistance who experienced recent intimate partner violence, 66% experienced birth control sabotage by a dating partner. Compared with women not experiencing abuse, women experiencing physical abuse and women disclosing psychologic abuse by an intimate partner had an increased risk of developing an STI. Based on this information, health care providers should include reproductive and sexual coercion and IPV as part of the differential diagnosis when patients are seen for pregnancy testing or STI testing, emergency contraception, or with unplanned pregnancies because intervention is critical.
ACOG is calling for ob-gyns to routinely screen teens and women for sexual and reproductive coercion at annual exams, new patients visits, during prenatal visits, and postpartum. Some examples of screening questions may include the following, according to the report:
–Has your partner ever forced you to do something sexually that you did not want to do or refused your request to use condoms?
–Has your partner ever tried to get you pregnant when you did not want to be pregnant?
–Are you worried your partner will hurt you if you do not do what he wants with the pregnancy?
–Does your partner support your decision about when or if you want to become pregnant?
ACOG offers these recommendations:
–Participate in education events regarding reproductive and sexual coercion that covers birth control sabotage, pregnancy pressure and coercion, and the effect of IPV on patients’ health and choices.
–Routinely screen women and adolescent girls for reproductive and sexual coercion in a safe and supportive environment that respects confidentiality.
–Counsel patients on harm-reduction strategies and safety planning.
–Offer long-acting methods of contraception that are less detectable to partners, like IUDs and the contraceptive implant or injection.
–Include reproductive and sexual coercion and IPV as part of the differential diagnosis when patients are seen for pregnancy or STI testing, emergency contraception, or with unintended pregnancies.
For more information, or for help, here are several resources:
National Domestic Violence Hotline
Rape Abuse & Incest National Network (RAINN) Hotline
Futures Without Violence (previously known as Family Violence Prevention Fund)