What You Need To Know About Reproductive Coercion

By Lilly Dancyger

In the mid-2000s, adolescent medicine specialist Elizabeth Miller at the University of California, Davis, noticed a troubling pattern. Several of her young female patients mentioned that their male partners were interfering with their use of birth control. “One patient described the condom breaking six times during sex,” recalls Dr. Heather McCauley, a colleague of Miller’s who was involved in the research. “And while she thought that was strange, she didn’t identify as experiencing abuse.” Miller decided to look further into the phenomenon. She eventually recognized it as a form of intimate partner abuse, and dubbed it reproductive coercion.

Miller published a study in 2010 called “Reproductive coercion and partner violence: implications for clinical assessment of unintended pregnancy,” the first mention of this phenomenon in the scientific literature. She and her co-author Jay G. Silverman discovered that reproductive coercion disproportionately affects younger women, is closely linked with intimate partner violence, and has negative implications for women’s reproductive and psychological health.

As with other forms of abuse, reproductive coercion is a way of asserting control over a partner. In these cases, that control manifests in the form of a male partner either directly interfering with birth control — like poking holes in condoms or hiding birth control pills — or using threats or manipulation to get the woman to agree to try to become pregnant.

“These behaviors look similar to what we see in physically and sexually violent relationships and are meant to exert control,” says McCauley, who is now a social epidemiologist at Michigan State University.

Yet many women who are experiencing reproductive coercion may not know that their partner’s behavior is wrong, or even abusive.

“If a woman is afraid about talking with her partner about condoms or other forms of birth control, or feels pressured or has been threatened by her partner about sex, she may be experiencing reproductive coercion,” McCauley says. “An important goal of our work is to help women recognize the ways their relationship may impact their health, and reproductive coercion is one of those ways.”

McCauley and a team of researchers, including Miller, published another study this month, aimed at finding the best ways for doctors to talk to their patients in order to identify and help women who may be experiencing reproductive coercion. Some of the questions used in the research include:

• Does your sexual relationship include sex you want to be having, or does your partner use pressure or make you feel bad for not having sex?

• Do you feel comfortable asking your partner to use condoms, or are you afraid because you partner has gotten mad at you in the past for initiating this conversation?

• Do you feel like you are using a contraceptive method of your choice, or does your partner tell you not to use it or tell you to use another method?

These questions are designed to determine whether reproductive coercion is taking place even if the patient doesn’t realize anything is wrong.

Certainly, reproduction can happen the other way around as well, with a woman tricking or coercing a man into conceiving a child. “That was a common stereotype before we first documented male-perpetrated reproductive coercion” in 2010, McCauley says. “But the burden of reproductive coercion falls primarily on women because it directly impacts their bodies and their health.”

McCauley says that while the goal of reproductive coercion is often to convince, force, or trick a woman into getting pregnant, it’s ultimately about control over sex and contraceptives. This means that if a male partner refuses to wear condoms or takes condoms off during sex without consent, regardless of whether his intention is pregnancy or if he just doesn’t like to wear condoms, this may still be reproductive coercion.

“I certainly hear stories of men taking off condoms during sex because they say they don’t want to wear them,” McCauley says, “but in many cases, the underlying issue is that men are doing so to exert control over their partner, which is abusive behavior and has implications for a woman’s health.”

“If a patient discloses to a provider that their partner took off the condom during sex and explains that it is because the partner simply didn’t want to wear it,” she says, “I still see that as a clinical red flag and recommend follow up questions to better understand the context of the woman’s relationship.”

McCauley and Miller want to help women identify this kind of behavior as abuse, but that’s only the first step. They’re also concerned with helping these women and their doctors figure out what to do next. Since leaving an abusive relationship can be complicated, they are looking into other options to help women who may be experiencing reproductive coercion.

“If a woman thinks she may be experiencing reproductive coercion, she may talk to her health-care provider about birth control options that her partner doesn’t have to know about,” McCauley says. In 2013, the American College of Obstetricians and Gynecologists officially endorsed incorporating assessment for reproductive coercion and intimate partner violence into routine women’s health care. That includes discussing harm reduction strategies, such as recommending intrauterine devices (IUDs), so that women can control their own reproduction without having to fight with an abusive partner about it.

Of course, this doesn’t solve the problem of abusive, controlling behavior, but it allows women to avoid bringing a child into an abusive relationship while they figure the rest out.

Having a child with an abusive partner makes leaving that relationship even more difficult than it already is, according to the chillingly titled 2004 study on the relationship between custody concerns and domestic abuse, “‘If I Killed You, I’d Get the Kids’: Women’s Survival and Protection Work with Child Custody and Access in the Context of Woman Abuse.” Women may delay leaving their abusers out of fear that they’ll lose custody of their children, that they won’t be able to support their children on their own once they leave, or that leaving will anger their spouse enough that they may hurt the children.

Knowledge that children are likely to keep a woman in a relationship that she might otherwise leave may be part of the motivation for reproductive coercion. This is why access to IUDs and other kinds of long-lasting birth control that a male partner doesn’t have to know about at all, that he can’t tamper with as easily as birth control pills or condoms, is extremely important, and why training doctors to identify and intervene in cases of reproductive coercion is an important step in fighting it.

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