What is reproductive coercion?
The term reproductive coercion is used to define a range of perpetrator pregnancy-controlling behaviours. These behaviours can include birth control sabotage (where contraception is deliberately thrown away or tampered with), threats and use of physical violence if a woman insists on condoms or other forms of contraception, emotional blackmail coercing a woman to have sex or to fall pregnant, or to have an abortion as a sign of her love and fidelity, as well as forced sex and rape . In these circumstances, pregnancy can be used as a tool of control, and a sign to a perpetrator of violence that they have power over their partner’s body. Reproductive coercion is an easy and effective and cowardly way of manipulating and controlling a woman by limiting her autonomy over her fertility and reproductive health and choices.
Women can experience coercion from a partner to either become pregnant or progress with a pregnancy they do not want, or to terminate a pregnancy they wish to continue. It usually occurs within the context of relationships which are violent in other ways, as an additional tool used by perpetrators of violence. [2,3]
What does the research say?
In the United States, the rates of reproductive coercion are suspected to be so large and yet so hidden that the American College of Obstetricians and Gynaecologists is recommending doctors screen for reproductive coercion alongside domestic violence .
Several studies into the rates of reproductive coercion have taken place, also in the US, with one finding that among 71 women with a history of intimate partner violence, almost three quarters had experienced some form of reproductive control , as this 2010 article explains.
The Global Turnaway Study shows that American women who seek and are denied an abortion are more likely to remain in violent relationships than women who are able to access a procedure.
In Australia this is an emerging area of research. However, we do know enough to know how serious a problem reproductive coercion is, and how much risk our complicated abortion access processes place women in violent relationships under.
For example, during pregnancy women face an increased risk of intimate partner violence, and unintended pregnancy occurs more commonly for women in violent relationships . Using medical contraception is often complicated for women in violent relationships, largely due to issues of control and financial surveillance .
What does our client data tell us?
In 2015, after our counselling team reporting increasing anecdotal evidence of reproductive coercion of our clients, we began collecting data on this alongside the longstanding collection of domestic and sexual violence data from our clients. This data helps contribute to a wider understanding of this issue and to ensure our service is responsive to our clients’ needs.
Though the recording of reproductive coercion is relatively new and the sample size is still small, some clear trends are emerging through the early analysis of these statistics, including:
- Around one in seven of our contacts are with women experiencing reproductive coercion;
- Women from culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander (ATSI) backgrounds are over-represented, with up to one in five CALD and ATSI contacts reporting reproductive coercion;
- Up to 60% of contacts experiencing reproductive coercion are aged in their 20s;
- A quarter of those experiencing reproductive coercion don’t report any other form of violence or control, but 74% report domestic violence and 24% sexual violence (with some overlap between these groups);
- Contacts reporting reproductive coercion were more than three times more likely to experience suicidality as our general contact base, and almost twice as likely to experience mental health problems.
Our early data collection on reproductive coercion shows us that around a third of all women reporting domestic violence to us also reported reproductive coercion. Women experiencing domestic violence and unplanned pregnancy are more likely to present at a higher gestation than other women seeking assistance with reproductive choice. Emerging data shows that this is even greater for women experiencing reproductive coercion, and that they are over-represented in those with pregnancies greater than 16 weeks.
Young women under 20 are under-represented in our reproductive coercion data. Some studies suggest they are more likely to go ahead with a pregnancy in this context than to seek support around reproductive choices, highlighting an increased vulnerability to coercion in this group. The inclusion of reproductive coercion screening in ante-natal settings will be vital in reaching appropriate support to these young women.
What are the implications?
While national data exists to show one in three women has experienced physical and/or sexual violence, more work must be done on researching and responding to the overlap between the two.
Any policy or strategy designed to address reproductive health or domestic violence should include reproductive coercion as an issue, in order to ensure women experiencing this type of violence and control have access services and supports which respond to their specific needs.
Reproductive coercion needs to be considered in domestic violence screening. Screening within abortion provision settings are vital if we are to connect supports to women whose lives are impacted by reproductive coercion. Where universal screening is not possible, the emerging trends in our data indicate targeted screening for reproductive coercion should include:
- CALD and ATSI women;
- Women between the ages of 20 and 30 presenting for abortion care; and
- Women presenting for assistance with pregnancies of a higher gestation.
Safety planning and harm reduction intervention for this group of women needs to include steps to ensure access to emergency contraception, access to pregnancy testing in domestic violence settings, and support to access forms of contraception that are less susceptible to detection and tampering.
1. E Miller, M Decker, H McCauley, D Tancredi, R Levenson, J Waldman, P Schoenwald, J Silverman, ‘Pregnancy Coercion, Intimate Partner Violence and Unintended Pregnancy’ (2010) 81 Contraception 316. Available online at http://www.contraceptionjournal.org/article/S0010-7824%2809%2900522-8/abstract.
3. Reproductive and Sexual Coercion American College of Obstetricians and Gynaecologists, Committee on Health Care for Underserved Women: Comittee Opinion Number 554, February 2013. Available online at http://www.acog.org/~/media/Committee%20Opinions/Committee%20on%20Health%20Care%20for%20Underserved%20Women/co554.pdf?dmc=1&ts=20130206T0531420146
4. A Moore, L Frohwirth, E Miller, 'Male reproductive control of women who have experienced intimate partner violence in the United States' Social Science and Medicine 2010, 70 (11): 1737-1744. Online at http://europepmc.org/abstract/MED/20359808.
5. E Miller, B Jordan, R Levenson and J Silverman, ‘Reproductive Coercion: Connecting the Dots Between Partner Violence and Unintended Pregnancy’ (2010) 81 Contraception 457; Available online at https://www.arhp.org/publications-and-resources/contraception-journal/june-2010.
6. C Williams, U Larsen, and L McCloskey, ‘Intimate Partner Violence and Women’s Contraceptive Use’ (2008) 14 Violence Against Women 1382. Online at http://vaw.sagepub.com/content/14/12/1382.abstract.