The relationship between domestic violence and poor reproductive health outcomes is well established. As well as the other outcomes of domestic violence for women and children, it has a particular reproductive health context.
The World Health Organization reports that intimate partner violence may lead to a host of negative sexual and reproductive health consequences for women, including unintended and unwanted pregnancy, abortion and unsafe abortion, and pregnancy complications .
There is evidence that unintended pregnancies are up to two or three times more likely to be associated with intimate partner violence than planned pregnancies . Reproductive coercion may be one mechanism that helps to explain the known association between intimate partner violence and unintended pregnancy. Reproductive coercion refers to a range of male partner pregnancy-controlling behaviours. See our fact sheet on reproductive coercion for more information.
It is important to note that some women in violent relationships will experience coerced abortion; although there is some available evidence relating to poor mental health outcomes for women in these circumstances , there is little data on the prevalence of coerced abortion in Australia, and what exists is largely anecdotal.
Children by Choice is a pro-choice service and under no circumstances supports a pregnancy termination without the express wish and consent of the pregnant woman herself. Coerced abortion is abhorrent.
Types of violence
Women may experience a range of different types of violence during pregnancy, including physical, sexual and emotional violence, by a variety of people. For the purposes of this fact sheet, the following describes the types of violence women report to us:
Domestic violence: behaviour within an intimate partner relationship that is used to entrench power and control over the other person. This behaviour may manifest in a number of physical, sexual, emotional, financial, or psychological ways.
Sexual violence: forced or coerced sex, or rape, either within an intimate partner relationship or by another person. This includes sex which was coerced using emotional violence and manipulation, threats or use of physical violence, and situations where a woman was unable to properly consent to sex due to the influence of alcohol or drugs or due to an intellectual or cognitive disability or extreme youth.
Reproductive coercion: interference with reproductive autonomy that denies a woman’s decision-making and access to options. This behaviour may be deliberate or indirect, and can manifest in a number of different ways.
Prevalence of violence in pregnancy
Data also shows that using medical contraception to control fertility is often complicated for women in abusive relationships .
National data exists to show one in three women has experienced physical violence and one in five has experienced sexual violence , although there is not a lot of information about women who experience both physical and sexual violence by an intimate partner.
Our service data
In 2014-15, 30.5% of contacts to our counselling and information service in Queensland disclosed violence (domestic violence, sexual assault, and/or reproductive coercion). In 2009-10, this figure was 6%.
7.5% of all our contacts in 2014-15 reported both sexual and domestic violence, highlighting the prevalence of forced sex within ongoing relationships which are also abusive in other ways.
Our client data also shows that women reporting violence are over-represented in later gestation presentation, which has repercussions no matter which pregnancy option they choose: if they wish to continue the pregnancy, they will have missed vital early antenatal care and testing, while if they would prefer to terminate the pregnancy, abortion procedures are more costly and harder to access in the second trimester. For more information on our clients and their experience of violence, you can read our latest Annual Report here.
D, 22, was brought to Australia by her 50 year old boyfriend after an online relationship lasting some years. He told her he would help her go to university in Australia and after her parents died, she had no family left at home to support her. When she arrived in Australia her boyfriend took her to a caravan park in a regional Queensland town – her new home. Far from sending her to university and supporting her to find work, he locked her in the caravan and wouldn’t allow her out except to go to church and the store. The only money she had was what he gave her. He made her have sex with him every day, even though she told him she didn’t want to. He refused to use contraception and she had no access to any, but even so he told her if she became pregnant he would send her back home to her poverty-stricken country, where her extended family wanted her to undergo female genital circumcision against her will. When she became pregnant she was too afraid to tell him in case he ‘hurt’ her. A friend from church gave her our number and we helped her financially and logistically to figure out how she was going to access the abortion she needed – the first step to escaping her relationship. She’s now in Brisbane receiving the help of specialist services for survivors of violence who are also helping navigate her immigration status.
Impacts on women of violence during pregnancy
The Turnaway Study being conducted by the University of Southern California examines the impact of being denied abortion for women in the United States. This longitudinal study shows that women who seek and are denied an abortion are more likely to remain in violent relationships than women who are granted access . There is no reason to suggest the results would be different in an Australian study of the same type, although no local data exists.
Pregnancy and co-parenting may impact on a woman’s capacity or willingness to leave the relationship due to:
- a fear she may lose her children in a custody battle, or that her partner will then have court-ordered unsupervised contact time with them without her there to intervene and potentially protect them from physical violence or worse;
- a fear that he may carry out threats to harm her, their children or himself if she leaves;
- a concern that she won’t be able to take care of herself and the children alone, either economically or psychologically after being subjected to the perpetrator’s emotional abuse undermining her belief in herself and her abilities;
- an awareness that she will need to find accommodation suitable for children, and financially support herself; and
- a belief that children need two parents.
Consequently, a pregnancy can be an impetus to end or leave an abusive relationship when considering the possibility of a child being exposed to his violence and control, or inform a decision to terminate when considering the life-long connection that a child would create between them.
What do women experiencing violence tell us?
A pregnancy in the context of a violent relationship which is unwanted by the pregnant woman herself can be extremely distressing. Certain themes are recurring in the conversations we have with clients who report violence:
Overall strain and distress as a result of the violence: women say they are ‘at breaking point’. The children they have are as much as they can handle given what they have been through.
Child Safety involvement as a result of the violence: women report that they can’t handle the mental health impact of having another child removed like they did the last one, due to violence in the relationship.
A desire to escape a relationship due to violence: women see ending the pregnancy as another strategy for cutting ties with the man involved, and of being less likely to subjected to further violence if there is no child connecting them.
In these circumstances a termination may be the preferred option of the pregnant woman directly as a result of the violence she experiences, in terms of not wanting to parent with the perpetrator and therefore expose a child to potential violence also, or wanting to make her ability to disentangle from the perpetrator easier. Continuing a pregnancy to become ‘co-parents’ can further entrench a connection between the woman and the perpetrator, which may continue regardless of the context of the relationship itself and can become a tool for further manipulation through family court proceedings.
Given this, access to and affordability of termination procedures can be entwined with a woman’s ability to escape domestic violence. Issues that are so often present in violent relationships, including surveillance, manipulation, and financial or other control, further restrict a woman’s capacity to access a termination, even if she is doing so to attempt greater safety for herself and any existing children.
As co-parents in a domestic violence context, a woman’s ability to ever be safe from that perpetrator’s violence against her and/or her children is significantly compromised. If women choose to access abortion in the context of domestic violence, it needs to be available.
1. C Garcia-Moreno, A Guedes and W Knerr (2012) Understanding and addressing violence against women: Intimate partner violence World Health Organisation Department of Reproductive Health. Available online at http://apps.who.int/iris/bitstream/10665/77432/1/WHO_RHR_12.36_eng.pdf?ua=1 or download at http://www.who.int/reproductivehealth/topics/violence/vaw_series/en/.
2. E Miller, R Decker, H McCauley, D Tancredi, R Levenson, J Waldman, P Schoenwald and J Silverman Pregnancy coercion, intimate partner violence and unintended pregancy' Contraception 2010 Volume 81 Issue 4. Online at http://www.contraceptionjournal.org/article/S0010-7824(09)00522-8/abstract.
3. American Psychological Association, Task Force on Mental Health and Abortion. (2008). Report of the Task Force on Mental Health and Abortion. Washington, DC. Available online at http://www.apa.org/pi/wpo/mental-health-abortion-report.pdf
4. K Chibber et al, ‘The Role of Intimate Partners in Women’s Reasons for Seeking Abortion’ (2014) 24(1) Women’s Health Issues e131; Lynn Meuleners et al, ‘Maternal and foetal outcomes among pregnant women hospitalised due to interpersonal violence: A population based study in Western Australia, 2002-2008’ (2011) 11(70) BMC Pregnancy and Childbirth.
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.
7. See the Our Watch website for an overview of Australian data around violence against women and children: http://www.ourwatch.org.au/Understanding-Violence/Facts-and-figures
8. S Roberts, M Biggs, K Chibber, H Gould, C Rocca, D Greene Foster, 'Risk of violence from the man involved in the pregnancy after receiving or being denied an abortion' BMC Medicine 2014, 12:144. Available online at https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0144-z.