Partner Violence and Unintended Pregnancy: Time to Make the Connections


We have known for many years that
violence and abuse are more closely associated with unintended pregnancy than with
pregnancies that are intended. Forced sex, fear of violence if she refuses sex,
and difficulties negotiating contraception and condom use in the context of an abusive
relationship all contribute to increased risk for unintended pregnancy as well
as for sexually transmitted infections including HIV. Newer research now also points
to the influences of male control of contraception and pregnancy pressure on
unintended pregnancy.

We are lead researchers of a new
study, which appeared in Contraception
online
in late January. The research
report, “Pregnancy coercion, intimate partner violence and unintended pregnancy,”
highlights a phenomenon we labeled reproductive
coercion
to describe explicit male behaviors to promote pregnancy.  Particularly for women with a history
of partner violence, these behaviors are significantly linked with unintended
pregnancy.

Such reproductive coercion takes
many forms, but frequently involves a male partner’s direct interference with a
woman’s use of contraception (‘birth control sabotage’). It includes removing condoms during sex
to get her pregnant, intentional breaking of condoms, and preventing her from
taking birth control pills.2,3  

In addition, a male partner may
utilize threats and coercion to pressure a woman to get pregnant (‘pregnancy
coercion’), such as telling her not to use contraception and threatening to
leave her if she doesn’t get pregnant.

Our previous qualitative research
has pointed to a range of reasons that a man might engage in such behaviors
including wanting to leave a legacy, desiring to keep a woman connected to him
in some way, as well as need for control in the relationship.  Clearly, much more research with men
and boys needs to be done to understand male involvement in unintended
pregnancies and how to positively engage men and boys in discussions of healthy
relationships.

Our new study included English-
and Spanish-speaking women ages 16 to 29 who sought health care at five
reproductive health clinics in California.  The reasons the women sought care included annual physical
exams, contraception, pregnancy testing, and testing for sexually transmitted
infections.

Participants completed a
confidential computerized survey (with questions read to them via headphones)
before their clinic visit; the clinic providers did not see the responses. More than half of the respondents (53
percent) reported experiencing physical or sexual violence from a male partner,
or someone they were dating or going out with some time in their lives. A quarter (25 percent) reported that
they had ever experienced ‘reproductive coercion,’ with 19 percent reporting
pregnancy coercion and 15 percent reporting birth control sabotage. Women who reported experiencing both
partner violence and reproductive coercion experienced a 100 percent increase
in their risk for unintended pregnancy.

Unintended pregnancy is clearly a
complex phenomenon. It can be
caused by a number of factors including: a mismatch of intentions and behaviors
for both males and females (i.e., not wanting to get pregnant, while not using
contraception or a condom, often called ‘contraceptive and pregnancy
ambivalence’); limited access to contraception; lack of knowledge about the
range of contraceptive options; stigma associated with asking a partner to use
a condom; as well as substance use such as alcohol accompanying intercourse.

Our study adds another important piece
to this puzzle: Male partners interfering with women’s reproductive
autonomy. Moreover,
the effect of male partner reproductive coercion on unintended pregnancy is likely
to be greater in the context of partner violence, given the clear threat of
violence if she tries to resist her partner’s wishes.

There are many unanswered questions around the interrelationship between
reproductive coercion, partner violence, and unintended pregnancy. Our study provides preliminary findings
indicating a significant connection, but it was limited to lower income women
seeking care in a particular type of family planning clinic in a particular
region. We need to know the
prevalence of reproductive coercion when women are seeking gynecologic care in
other settings such as hospitals or primary care clinics, as well as how
prevalent this is across the general population.How often does reproductive coercion occur in the
absence of partner violence? Does
partner violence precede effective attempts to control a woman’s pregnancy and
the outcomes of that pregnancy? Or do men’s coercive behaviors regarding contraception and reproductive
outcomes precede physical and sexual violence in the relationship? How do men recognize and understand
reproductive coercion? And, perhaps
most critically, why do men engage in such controlling behaviors, and what
strategies will successfully engage men and boys in preventing partner violence
and reproductive coercion?

Beyond answering such research questions, we need to identify effective
strategies to increase awareness about reproductive coercion among both men and
women.  Women may perceive
reproductive coercion and physical violence in a relationship as distinct
issues, and may need support and information to connect the dots between this
range of behaviors and their reproductive health needs.
If family planning practitioners pay attention to and address
reproductive coercion, they may be more successful at identifying clients at
risk both for unintended pregnancy and for harm from partner violence.

Further, such identification is
likely to improve the efficacy of family planning services, because knowledge
of reproductive coercion can inform counseling about contraceptive adherence and
choices (women at risk can be offered methods that are not easily detected by
male partners and are not reliant on male partner consent).  This knowledge that a woman is
experiencing reproductive coercion can trigger more intensive use of prevention
strategies that can reduce unintended pregnancies, including among adolescents,
and promote a woman’s safety. 

It also would be wise to consider
incorporating efforts to reduce reproductive coercion into comprehensive sexuality
education and pregnancy prevention programs.  Making discussions of healthy relationships the foundation
of sexuality education would be a good start.  Then incorporating discussions of abusive behaviors and
partner violence into curricula that discuss contraceptive negotiation would be
particularly helpful in increasing a woman’s success at contraceptive
negotiation and enhancing her reproductive autonomy.  Prevention programs that engage men and boys in reducing
unintended pregnancies should also offer opportunities to discuss
masculinities, gender equity, and reproductive justice.

Finally, vehicles like the currently authorized Violence Against
Women Act’s Health Provision could assist in supporting needed health research
and innovations in practice related to intimate partner violence and reproductive
coercion, including efforts to promote healthy relationships.  We should encourage professional health
care provider organizations to recognize and develop relevant standards and
competencies.  For instance, family
planning standards can be updated to address issues of partner violence and
reproductive coercion.  

Many people were stunned and alarmed by the Guttmacher Institute’s January
report
on teen pregnancy rates in the United States.  It noted a three percent increase in pregnancies among 15-
to 19-year-olds from 2005 to 2006—the first increase in some 15 years.  While teens and young women report the
highest rate of unintended pregnancies, many adult women experience unintended
pregnancies as well. Experts have been
telling us for years that almost half of pregnancies in the United States are
unintended (i.e., mistimed, unplanned, and/or unwanted).

The causes and mechanisms that underlie unintended pregnancy are
numerous and complex, but one thing is clear.  If we are serious about reducing unplanned pregnancies in
this country, we must bridge the gap between efforts
to reduce violence against women and girls and efforts to reduce unintended pregnancy.  We need innovative programs for both
young men and women that address both partner violence and healthy relationships.

1. Miller, E., M. R. Decker, et al. (2010
Epub ahead of print). "Pregnancy Coercion, Intimate Partner Violence, and
Unintended Pregnancy." Contraception.

2. Center for Impact Research. (2000).
"Domestic Violence & Birth Control Sabotage: A Report from the Teen
Parent Project."

3. Miller, E., M. R. Decker, et al. (2007).
"Male Partner Pregnancy-Promoting Behaviors and Adolescent Partner
Violence: Findings from a Qualitative Study with Adolescent Females."
Ambulatory
Pediatrics
7(5): 360-366.

4. Finer, L. B. and S. K. Henshaw (2006).
"Disparities in rates of unintended pregnancy in the United States, 1994
and 2001." Perspectives on Sexual & Reproductive Health 38(2): 90-96.

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To schedule an interview with Elizabeth Miller MD PhD and Jay Silverman PhD please contact Communications Director Rachel Perrone at rachel@rhrealitycheck.org.

  • paul-bradford

    If we are serious about reducing unplanned pregnancies in this country, we must bridge the gap between efforts to reduce violence against women and girls and efforts to reduce unintended pregnancy. We need innovative programs for both young men and women that address both partner violence and healthy relationships.

     

    This is a perfect example of an issue where the impulse to protect women and the impulse to protect the very young find common cause.  Domestic violence is very bad for women and it’s very bad for the unborn since more violence equals more unwanted pregnancy equals more abortion.

     

    The more power women have to choose ‘whether’, ‘when’ and ‘how’ with respect to sex, the less they will be forced to confront an abortion decision.  Violence against women is violence against the unborn.

     

    Paul Bradford

    Pro-Life Catholics for Choice

  • crowepps

    Including the guy doing the battering — who is terrified of abandonment and yet has absolutely no idea how to have a healthy relationship –

  • grayduck

    "The research report, ‘Pregnancy coercion, intimate partner violence and unintended pregnancy,’ highlights a phenomenon we labeled reproductive coercion to describe explicit male behaviors to promote pregnancy. Particularly for women with a history of partner violence, these behaviors are significantly linked with unintended pregnancy."

     

    How can you call these pregnancies unintended when explicit behaviors were engaged in to promote pregnancy?

     

    "In addition, a male partner may utilize threats and coercion to pressure a woman to get pregnant (‘pregnancy coercion’), such as telling her not to use contraception and threatening to leave her if she doesn’t get pregnant."

     

    Are you suggesting that men who wish to become fathers should not have the right to discontinue romantic relationships with women who do not share that goal? If a man wants to avoid causing a pregnancy in a woman who does not wish to become pregnant, why should he not avoid relationships with such women and seek out relationships with women who do wish to become pregnant?

     

    "More than half of the respondents (53 percent) reported experiencing physical or sexual violence from a male partner, or someone they were dating or going out with some time in their lives."

     

    !

     

    "Women who reported experiencing both partner violence and reproductive coercion experienced a 100 percent increase in their risk for unintended pregnancy."

     

    It seems to me that this is potentially a good area for common ground action on abortion. If partner violence or coercion are resulting in abortions, then the solution of preventing such violence or coercion would not be inconsistent with the ideals of either right-to-lifers or pro-choicers.

     

    http://www.abortiondiscussion.com

  • marysia

    i am someone who has worked many years, including in clinical practice with victims of gender based violence, to ensure that women have the power to prevent unintended pregnancies and if pregnant to access alternatives to abortion.

    these problems of reproductive coercion have been going on a long time. and i would add to them the frequent escalation of battery during pregnancy. this can result in miscarriage.

    the male partner might also overtly force the woman to have an abortion, or leave her in a situation where she feels she has no other choice for herself and her child.

    women and children born and unborn will not be able to live and thrive in freedom and safety unless these problems are addressed systematically, at the root.

    and yes, being a perpetrator of violence is deeply harmful to that person, too. men are far less than men can be when they go unchallenged in these behaviors and unsupported in learning constructive ones.


    On Common Ground Columnist & Editor, Nonviolent Choice Directory

  • jodi-jacobson

    The decision to carry or not carry a pregnancy to term is complex and encompasses many factors.

     

    Gray Duck writes:

    It seems to me that this is potentially a good area for common ground
    action on abortion. If partner violence or coercion are resulting in
    abortions, then the solution of preventing such violence or coercion
    would not be inconsistent with the ideals of either right-to-lifers or
    pro-choicers.

    It is not a good area for common ground on abortion.  It is a good area for real, constructive work to prevent domestic violence and abuse, period, and violence and rape more generally, irrespective of the effects on abortion.

     

    The last thing a woman in an abusive relationship needs is someone else taking control over her decisions for their own agenda–which is kind of the point of abuse in the first place…..to control.

     

    If you are interested in preventing violence against women then do so for the sake of it; don’t measure it against your notion of what the ultimate outcome of her vision of safety and autonomy may be as against your own.  Working on the core issue may well result in fewer unintended/unwanted pregnancies related to abuse–and that would be great–but the focus should be on the woman, her autonomy, her safety, and her choices as she defines them, no one else.

     

  • paul-bradford

    Domestic Violence Is Bad For Everybody….Including the guy doing the battering — who is terrified of abandonment and yet has absolutely no idea how to have a healthy relationship –

     

    Let there be no question or confusion on this point: What a batterer does to his partner is wrong.  An actual human being who actually matters for more than her capacity to meet his needs or please him is actually suffering harm.  How shall we name this?  Call it immoral.  Call in criminal.  Call it sinful.  I don’t think the words are what’s important, what matters is to reduce the harm that’s done to the victim.

     

    It’s all well and good to point out that the batterer is troubled by unmet needs of his own, and dealing with those ‘unmet needs’ equals more protection for his victim(s); but the violence is WRONG!  Not by "my" truth, not by "your" truth, just plain wrong.  Wrong all around, and anyone who has trouble seeing that is afflicted by moral blindness (or moral myopia).

     

    How can we stop the wrongdoing?  Does it help to shame the perpetrator, does it help to stigmatize him, does it help to victimize him with violence?  None of these things help, but the fact that there are ineffective ways to deal with domestic violence ought not be a reason for us to lose hope that we can find effective ways to deal with it.

     

    Paul Bradford

    Pro-Life Catholics for Choice

  • paul-bradford

    If you are interested in preventing violence against women then do so for the sake of it; don’t measure it against your notion of what the ultimate outcome of her vision of safety and autonomy may be as against your own.  Working on the core issue may well result in fewer unintended/unwanted pregnancies related to abuse–and that would be great–but the focus should be on the woman, her autonomy, her safety, and her choices as she defines them, no one else.

     

    It’s not as if there’s a limited amount of care and concern and love and compassion to go around.  The same impulse that leads people to want to protect women from violence also leads people to want to protect children from violence.  Policies to reduce violence against women are also policies that will reduce violence against children.

     

    Please don’t imagine there’s any advantage to trying to contain the spread of non-violence.  The fact that one person’s "notion of an ultimate outcome" might be more expansive than another’s should not be a cause for dispute.  To care about the right of determination and the bodily autonomy of women doesn’t preclude a person from caring about the right of determination and the bodily autonomy of a woman’s unborn child.

     

    Paul Bradford

    Pro-Life Catholics for Choice

  • jodi-jacobson

    Policies to address gender-based violence against women by intimate partners are vastly different than those that address violence against living, extant, born children.  They may have similar roots, they may similarities in the exercise of power, but they are vastly different. Confusing these two infantilizes women.

     

    Eliminating violence against women by intimate partners will have an effect on unintended pregnancies and by extension abortions that might have resulted from those unintended pregnancies—-not to mention health outcomes not related to pregnancy, such as fewer broken bones, black eyes, damage to internal organs, less depression and so forth.

     

    It is so predictable to see this reduced to a discussion of your agenda on abortion.  The reality is that any individual woman leaving a violent relationship with an unwanted pregnancy might choose to end that pregnancy and exercise her rights to do so.  Ending/reducing violence will reduce unintended pregnancies that will never happen in the first place, and by extension the need for abortion. There is no cause and effect relationship. 

     

    When you confuse the broader public health outcomes with individuals and individual circumstances, you more often than not end up with coercion of another kind in seeking an outcome.

     

    Women in violent relationships who seek abortion to end an unwanted pregnancy don’t necessarily share your views, Paul, on abortion, nor do they need to be further victimized, shamed, or told what to do.

     

    Care about violence against women for the sake of ending violence against women. Work on violence against born persons for the sake of ending violence against born persons.  Don’t impose your agenda on persons subject to or already victimized by violence by measuring outcomes they may not seek.

     

  • grayduck

    Jodi Jacobson, Editor, RH Reality Check on February 11, 2010 – 4:08pm: "The last thing a woman in an abusive relationship needs is someone else
    taking control over her decisions for their own agenda–which is kind
    of the point of abuse in the first place…..to control."

     

    How does "…preventing [domestic] violence or coercion…"  take "control over [the victim's] decisions?"

     

    http://www.abortiondiscussion.com

  • crowepps

    Well, it’s actually kind of hard to tell whether your plan to end domestic violence is controlling of the women’s decisions or not, since you haven’t actually stated any plans.  Just how would you go about ending domestic violence and abuse?

  • prochoiceferret

    Just how would you go about ending domestic violence and abuse?

    Why, by making fornication illegal, of course! Gray ducks believe that if we would only take that bold legal step, then abortion, rape, domestic violence, child abuse, irresponsible men, bad breath, etc. will be things of the past!

  • crowepps

    And of course Jim Grant’s One Big Idea is ‘No Abortion Under Any Circumstances’ because when a woman has sex, even if she’s raped or the pregnancy has gone wrong, the consequences are ‘pregnancy or death’.

     

    Are there any men participating here who actually recognize that this is a complex issue?  Most of the women, even the passionately ProLife women, seem to understand that there is more than one reason abortions happen and that some of them are absolutely necessary.

     

    Why is it so many of the men seem to be fully invested in their One Big Idea that will be a Simple Solution if only Women Weren’t so insistent on remaining stupid/ignorant/selfish/slutty?

  • crowepps

    Does it help to shame the perpetrator, does it help to stigmatize him, does it help to victimize him with violence?  None of these things help,

    Well, actually, most batterer’s intervention problems do use group counseling to shame the perpetrator which has a fair success rate, stigmatizing him publicly alerts potential victims to avoid him, and putting him in jail for a while will certainly prevent his violence from impacting others altogether so long as he’s locked up.

     

    What actually would make the biggest difference would be getting through to him that controlling other people does not solve his abandonment issues or resolve his anxiety but instead exacerbates it.  The more people there are under his control, the more of their behavior the authoritarian feels it is necessary to monitor, the more intense his anxiety becomes.

     

    This, of course, also applies to the various anti-individualism, anti-immorality crusaders, but it’s really hard to convince them to go in for some helpful counseling since they’re absolutely certain they can solve all their problems by making everybody be Just Like Me.

  • faultroy

    I’m all for studies, but in looking at the summation of the "Contraception Online Study," I note that there are some serious flaws. To begin with the study group is aged 16-29. I don’t know about you, but it is my understanding that a 16 year old being coerced to have sex is a FELONY. Why are minors included in such a study? The police should be called and the perpetrator arrested. The fact that obstensibly responsible "professionals" would include minors in a study indicates a serious ethical lack. The study does not define "sexual violence." In some studies for example the Center for Disease Control)intimate partner violence is defined as "using demeaning language," or " putting someone down." The fact that the study members would define "coercion" as a male telling the woman he will leave her if she does not get pregnant shows me that the study is hopelessly biased and even demeaning to women. Like Martin Luther King, I also have a dream–I have a dream that women at large will not constantly make such absurdly bigoted statements. If a man says that he will leave you if you don’t become pregnant: to most Americans that means that the relationship is thru. From what I remember, the actor Brad Pitt decided that he wanted a divorce from wife Jennifer Anniston because she did not feel the time was right for children, and he wanted them. Do we say that Pitt was acting "coercively?" If a woman wants children and a man does not–does that mean she is utilizing coercion? Well according to these academicians she is. Let’s call the police–or better yet, let’s have a study of female on male "sexual violence" on the number of men that are "coerced" into fathering children that are unwanted and that they must pay for until they are emancipated. It is these kind of mindless studies that anti abortion advocates jump on and show their Congressmen to substantiate the ignorant and mindless waste of taxpayer money. By all means, let’s find out the relationship of Partner violence and unwanted pregnancy–this is a laudable goal. But let’s not include children that under the law are having felonies perpetrated against them into the study and let’s not taint the value of the study with crude biases and bigotry by painting only women as victims of intimate partner coercion when all legitimate studies show this is just not accurate.