Study: Simple Intervention May Reduce Reproductive Coercion


A new pilot study by researchers at the University of California-Davis School of Medicine finds that a simple intervention–asking women visiting family planning clinics about sexual violence and coercion–can dramatically reduce the incidence of a form of intimate-partner violence known as reproductive coercion.

Reproductive coercion can involve various actions by abusive spouses or partners.  One example is pregnancy coercion, in which partners pressure women to become pregnant.  Another is birth-control sabotage, in which a partner secretly or overtly damages condoms, throws away or prevents her from using birth control pills or uses other means to force a woman to become pregnant. Intimate partner violence, including pregnancy coercion, is a widespread public health problem, both in the United States and globally.

Researchers specifically asked young women whether their partners had attempted to force them to become pregnant.  The study found that young women who recently experienced partner violence had a 70 percent reduction in the odds that they would continue to experience pregnancy coercion following the questioning. The study participants also were 60 percent more likely to report ending a relationship with a partner because they felt unsafe or the relationship felt unhealthy.

“This pilot study was focused on how we might better identify intimate-partner violence and reproductive coercion in clinical settings and offer women specific strategies to reduce their risk of an unwanted pregnancy and increase their safety,” said Elizabeth Miller, associate professor of pediatrics at the UC Davis School of Medicine and the study’s lead author.

“These findings are extremely encouraging, and suggest that such clinical interventions may be useful in reducing both partner violence and unintended pregnancy.”

The study, “A Family Planning Clinic Partner Violence Intervention to Reduce Risk Associated with Reproductive Coercion,” is published in the journal Contraception. It assessed the effectiveness of what the authors said is the first step toward a harm-reduction health-care protocol for reducing women’s risk of becoming pregnant by abusive partners.

The study was conducted in four Northern California family-planning clinics between May 2008 and October 2009. The intervention was designed collaboratively with the Family Violence Prevention Fund and reproductive health experts. Family planning counselors and clinicians were trained to implement the intervention at two of the four sites. Two control sites provided standard domestic violence and sexual assault screening. Participants included approximately 900 English- and Spanish-speaking women between the ages of 16 and 29 years old, with the vast majority of the women, 76 percent, age 24 or younger.

The intervention involved assessing for partner violence and reproductive coercion during a reproductive health visit, discussing harm-reduction strategies to reduce risk for unintended pregnancy and connecting women to violence-related resources. In the context of inquiries about the reason for the clinic visit, the participants who received the intervention were asked straight-forward questions about pregnancy coercion and birth-control sabotage integrated into their reproductive health visit. A positive response to any of these inquiries was considered reproductive coercion.

The inquiries included:

• “Have you hidden birth control from your partner so he wouldn’t get you pregnant?”
• “Has your partner tried to force you to become pregnant when you didn’t want to be?”
• “Does your partner mess with your birth control?”
• “Does your partner refuse to use condoms when you ask?”
• “Has your partner ever hurt you physically because you didn’t agree to become pregnant?”

Study participants at control clinics who did not receive the intervention received standard-of-care questionnaires that asked: “Have you ever been hit, kicked, slapped or choked by your current or former partner?” and “Have you ever been forced to have sex against your will?” Follow-up surveys with all participants were conducted between 12 and 24 weeks from the date of the initial interviews.

While the odds of pregnancy coercion dropped by 70 percent for women who received the intervention, there was no significant change in the odds of pregnancy coercion for women who had not reported experiencing intimate-partner violence within the past three months, or for women who did not receive the intervention. However, awareness of intimate-partner violence-related resources increased in both the intervention group and the control group, the authors said.

“Given recent reports that question the usefulness of screening for intimate-partner violence in clinical settings and the current critical need for effective low-cost unintended- and teen-pregnancy prevention, it is extremely encouraging that this combination of screening for reproductive coercion and abuse and providing simple educational information significantly reduced women’s pregnancy coercion,” said  Jay Silverman, senior author of the study and associate professor of society, human development and health at the Harvard School of Public Health.

“There is a strong, indisputable link between domestic and dating violence and unintended pregnancy. This study is extremely important because it identifies an effective solution that can be implemented relatively easily,” said study author Rebecca Levenson, of the Family Violence Prevention Fund.  “We need to build on these results by making this intervention the norm in health-care settings throughout the nation as quickly as possible.”

Like this story? Your $10 tax-deductible contribution helps support our research, reporting, and analysis.

Follow Jodi Jacobson on twitter: @jljacobson

  • kevin-rahe

    Researchers specifically asked young women whether their partners had attempted to force them to become pregnant.

     

    Did it ever occur to them to ask whether young women had been pressured to abort their baby?  Or does that just never happen?  I know a woman who was pressured to have an abortion, and I know another who quit taking her oral contraceptives without her husband’s knowledge because she wanted to have a baby.

     

    Are we really to believe that there is an epidemic of men who are forcing women against their will to get pregnant because they want her to have a baby?  If so, that’s huge news because it’s incredibly counter-cultural in a world where too many men simply want sex with no strings attached.

  • jodi-jacobson

    This comment is based on misunderstanding of women, pregnancy, childbirth, abortion and reproductive health and lack of knowledge about the research.

     

    First off, all women seeking an abortion at reputable clinics are always asked by trained counselors whether they are making this decision on their own, whether they have any doubts, and whether anyone is forcing them to undergo an abortion.

     

    But more to the point of this study: Reproductive health experts investigating coercion are interested in what is happening to the women–for their own sake, for the safety and wellbeing of the client–because they, like all of those of us who work to better women’s health, believe that all people should be able to exercise their rights to reproductive and sexual health services and to make choices on sex and childbearing free of coercion.  By anyone. And that no one should be forced to be pregnant against their will or as a result of coercion. Hence this study conducted among women visiting a clinic for health care.

     

    The study sought to identify the incidence of women who had been forced/coerced to become pregnant, an internationally recognized form of control among abusive partners.

     

    Reasons for the visits made by all participants in the study (intervention and control groups together) were 48.8 percent general ob-gyn visit/check-up; 44.0 percent related to obtaining birth control information or supplies or both; 23.3 percent for STI/HIV testing; 9.7 percent for abortion care and 8 percent for emergency contraception.  All of these were asked questions about coercion and coercion related to abortion would have been picked up by counseling at the clinic.  The questions here relate to why they are facing an unwanted/unintended/untenable pregnancy in the first place.

     

    Knowing from existing research that intimate partner violence is indeed an epidemic in many countries and that reproductive coercion is one tool in the arsenal of abusers, they sought out to find out what role coercion played in unintended pregnancy and whether even this simple intervention could assist the women being abused.

     

    Its about the women and their safety.  Can we stick to the subject?

     

  • squirrely-girl

    This topic has actually been addressed several times here on RHRC with numerous links to outside research articles so feel free to do a search. But the short answer is, yes, this is an issue. 

    Are we really to believe that there is an epidemic of men who are forcing women against their will to get pregnant because they want her to have a baby?

    Keep in mind there is a HUGE difference between coercing a girl or woman into getting pregnant and actually wanting them to have the child. 

     

    Similarly, not all reproductive health issues addressed here cover the MAJORITY of situations… however, this in no way diminishes the impact it has on those it affects. Kinda like how pregnancy complications may not be the norm but the effects are still significant to those experiencing them. 

     

    Did it ever occur to them to ask whether young women had been pressured to abort their baby?

     

    Did it ever occur to you that more than one form of reproductive coercion exists? This is yet another form of reproductive coercion and is sometimes related to the aforementioned type. Some abusive men enjoy coercing a woman into pregnancy, blaming the girl/woman for the results and then coercing into an abortion all just to show how much control he has over her body. Sound psycho? It is. 

     

    If so, that’s huge news because it’s incredibly counter-cultural in a world where too many men simply want sex with no strings attached.

    Crazy but true, sometimes that’s what research finds. One might think a person with a medical emergency would have a greater likelihood of being helped with more people standing around, but social psychology research on the bystander effect and diffusion of responsibility found exactly the opposite. Similarly, aren’t you and some other men here constantly trying to argue what “stand up” guys and so not like “the others” you are? If you exist why can’t these men? 

  • prochoiceferret

    This comment is based on misunderstanding of women, pregnancy, childbirth, abortion and reproductive health and lack of knowledge about the research.

     

    Which isn’t a surprise, given that the entire anti-choice movement is based on misunderstanding of women, pregnancy, childbirth, abortion and reproductive health and lack of knowledge about the research!

  • kevin-rahe

    This comment is based on misunderstanding of women, pregnancy, childbirth, abortion and reproductive health and lack of knowledge about the research.

     

    In other words, my comment is based on nothing more than common sense and the experience of acquaintances.  I concede.

     

    First off, all women seeking an abortion at reputable clinics are always asked by trained counselors whether they are making this decision on their own, whether they have any doubts, and whether anyone is forcing them to undergo an abortion.

     

    That would also be “reproductive coercion.”  Where are comparable statistics about the answers to those questions?

     

    9.7 percent for abortion care

     

    Abortion care?  Is that anything like plain old abortion?  Or is it care that was needed after an abortion?  You can dispense with the euphemisms.  I know what you’re talking about.

     

    I’ve scanned several articles about this issue, and almost none of them suggest any real solution, or even suggest that we ought to seek one.  They suggest more contraception as a way to deal with it, and stop there.

     

    From my perspective, this is just one more sign that society’s views of the proper use of sex have not only gone awry, but are getting increasingly sick.  The only real answer is a fundamental change in the way we present sexuality to young people, in order to develop in them an appreciation and respect for both the creative and unitive power of the sexual act.  Selling them short as we have leads to a dark existence.

  • saltyc

    If so, that’s huge news because it’s incredibly counter-cultural in a world where too many men simply want sex with no strings attached.

    Or maybe they have observed other situations in which a woman has a baby and the dude leaves scott-free of any responsibility. Yes this happens. A lot. Just her having a baby does not instantly make the dude responsible. Shocking but true.

  • prochoiceferret

    In other words, my comment is based on nothing more than common sense and the experience of acquaintances.  I concede.

     

    Like they say… the plural of anecdote is not data.

     

    I love it when people think hugely complex social problems have simple, “common sense” solutions. Unless they’re politicians. Then, it leads to real trouble.

     

    I’ve scanned several articles about this issue, and almost none of them suggest any real solution, or even suggest that we ought to seek one.  They suggest more contraception as a way to deal with it, and stop there.

     

    You must have missed the few hundred or so articles advocating for comprehensive sexual education, and how right-wingers constantly fight against it. I thought you wanted poor women to have more abortions?

     

    From my perspective, this is just one more sign that society’s views of the proper use of sex have not only gone awry, but are getting increasingly sick.  The only real answer is a fundamental change in the way we present sexuality to young people, in order to develop in them an appreciation and respect for both the creative and unitive power of the sexual act.  Selling them short as we have leads to a dark existence.

     

    In other words, you think they should only have sex when they want a baby. Good luck convincing people of that… you’ve only been at it for how many thousands of years?

  • kevin-rahe

    In other words, you think they should only have sex when they want a baby.

     

    The only ones who say that are those who are terrified of sex, which includes more of those who point that finger than those they’re pointing at.  (If you don’t think you’re terrified of sex, then ask yourself why you go to war against it with an arsenal full of chemicals and devices.)

     

    You must have missed the few hundred or so articles advocating for comprehensive sexual education

     

    Of course, more contraception is always the solution.  I just don’t believe that the human body was designed so badly that we ought to need all these concoctions, contraptions and procedures just to remain “healthy.”  Those who think we need these things are like someone who clamors for more and better antibiotics and health care, then insists on sitting down to dinner each night with dirty hands to eat an undercooked burger on a moldy bun with unwashed vegetables.  Then when someone else suggests that their hands should be clean and their food washed and well-prepared before they eat, they complain that they’re just trying to “impose their religion on everyone else.”  This web site at the very least excuses, and in many ways promotes, such insanity.

     

    Anyone who would like to see themselves as more than a slave to their own desires, wants to understand why we are male and female and hungers for a truly healthy view of human sexuality, ought to read Pope John Paul II’s Theology of the Body.  A word of warning, though – don’t go there if you’re not ready to be challenged.  http://www.ewtn.com/library/papaldoc/jp2tbind.htm

     

  • beenthere72

    Talk about insanity.  

  • squirrely-girl

    (If you don’t think you’re terrified of sex, then ask yourself why you go to war against it with an arsenal full of chemicals and devices.)

     

    … any way you look at it, people spread germs to other people. 

     

    By the way, do you build houses by hand with sticks and rocks? Do you analyze data with an abacus? One doesn’t have to be afraid of something to appreciate modern technology and conveniences. 

    I just don’t believe that the human body was designed so badly that we ought to need all these concoctions, contraptions and procedures just to remain “healthy.” 

    So how do you feel about diabetes? Chronic health problems? Congenital defects? Do you take vitamins? Do you exercise? 

     

  • julie-watkins

    I noticed this:

    I just don’t believe that the human body was designed so badly that we ought to need all these concoctions, contraptions and procedures just to remain “healthy.”

    And I think that human childbirth (like the human knee) is something that could have been designed better. One thing that kills women in childbirth is the fetus/baby’s head being too large to pass her hips. From an evolutionary perspective, it’s odd that a process breeds true that can kill or cripple the mother in a significant percentage of births. However, increased brain size was such an advantage that those genes did breed true, even if mothers were dying. The mother’s genes are going to be passed down if she manages, for instance, 4 live births before the 5th birth kills her. Even the genes that cause a woman to die with her first birth may be passed down if there’s another mother in the vicinity who’s still got milk and adopts the baby.  Just because something is “natural” doesn’t mean it’s necessarily safe, and not something to worry about.

    Pregnancy is strain enough without added “reproductive coercion” …

  • kevin-rahe

    any way you look at it, people spread germs to other people.

     

    My wife and I just avoid contact when one of us is sick.  Simple.

     

    One doesn’t have to be afraid of something to appreciate modern technology and conveniences.

     

    True, but modern technology and conveniences do have a way of consuming our lives if we don’t exercise discipline in their use.  Take text messaging.  As little time as we have on this planet, how much do you think is wasted sending text messages that are irrelevant and/or totally unnecessary?  It’s mind-boggling.  And it’s amazing how many “essential” technologies we could not only do, but be better off, without.  (Though I rarely used it anyway, I just had text messaging completely disabled on my cell phone a few days ago.)

     

    So how do you feel about diabetes? Chronic health problems? Congenital defects?

     

    They’re not fun, and if they came about because I didn’t choose to take good care of myself, even more unfortunate.  However, if they were the result of deliberately engaging in risky behavior that I could have avoided at no cost, I’d find that particularly devastating.

  • cc

    Anyone who would like to see themselves as more than a slave to their own desires, wants to understand why we are male and female and hungers for a truly healthy view of human sexuality, ought to read Pope John Paul II’s Theology of the Body.  A word of warning, though – don’t go there if you’re not ready to be challenged.  http://www.ewtn.com/library/papaldoc/jp2tbind.htm

     

    Submitted by Kevin Rahe on August 31, 2010 – 1:41pm

     

    Right, we need to read a treatise on sex written by an old celibate who is the head of a 2,000 year old misogynistic men’s club which sees women as handmaidens for the sacred sperm. Puleeze.  And BTW, Kevin, for many women, the prospect of unlimited childbirth is unhealthy so that’s why they use contraceptives. And another BTW, birth control pills are also used to alleviate painful periods and acne so there is medicinal value.

  • squirrely-girl

    My wife and I just avoid contact when one of us is sick.  Simple.

    Awesome solution for the two of you! But, do you think sexual activity is limited to heterosexual, healthy, married couples? If you’re not getting what I’m saying, did you ever use training wheels on your bike? If not, do you know children who benefit from their use? If yes, do you still use them today? Should we just get rid of training wheels altogether if some person, somewhere doesn’t see the need for them, either currently or ever? Imagine if we used this line of reasoning for every technology. Shit, if we went that route we’d always be limited by the least technologically inclined individuals (e.g., Christian Scientists and their views on medicine, the Amish in general). 

     

    Quite simply, not all aspects of comprehensive sex education will apply equally to all individuals. This is generally true for all educational experiences.

     

    True, but modern technology and conveniences do have a way of consuming our lives if we don’t exercise discipline in their use. 

    Don’t get me wrong, I do agree with this statement. But the exercise of restraint or personal discipline are individual decisions. We don’t mandate these concepts by removing choice or information. In other words, we’re not supposed to purposefully teach ignorance to ensure a specific (moral) result. Even God told Adam and Eve about the tree…

    They’re not fun, and if they came about because I didn’t choose to take good care of myself, even more unfortunate.  However, if they were the result of deliberately engaging in risky behavior that I could have avoided at no cost, I’d find that particularly devastating.

    It might be devastating, but would you forgo treatment? Should treatment for these disorders and conditions be reserved for only those individuals who live “morally correct” lifestyles? In other words, should we just not give insulin to a person with bad eating habits? Should we not set bones of people who broke them making stupid decisions? 

     

    Again, don’t get me wrong, I think there are PLENTY of people suffering physically and psychologically due to their own stupid decisions and behaviors. But my reasoning with regard to lifestyle choices doesn’t necessarily transfer to society as a whole. And if adopted as public policy, what I consider to be a physically and psychologically healthy lifestyle would likely exclude all but <10% of the population from medical services. Fair? Not at all. 

     

     

  • beenthere72

    Now can we ban the troll?

  • bornin1984

    Where, exactly, are all the mind your own business people? Especially PCF, who thinks that one should not get involved in the affairs of others unless they ask one to get involved (of course, she prefaces that by stating that someone who does not ask for help probably does not do so because she is not in the right state of mind, in which case intervention is necessary in order to determine if she is).

  • bornin1984

    This is the second time this has happened to me where I click post once and I proceed to make a million of the same posts in a row. I really do want to know why that happens, because it is annoying (plus it makes it seem as if it intentional, when it is not). And what is even funnier, is that the other posts keep being posted even while I am doing something else. That really is messed up.

  • colleen

    (If you don’t think you’re terrified of sex, then ask yourself why you go to war against it with an arsenal full of chemicals and devices.)

    One trouble with the thinking of social conservatives is that you confuse sex with excessive reproduction and fear with self respect. Most people don’t want to have 9 or 10 children and most women don’t wish to demean themselves by marrying someone with your beliefs.

  • bornin1984

    Now can we ban the troll?

    Since it was not done on purpose, I do not see why I would be banned. At any rate, thanks to whoever deleted the mega spam :\\

  • jodi-jacobson

    Is it your position to advocate that victims of intimate partner violence not be assisted?

     

    If someone comes into a clinic of their own accord (a doctor’s office, emergency room, or some other health facility) and is assisted by a medical professional, it is that medical professional’s duty to screen for risk factors.  Intimate partner violence and indeed any form of gender-based violence is a risk factor affecting the health and lives of women and LGBTQ persons, and abrogates their basic human rights.

     

    If it is a difficult concept to grasp, you are clearly in the wrong place.

     

     

  • jayn

    I can’t help but think that if we advocated against this type of intervention (which, as Jodi notes, is part of the job doctors are expected to do), people would complain that we’re not doing enough to prevent reproductive coercion.

     

    Somedays you lose just by waking up in bed.

  • bornin1984

    PCF tried telling me in another thread that we do not assist people unless they specifically ask for that help, to which I pointed out to her that she was wrong (though she did try to cover her proverbial backside by adding in that even if people do not specifically ask for help, we should intervene to make sure that they are in the right state of mind to be refusing help). I am just finding it mildly humorous how she seemingly forgot what she was arguing with me elsewhere.

  • colleen

    Since it was not done on purpose,

    I don’t believe you.

  • ack

    “I’ve scanned several articles about this issue, and almost none of them suggest any real solution, or even suggest that we ought to seek one.  They suggest more contraception as a way to deal with it, and stop there.”

     

    Actually, Dr. Miller and her associates advocate that any woman experiencing pregnancy coercion, defined as “threats or acts of violence attempting to influence the outcome of a pregnancy,” receive a supported referral to a local agency that responds to intimate partner violence, as well as receiving patient education materials with resources and information. Whether an abuser is attempting to force or coerce continuation of the pregnancy or an abortion, they think she needs information identifying that behavior as unhealthy and/or abusive and places to go for help.

  • ack

    Survivors think it’s appropriate for health care providers to ask about their experiences with violence, provided proper confidentiality protocols are maintained. Every patient can choose to disclose or not. The great part about universal education regarding IPV is that people who might not be ready to disclose get resources, people who disclose get resources, and people who can pass the information on to their friends, family, and coworkers get resources. 

  • kevin-rahe

    But, do you think sexual activity is limited to heterosexual, healthy, married couples?

     

    No, unfortunately it’s not.  But that is the ideal we strive for as a society.  And the accommodation of anything other than the ideal undermines the objective of getting people, especially young people, to do the right thing.

     

    But the exercise of restraint or personal discipline are individual decisions.  We don’t mandate these concepts by removing choice or information. In other words, we’re not supposed to purposefully teach ignorance to ensure a specific (moral) result. Even God told Adam and Eve about the tree…

     

    True, but the most important thing He told them was not to eat of it.  No one can be expected to make the right decision, or even the decision that’s “best for them,” if information about the consequences of those decisions have been squelched or presented unfairly.  In real life, the choices that accompany a significant decision rarely if ever have equal consequences.  One choice is always superior to the others, even if in some cases it may appear to be the more difficult one.  Yet, in our bizarre world, some actually try to teach children that the different choices available when a major decision must be made can be equally valid.  Imagine the chaos that would ensue if we trained police officers or air traffic controllers by the same principle.

     

    It might be devastating, but would you forgo treatment? Should treatment for these disorders and conditions be reserved for only those individuals who live “morally correct” lifestyles? In other words, should we just not give insulin to a person with bad eating habits? Should we not set bones of people who broke them making stupid decisions?

     

    No, treatment should not be withheld just because someone arrived at a particular condition through less than noble actions.  But neither should we send a diabetic home with a bag of potato chips and a box of chocolate chip cookies, or give an invitation to a street luging competition to someone who just got their arm put in a cast.

  • ahunt

    The only ones who say that are those who are terrified of sex, which includes more of those who point that finger than those they’re pointing at. (If you don’t think you’re terrified of sex, then ask yourself why you go to war against it with an arsenal full of chemicals and devices.)

    Um…it is not the sex that terrifies us…it is the unwanted pregnancies that can result sans adequate contraception.

    Of course, more contraception is always the solution. I just don’t believe that the human body was designed so badly that we ought to need all these concoctions, contraptions and procedures just to remain “healthy.”

    Think “healthy” AND happy, and you might change your view.

    Those who think we need these things are like someone who clamors for more and better antibiotics and health care, then insists on sitting down to dinner each night with dirty hands to eat an undercooked burger on a moldy bun with unwashed vegetables. Then when someone else suggests that their hands should be clean and their food washed and well-prepared before they eat, they complain that they’re just trying to “impose their religion on everyone else.” This web site at the very least excuses, and in many ways promotes, such insanity.

    WTH? You cannot be suggesting here…that planning one’s family size by the means most appropriate for one’s circumstances is the equivalent of bad hygiene? Your analogy makes no sense.

    Anyone who would like to see themselves as more than a slave to their own desires, wants to understand why we are male and female and hungers for a truly healthy view of human sexuality, ought to read Pope John Paul II’s Theology of the Body. A word of warning, though – don’t go there if you’re not ready to be challenged. http://www.ewtn.com/library/papaldoc/jp2tbind.htm

    Well Kevin…given that the Better Half’s employment kept him away from home roughly six months out of the year….for many, many moons….I don’t have a problem with “seeing” us as a couple of crazed, fornicating weasels during those years.

    Don’t get me wrong….I love the image you conjure with your use of the term “slave.” That’s some loaded language right there! Then I look around, at the home we built together, the photo wall of kids and grandkids and critters and adventures, all documenting well-lived lives…

    …and I wonder WHY THE HELL I SHOULD GIVE A SAILING SHIT ABOUT WHAT THE POPE THINKS ABOUT ANYTHING!

  • kevin-rahe

    WTH? You cannot be suggesting here…that planning one’s family size by the means most appropriate for one’s circumstances is the equivalent of bad hygiene? Your analogy makes no sense.

     

    I was responding to a suggestion about the benefits of “comprehensive” sex education.  If said education is intended only for married people, then your comment is valid.  Otherwise, it’s not.

     

    I look around, at the home we built together, the photo wall of kids and grandkids and critters and adventures, all documenting well-lived lives…and I wonder WHY THE HELL I SHOULD GIVE A SAILING SHIT ABOUT WHAT THE POPE THINKS ABOUT ANYTHING!

     

    Great.  More power to you.  You aren’t then among the group of people that I recommended take a look at the Pope’s teachings, as you apparently don’t see yourself as a “slave to your own desires,” you are comfortable that you “understand why we are male and female,” and you believe you already have a “healthy view of human sexuality.“  Not everyone falls into your category of existence, however.