How doctors can ask women about reproductive coercion

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Some men purposely break their own condoms or pressure female partners in their teens and 20s to go without birth control in order to get them pregnant.

A new study, published in the journal Contraception, provides doctors and nurse practitioners a streamlined set of questions to discuss with their female patients about a practice known as “reproductive coercion.”

Half of all pregnancies in the United States are unintended. Further, women of reproductive age are at highest risk of intimate partner violence and often experience unintended pregnancies, miscarriages, and preterm labor as a result of the victimization. Similar to other forms of controlling behavior in abusive relationships, some men use reproductive coercion to interfere with women’s birth control use as a means to control them.

“This study provides guidance for clinicians to augment interventions that have already been proposed for reproductive coercion—specifically which questions they should be asking to guide their clinical decision-making with their patients, including whether a partner has ever prevented them from using birth control and whether a partner has ever interfered with condom use while having sex,” says Heather McCauley, a social epidemiologist and assistant professor in the human development and family studies department at Michigan State University.

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McCauley was part of the medical research team—led by physician and researcher Elizabeth Miller—that in 2010 identified reproductive coercion as a phenomenon in abusive relationships. That work has influenced clinical practice guidelines; in 2013, for example, the American Congress of Obstetricians and Gynecologists recommended doctors incorporate intimate partner violence and reproductive coercion assessment into routine sexual and reproductive health care.

But clinicians were still unsure how to talk to their patients about the issue—so for the current study, researchers dug further into the issue for answers.

For the study, researchers surveyed 4,674 women seeking care at reproductive health clinics in California and Pennsylvania and discovered that reproductive coercion included two distinct characteristics: pregnancy coercion and condom manipulation.

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Pregnancy coercion includes threats or pressure to promote a pregnancy, while condom manipulation includes active sabotage of condoms. From those findings, the study recommends that health care providers ask their patients the following questions:

In the past three months, has someone you were dating or going out with:

  • Told you not to use birth control (like the pill, shot, ring, etc.)?
  • Taken your birth control away from you or kept you from going to the clinic to get birth control?
  • Made you have sex without a condom so you would get pregnant?
  • Taken off the condom while you were having sex, so you would get pregnant?
  • Put holes in the condom or broken the condom on purpose so you would get pregnant?

It’s not that doctors don’t want to talk to their patients about reproductive coercion and intimate partner violence, but that they don’t know how to talk to them about these complex issues and, until recently, didn’t recognize that violence and coercion in women’s relationships could be driving why they were seeking reproductive health care, McCauley says.

“This study helps clinicians provide better care for their patients, particularly their adolescent patients.”

Coauthors of the study are from Johns Hopkins University; Johns Hopkins University; the University of Pittsburgh; Harvard University; and the University of California, San Diego.

Source: Michigan State University