Enough women experience reproductive coercion - male behavior to control contraception and pregnancy outcomes - that a research team now recommends health care providers address the subjects with their patients and tailor family planning discussions and recommendations accordingly.
Researchers from Women & Infants Hospital of Rhode Island were part of a team that published "Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients" in a recent issue of the American Journal of Obstetrics and Gynecology.
"Reproductive coercion, co-occurring with intimate partner violence, is prevalent among women seeking general obstetrics and gynecology care," notes Rebecca H. Allen, MD, of Women & Infants. She and Amy S. Gottlieb, MD, of the hospital's Women's Primary Care Center, participated in the study of 641 women ages 18 to 44, along with Chris Raker, ScD, a statistician in the hospital's Division of Research.
Study participants completed anonymous surveys. The survey defined reproductive coercion as:
- Pregnancy coercion, such as a male partner threatening to harm the woman physically or psychologically (with infidelity or abandonment) if she did not become pregnant
- Birth control sabotage, such as flushing oral contraceptive pills down the toilet, intentionally breaking or removing condoms, or inhibiting a woman's ability to obtain contraception
"This is a far too common problem in this country. A study of 9,000 women by the National Center for Injury Prevention and the Centers for Disease Control and Prevention indicated that at least 9% of adult females in the United States have experienced reproductive coercion," Dr. Gottlieb explains. "Such coercion could have tremendous impact on a woman's ability to plan pregnancies or control her own fertility."
In addition, reproductive coercion has been associated with intimate partner violence, including threats, physical injury, or sexual abuse. This study is the first to examine both measurements - reproductive coercion and intimate partner violence - in the same relationship.
"We wanted to investigate the co-occurrence of these two types of male behavior toward female intimate partners," Dr. Gottlieb says.
Among the women who reported reproductive coercion, 32% experienced intimate partner violence in the same relationship. Nearly half of the women who experienced birth control sabotage also reported intimate partner violence, as did more than one third of the women who experienced pregnancy coercion.
"This is helpful information for health care providers who should tailor the reproductive care they deliver to each patient's particular situation," Dr. Allen says. "Asking questions about reproductive coercion and intimate partner violence is key to giving a woman the family planning counseling she needs."
About Women & Infants Hospital
Women & Infants Hospital of Rhode Island, a Care New England hospital, is one of the nation's leading specialty hospitals for women and newborns. The primary teaching affiliate of The Warren Alpert Medical School of Brown University for obstetrics, gynecology and newborn pediatrics, as well as a number of specialized programs in women's medicine, Women & Infants is the eighth largest stand-alone obstetrical service in the country with nearly 8,400 deliveries per year. In 2009, Women & Infants opened the country's largest, single-family room neonatal intensive care unit.
New England's premier hospital for women and newborns, Women & Infants and Brown offer fellowship programs in gynecologic oncology, maternal-fetal medicine, urogynecology and reconstructive pelvic surgery, women's mental health, neonatal-perinatal medicine, pediatric and perinatal pathology, gynecologic pathology and cytopathology, and reproductive endocrinology and infertility. It is home to the nation's only mother-baby perinatal psychiatric partial hospital, as well as the nation's only fellowship program in obstetric medicine.
Women & Infants has been designated as a Breast Center of Excellence from the American College of Radiography; a Center for In Vitro Maturation Excellence by SAGE In Vitro Fertilization; a Center of Biomedical Research Excellence by the National Institutes of Health; and a Neonatal Resource Services Center of Excellence. It is one of the largest and most prestigious research facilities in high risk and normal obstetrics, gynecology and newborn pediatrics in the nation, and is a member of the National Cancer Institute's Gynecologic Oncology Group and the National Institutes of Health's Pelvic Floor Disorders Network.