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 This type of intimate partner violence is called ‘reproductive
coercion,’ and health care providers should know how to screen for
it and intervene effectively, the authors write.
“Ultimately, (reproductive coercion) is about power and control -
the perpetrators get off on that feeling of having complete power
over their partners, even to the point of controlling a bodily
function exclusive to women: pregnancy,” said lead author Dr. Jeanna
Park of the University of Illinois in Chicago.
“And although it seems irrational to threaten, coerce or trick a
woman into acts that lead to pregnancy, perpetrators will then often
force their partners to abort the pregnancy, further perpetuating
the cycle of partner violence,” Park told Reuters Health by email.
Most often, women are the victims of reproductive coercion, but men
can be victimized as well, the authors write. It often goes
unrecognized by doctors or victims themselves.
Birth control sabotage can include hiding or destroying
contraceptive pills, removing vaginal rings, patches or intrauterine
devices (IUDs) without a partner’s permission, removing or breaking
condoms, or not withdrawing when that was the agreed upon method of
contraception.
Coercion can also include threatening to leave or to hurt a partner
who does not agree to become pregnant, or who does not agree to
terminate a pregnancy, depending on the desires of the perpetrator.
Between 15 and 25 percent of women may experience reproductive
coercion at some point, according to other studies.
“Screening can be performed in conjunction with, or independent of,
intimate partner violence screening with an open ended question
like, "what challenges have you had with your current or previous
contraceptive methods?’” Park said.
A more detailed screening and assessment script is provided by the
National Health Resource Center on Domestic Violence in partnership
with The American Congress of Obstetricians and Gynecologists that a
provider can request online, she said.
Pediatricians, family practitioners, obstetrician/gynecologists,
internists, and nurse practitioners should all be aware of
reproductive coercion, she said.
Future studies should also investigate if and how men or people in
the LGBT community experience reproductive coercion, the authors
write in the American Journal of Obstetrics and Gynecology.
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“Intimate partner violence happens (to women in) all races,
socioeconomic classes, all levels of education,” said Dr. Rebekah
Gee, associate professor of Health Policy and Management and
Obstetrics and Gynecology at Louisiana State University, who was not
part of the new review. “It doesn’t spare anyone, and I ask every
single patient.”
Women who are poorly educated, have low economic means or rely on
partners for income are more vulnerable and have a harder time
leaving or becoming independent, Gee told Reuters Health by phone.
“Providers may suspect (reproductive coercion) when a patient has a
known history of intimate partner violence, expresses a desire to
obtain contraception but repeatedly loses her prescription or
changes her contraceptive method frequently, presents with frequent
unintended pregnancies or sexually transmitted infections, or
appears apprehensive of her partner discovering her contraceptive or
pregnancy choices,” Park said.
If a patient says yes, they are being victimized, the next steps
will depend on where in the country they live and what the patient
desires -- ideally she can immediately be referred to a shelter or
social services, Gee said. But this process can be complicated and
take hours to sort out, and those hours are not reimbursed by
insurance companies, she noted.
If a woman chooses to stay with the perpetrator, discrete methods of
contraception that are less susceptible to tampering, such as an
intrauterine device, subdermal implant or contraceptive injection
should be discussed, Park said.
SOURCE: http://bit.ly/1JFku5r American Journal of Obstetrics and
Gynecology, August 24, 2015.
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