MEDICAL NEWS: Domestic Abuse May Affect Reproductive Freedom

MedPage Today
By Kristina Fiore, Staff Writer, MedPage Today
Published: January 25, 2010
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

In some abusive relationships, men may use strategies to force women to become pregnant, including sabotaging their birth control, researchers reported.

In a cross-sectional study of women treated at five family clinics across northern California, about 20% of women said that their partner tried to coerce them into having a child, Elizabeth Miller, MD, of the University of California Davis, and colleagues reported online in the journal Contraception.

Beyond outright coercion, abusive partners also engaged in birth control sabotage, for example, poking holes in condoms and flushing birth control pills down the toilet.

"It was stunning to have this many women seeking reproductive health services saying, 'this has happened to me,'" Miller said.

To investigate a possible link between domestic violence and forced pregnancy, the researchers conducted a survey of 1,278 women ages 16 to 29 who sought care at the five family planning clinics in northern California.

More than half of the women surveyed -- 53% -- reported physical or sexual partner violence.

Approximately a third of the women who reported partner violence also reported pregnancy coercion or birth control sabotage.

Altogether, the effect of both partner violence and reproductive control nearly doubled a woman's odds of unintended pregnancy (OR 1.99, 95% CI 1.11 to 3.58).

Both pregnancy coercion and birth control sabotage were separately associated with unintended pregnancy as well (OR 1.83, 95% CI 1.36 to 2.46 and OR 1.58, 95% CI 1.14 to 2.20, respectively).

"The findings suggest that pregnancy coercion and birth control sabotage may be an aspect of partner violence that, given its relevance to reproductive health, should be identified by providers in clinical settings," the authors wrote.

Among the reasons men would want their partners to bear children: "It ranges from things like wanting to leave a legacy, to a straightforward desire for attachment, to having absolute control over her body," Miller said. "There are all of these elements to it."

Aisha Mays, MD, director of the Teen and Young Adult Clinic at San Francisco General Hospital who was not involved in the study, said pregnancy coercion is a growing problem that has been around for "quite some time" but is just now being recognized as a major health issue.
"It's about power and control," Mays said. "It's another way of saying, 'this girl's taken, this girl's mine.'"

Mays said she has seen cases in which a young mother who has a child with another partner will be forced by her new boyfriend to have another baby with him.

It's also a way for males to make their partners more dependent on them, according to Amy Bonomi, PhD, MPH, of Ohio State University.
"Women in abusive relationships are sometimes forced to bear children as a means to keep them dependent on their partner and sometimes as a means to justify additional -- and sometimes more severe -- abuse," Bonomi said.

Miller said the findings emphasize the need for family planning clinics to provide intervention programs to combat both reproductive control and partner violence.

Key strategies include advising women about "invisible" forms of birth control such as injectable and intrauterine contraceptives, as well as easy access to emergency contraception.

"If we can identify that reproductive control is going on," Miller said, "we can offer the woman methods for birth control that the partner can't mess with."
Mays added that physicians and counselors should talk about women's empowerment with regard to reproduction during reproductive health visits.
"It tends to be left out," Mays said. "We talk about getting the prescription [for birth control] and its side effects. But we really need to have a discussion around whether the girl is feeling ready for sex."

The study was limited by its cross-sectional design, which "precludes conclusions concerning temporality regarding associations observed among pregnancy coercion, birth control sabotage, and intimate partner violence with unintended pregnancy." Miller et al said additional studies are needed to clarify the chronology of reproductive control and partner violence, and how those factors might combine to affect risk for unintended pregnancy.

The study was supported by grants from the National Institute of Child Health and Human Development, a UC Davis Health System Research Award, and a Building Interdisciplinary Research Centers in Women's Health award.
The researchers reported no conflicts of interest.

This article was developed in collaboration with ABC News.

Primary source: Contraception
Source reference:  Miller E, et al "Pregnancy coercion, intimate partner violence and unintended pregnancy" Contraception 2010; DOI: 10.1016/j.contraception.2009.12.004.