Women in abusive relationships often don’t have control over their own reproductive systems because their abusers prevent them from taking birth control, the nation’s leading group of obstetricians and gynecologists warns. The women’s health experts are encouraging doctors to start screening patients for what they call “reproductive coercion” — any situation in which a woman’s partner won’t let her make her own choices about pregnancy.
The American College of Obstetricians and Gynecologists (ACOG) has issued new guidelines to help doctors recognize signs of reproductive coercion within an abusive relationship. “Most OB/GYNs are probably unfamiliar with sexual and reproductive coercion as an entity and probably don’t ask about it,” Dr. Eve Espey, one of the experts who helped write the new guidelines, explained to HealthDay.
Abusers often try to get a woman pregnant against her will — not only by forcing her into sex, but also by hiding her birth control pills or putting holes through condoms. Some abusive partners will even go so far as pulling out a woman’s intrauterine device (IUD) or vaginal ring. And if a woman does become pregnant, reproductive coercion can take the form of pressuring her to continue an unwanted pregnancy when she wants to get an abortion, or forcing her to terminate a pregnancy when she wants to have a child. Ultimately, medical experts explain, this form of abuse is another method of controlling women’s bodies:
“What we’re talking about is specific to women and girls’ ability to contracept, to control their reproductive health,” said Jay Silverman, who studies violence against women at the University of California, San Diego School of Medicine.
“What we’ve found is that many male partners are more actively involved than we would have thought in really blocking women and girls’ ability to do that, as a form of control that’s part of a larger picture of violence against women and girls,” added Silverman, who wasn’t part of the ACOG committee.
One study of the National Domestic Violence Hotline found a fourth of callers had experienced reproductive coercion.
“All the different forms of violence and coercion of women and girls from male partners are based in the entitlement to control their lives, physically and otherwise,” Silverman said. “They also feel entitled to decide whether she’s going to get pregnant or not.”
ACOG’s new guidelines encourage doctors to talk with their patients about reproductive coercion, since some women may not initially recognize it as a form of abuse. In one study in San Francisco-area clinics, reports of reproductive coercion dropped more than 70 percent after patients began receiving more information about it and filling out additional questionnaires about their birth control use. Doctors can also help give women contraceptive options that are harder for their abusers to detect, like IUDs with the removal strings cut out or an extra stash of birth control pills in an unmarked envelope.
As the women’s health experts explained, these coercive tactics are just one piece of the larger issue of sexual abuse and violence against women. But rather than address the roots of intimate partner violence, or secure national funding for domestic abuse prevention programs through the Violence Against Women Act, the anti-choice community has preferred to focus narrowly on coerced abortions — imposing unnecessary abortion restrictions rather than taking real steps to protect women from their abusers.