Reproductive and Sexual Coercion: State Sanctioned and Intimate Partner Violence

Reproductive coercion is defined as threats or acts of violence against a partner’s reproductive health or reproductive decision-making and is a collection of behaviors intended to pressure or coerce a partner into becoming a parent or ending a pregnancy. Reproductive coercion is a form of domestic violence (DV), also known as intimate partner violence (IPV), where behavior concerning reproductive health is used to maintain power, control, and domination within a relationship and over a partner through an unwanted pregnancy. It is considered a serious public health issue and has great psychological and social consequences including drug dependence, suicide attempts, and post-traumatic stress disorder.

Traditionally, three forms of reproductive coercion have been identified.  These are pregnancy pressure, birth control sabotage, and pregnancy coercion; they can exist independently or occur simultaneously. There are also three identified periods in which reproductive coercion can take place: pre-intercourse, during intercourse, and post-intercourse. Pre-intercourse may involve pregnancy pressure, during intercourse may involve birth control sabotage, and post-intercourse may involve pregnancy coercion. If a woman does not comply with her partner’s wishes, her partner may act out violently against her, which is a common response.

A forth form of reproductive coercion is called State Sanctioned Reproductive Coercion.  This is institutionalized governmental intervention and criminalization of the reproductive decisions of women.  This encompasses all of the abortion restrictions and bans enacted by state governments across the US, including the ultrasound laws, fetal pain laws, and fetal heartbeat mandates, and “personhood” bills that have been legislated to coerce women into not choosing to terminate unwanted pregnancies.  Furthermore, 27 states have no statutes to protect the mothers of rape-conceived children, allowing rapists to use the threat of custody actions to blackmail and intimidate their victims into not pressing criminal charges. *

Reproductive and sexual coercion is a prevalent tactic used by abusers to assert power and control over their victims in intimate partner relationships and is highly correlated to unintended pregnancy. Victims and survivors are significantly more likely to describe their pregnancy as unplanned and unwanted than women without these violent experiences. In one study, 74% of intimate partner violence victims seeking services at a family planning clinic, an abortion clinic and a domestic violence shelter reported that their partners had threatened to get them pregnant, forced them to have unprotected sex, sabotaged or interfered with their contraception, threatened them with sexual intercourse, tried to control the outcome of their pregnancies if they became pregnant, or in other ways tried to coerce their reproductive outcomes.[i] Intimate partner violence (IPV) is associated with unwanted pregnancy, women not using their preferred contraceptive method, sexually transmitted infections including HIV/AIDS, miscarriages, repeat abortion, a high number of sexual partners, and poor pregnancy outcomes.[ii]

Batterers often implement this type of abuse to assert their power over their victims and they do so in many ways: by refusing access to money for birth control; by sabotaging birth control; by accusing her of infidelity if she requests protection; by purposefully trying to impregnate her so she will forever be connected to him or in effort to thwart any life-goals she may have for herself (school, work, etc.); by punishing her with further forms of abuse if she gets pregnant (all her fault) or if she doesn’t (she’s not getting pregnant and it’s all her fault); by forcing her to perform sexual acts against her will;  by forcing her to perform humiliating sexual acts; by prostituting her; by refusing to support an abortion or forcing her to have one; by denying paternity; by beating her while pregnant causing miscarriage; by exposing her to sexually transmitted diseases—the list goes on.

The ramifications of reproductive and sexual coercion have a huge impact on a victim’s health, safety, autonomy from their abuser, and their ability to live healthfully, free from the impact of violence.  Women who experienced intimate partner violence were over 3 times more likely to have a diagnosis of HIV/AIDS. [iii] Men who rape or are physically violent with partners are shown to have more sexual partners and more frequent intercourse (therefore are more at-risk of exposure to sexually transmitted diseases). [iv] Intimate partner violence can lead to various psychological consequences for victims such as anxiety, depression, post-traumatic stress disorder (PTSD), as well as substance abuse, alcoholism and attempts at suicide.[v]

“Prevalence of Control of Reproductive or Sexual Health by an Intimate Partner Approximately 8.6% (or an estimated 10.3 million) of women in the United States reported ever having an intimate partner who tried to get them pregnant when they did not want to, or refused to use a condom, with 4.8% having had an intimate partner who tried to get them pregnant when they did not want to, and 6.7% having had an intimate partner who refused to wear a condom (data not shown).” vi

Reproductive health professionals are in a critical position to reach women victimized by abusive relationships. The prevalence of intimate partner violence reported among women utilizing sexual health services and seeking care in gynecologic and adolescent clinics is generally about 40-50%. This is not surprising; as such victimization is consistently associated with increased pregnancy and sexually transmitted infection (STI), with abused women demonstrating disproportionately higher rates of seeking care at family planning and other health services related to sexual health, such as HIV and STI testing. Thus, in settings where women seek care for sexual and reproductive health services, providers are well-situated to build a bridge to further services for a significant number of women affected by partner violence. Reproductive health care providers should receive specific tools to assess for reproductive coercion, and strategies to help affected clients. Screening and counseling on this topic may encourage women to recognize how an unhealthy relationship might be constraining her reproductive autonomy and affecting her health, while simultaneously providing an opportunity to introduce strategies to protect her sexual and reproductive health.

While some information and programming is available to assist anti-violence advocates in their efforts to provide the best services possible to victims of intimate partner violence experiencing reproductive and sexual coercion, effective support and assistance varies from state to state and program to program. Not all anti-violence advocates are equipped or well-versed enough about the nuances and issues associated with the dynamics of this type of abuse and how to best assist a victim experiencing it while it is happening nor following a victim’s escape from the relationship. Additionally, it is not uncommon to find that assistance agencies do not always have relationships with one another or collaborate effectively together. In a recent national training sponsored by NCADV and NOMAS on the intersection of intimate partner violence and HIV/AIDS, anti-violence advocates were asked to raise their hands if they had received no more than two hours of training about HIV/AIDS; more than half of anti-violence advocates raised their hands. The reverse was not found to be true of HIV/AIDS counselors when asked the same question of the number of hours they had received of training on intimate partner violence. When the group was asked how many programs had existing, collaborative partnerships with one another (in this case, domestic violence agencies and HIV/AIDS programs) very few raised their hands.

In summary, the impact of reproductive and sexual coercion on victims of intimate partner violence is multi-layered and complex and collaboration between assistance agencies is critical to the safety and long-term health of victims. If collaboration between assistance agencies is lacking as well as advocate training and education on issues related to reproductive and sexual coercion and intimate partner violence, victims suffer. More can and should be done.

*on June 24, 2022 the Unites States Supreme Court reversed 50 years of women’s constitutional rights  (overturning Roe v. Wade) to body autonomy in making private medical decisions to terminate a pregnancy.

 

References

[i]  Moore, A., Frohwirth, L., & Miller, E. (n.d.). Retrieved from http://www.guttmacher.org/pubs/journals/socscimed201002009.pdf

[ii]  Ibid

[iii] Sareen, J., Pagura, B., & Grant, B. (2009). Is intimate partner violence associated with hiv infection among women in the united states?. Science Direct.

[iv] Dunkle, K., Jewkes, R., Nduna, et al Connections between perpetration of partner violence and HIV risk behavior among young men in the rural Eastern Cape province of South Africa. AIDS (in press) and Abrahams, N., Jewkes, R., Hoffman, M., Laubascher, R., Sexual violence against intimate partners in Cape Town: prevalence and risk factors reported by men. Bull World Health Organ 2004; 82:330-37.

[v] Moore, A., Frohwirth, L., & Miller, E. (n.d.). Retrieved from http://www.guttmacher.org/pubs/journals/socscimed201002009.pdf.

vi http://www.cdc.gov/ViolencePrevention/pdf/NISVS_Report2010-a.pdf