The High Cost of Reproductive Coercion

(Photo: AP/Nick Ut)

Planned Parenthood supporters rally in Los Angeles.

For many women, birth control unquestionably improves the quality of their lives. Amid conservative attacks on Planned Parenthood, reproductive-rights activists this month launched a social media campaign dubbed “Thanks Birth Control” to celebrate the economic, social, and health benefits of family planning.

It’s true that contraception can be transformative—but only when it’s voluntary. Unfortunately, contraception can also be used as a tool to abuse and control women. When that happens it’s called contraceptive coercion, or birth control sabotage—and it’s more widespread than you think. Such coercion has been linked to domestic violence, rape, and even the spread of HIV.

While men also experience violence at the hands of an intimate partner, women suffer it at much higher rates. A woman is assaulted every nine seconds, and 72 percent of murder-suicides involve intimate partners (94 percent of those killed are women). I have seen intimate partner violence firsthand in my work with survivors, among friends and colleagues, and as an advocate for reproductive rights and justice.

You might ask: What do reproductive rights have to do with violence inflicted by an intimate partner? Think of it this way: What would life be like if the partner you loved physically abused you? What if that partner not only physically abused you, but also subjected you to sexual violence in your relationship? And then used the relationship to control your reproductive health decisions? This is the reality for many women who live their lives in fear of violence from their partners.

The National Domestic Violence Hotline defines reproductive coercion as what happens when one partner strips the other of the ability to control his or her own reproductive system. It is sometimes difficult to identify this coercion because other forms of abuse are often occurring simultaneously. Examples of reproductive coercion include refusing to use a condom or other type of birth control; breaking or removing a condom during intercourse, and sabotaging birth control methods by tampering with pills or poking holes in condoms. Such coercion can also take the form of lying about birth control (such as lying about having a vasectomy); forcing a partner to forgo birth control; and forcing a partner to continue a pregnancy or have an abortion against her will.

Most think of intimate partner violence as wholly separate from reproductive health. In fact, such violence reflects the abuser’s desire to control the abused—a need that can manifest itself through manipulating reproductive health-care access, decisions, and outcomes.

How often does this happen? Often enough, studies show, to arouse concern among advocates, health-care providers, and policymakers alike. Women who had unintended pregnancies were 4 times more likely to experience intimate partner violence than women whose pregnancies were intended. And those women who had experienced intimate partner violence were more likely to report a lack of birth control use, either because of simple refusal from their partner or because the partner wanted a pregnancy. In 2011, the National Domestic Violence Hotline conducted a survey to find out the extent of reproductive coercion. Out of more than 3,000 callers, 25 percent reported some form of reproductive coercion.

In 2013 a Brown University study showed that of 641 obstetric and gynecological patients, 16 percent reported that their partners had secretly pricked holes in condoms or had hidden birth control pills. Dr. Lindsay Clark, the project’s lead researcher, decided to conduct the study when she realized many of her patients were still getting pregnant even after receiving contraceptive counseling. In 2013, the American College of Obstetricians & Gynecologists (ACOG), responding to both research and clinical observations, recommended that its doctors screen more regularly for intimate partner violence, including reproductive coercion, during patient visits.

One group that’s tackling reproductive coercion head on is Futures Without Violence, an advocacy organization that trains a variety of professionals such as doctors, nurses, judges, and athletic coaches on how to respond more effectively to violence and abuse. Futures has brought together reproductive-health advocates to brainstorm ways to address reproductive coercion.

“The data have long shown us strong connections between intimate partner violence, reproductive coercion, and HIV,” said Kiersten Stewart, the group’s director of public policy. “The truth is you can be married to someone and they can rape you [or] sexually assault you. You can have your birth control sabotaged; it’s a real thing.” Futures has worked with family planning programs to identify signs of relationship violence when providing contraceptive counseling services. Futures has also worked with advocates fighting intimate partner violence, including direct-service shelter counselors, to anticipate reproductive coercion as a part of life for domestic violence survivors.

But identifying reproductive coercion indicators can be hard given the shame experienced by survivors of intimate partner violence and sexual assault. “She’s not going to tell a brand new person in her life about all of the worst things that have happened to her,” said Stewart. “So our job as advocates is to make sure they have all the information.”

While intimate partner violence happens to women of all races and socioeconomic backgrounds, intimate partner violence can hit lower-income women particularly hard. One study by the University of California in San Francisco’s Institute for Advancing New Studies in Reproductive Health (ANSIRH) examined what happens to women when they seek an abortion but are turned away. The findings of that study, known as the Turnaway Study, were summarized in a policy report published by the Reproductive Health Technologies Project. Sixty percent of the women in the study lived below the federal poverty level and almost half were enrolled in public assistance when seeking their abortion.

The study also had some interesting findings related to intimate partner violence. Nearly one in three participants had sought an abortion due to partner-related reasons; of those, 8 percent specifically sought an abortion because of an abusive partner. The data show that at least one woman in this 8 percent subgroup reported being pressured by her partner to seek an abortion. Others were trying to end abusive relationships or avoid bringing children into those abusive relationships. Those women unable to obtain an abortion continued to have contact with the abusive partner after the dissolution of the relationship once becoming parents.

All this sparks the question: What can be done to prevent reproductive coercion? Politically, calls to address intimate partner violence have been viewed as more popular than defending reproductive rights. Some conservative advocates and even elected officials have given time and money to organizations that support survivors of intimate partner violence.

Attempts to enact legislation have simply served to underscore the difficulty of reaching bipartisan consensus. Conservative state legislators in Michigan framed a bill addressing reproductive coercion as an “abortion coercion” ban. At first, this seemed like a step in the right direction until they rejected all amendments suggested by Democrats that would have also made it a crime to coerce a woman not to have an abortion and force her to carry a pregnancy to term against her will.

Futures Without Violence has struggled uphill to educate legislators about the abusive nature of reproductive coercion. “We’ve always tried to educate lawmakers about the linkages between reproductive rights and domestic violence,” said Stewart of Futures Without Violence.  “Many lawmakers are unaware of how prevalent sexual violence is, period.”

Legal remedies have also hit roadblocks. Many advocates for survivors of intimate partner violence would like more rigorous prosecution for abusers who engage in reproductive coercion. One case of reproductive coercion in Canada was successfully prosecuted. But Canadian law distinguishes between consenting to sex or sex acts and consenting to sex acts without contraception. However, American law makes no such distinction, focusing instead on “generalized consent.”

“Generalized consent makes it difficult to prosecute,” said Eesha Pandit, a writer, advocate, and former executive director of the group Men Stopping Violence. “To prosecute [reproductive coercion], you would need to have documentation, forced ingestion, and be able to prove tampering with birth control [or a] condom.”

Conservative attacks on sexual assault survivors make matters worse. Washington Post columnist George Will wrote that sexual assault survivors on campus receive “a coveted status that confers privileges. A controversial Rolling Stone story recounting a gang rape at the University of Virginia prompted high-profile blogger Chuck Johnson to attempt to rattle and expose the student victim’s identity and reveal “everything about her past.” While there were questions about the student’s story that the magazine’s staff failed to verify, advocates pointed out that it is this climate of disbelief, doubt, and persecution that leaves survivors reticent to say anything. This climate is commonly referred to as rape culture. 

“It's a perfect storm,” says Pandit. “The complicated legal interpretation of consent alongside our common problem of placing the burden of proof on the victim, [creates] a climate in which reproductive coercion is almost impossible to prove.”

Unfortunately, no single legal group focuses specifically on prosecuting reproductive coercion in the U.S. This dynamic might change if policymakers on both sides of the aisle worked together on the issue. But the swirl of issues complicating reproductive coercion—domestic violence, poverty, reproductive rights—present built-in political challenges.

 “The people who are most affected by laws restricting abortion access are the same ones who are most vulnerable to reproductive coercion,” said Pandit. “Our response needs to take that into account. We need a response that accounts for racism, sexism, and poverty.”

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