Pregnancy Coercion Research Articles

Reproductive Coercion: Prevalence and Risk Factors Related to Relationship Health Knowledge and Skills.

Reproductive coercion is any behavior that limits a person's reproductive decision-making and can lead to negative health and safety outcomes. Previous research has explored reproductive coercion prevalence rates in clinical samples, as well as demographic risk factors for experiencing reproductive coercion. The purpose of this study is to assess the prevalence rates of two specific forms of reproductive coercion, pregnancy coercion and condom manipulation, in an ethnically and racially diverse sample of young females. We also explore the association between relationship health knowledge and skills with reproductive coercion. We used a sample of 143 females with previous sexual activity. Participants were diverse in terms of race, ethnicity, sexual orientation, and family immigration status. Descriptive statistics and logistic regression analyses were used to determine prevalence rates of pregnancy coercion and condom manipulation and the likelihood of experiencing reproductive coercion based on participants' knowledge and skills related to relationship health. Results revealed that 16.1% of the sample had experienced reproductive coercion, with all participants in this group reporting lifetime experiences of pregnancy coercion. Lifetime experiences of condom manipulation were reported by 6.3% of the sample. The most common form of reproductive coercion experienced by participants was being told by a partner not to use any birth control. Furthermore, results indicate that higher relationship health knowledge may be a protective factor for pregnancy coercion and condom manipulation. Likewise, higher decision-making skills in relationships and higher confidence in relationships may also protect against condom manipulation. Results from this study suggest implications for sexual and relationship health programming that expands education around consent, choice, decision-making, and communication around the use of contraception.

Women’s Lived Experiences of Reproductive Coercion and Abuse

Abstract Purpose Reproductive coercion and abuse (RCA) refers to the use of physical, psychological or sexual violence or coercive behaviours to control a woman’s reproductive choices. Perpetrators use various forms of RCA such as controlling the outcome of a pregnancy, contraceptive sabotage and pregnancy coercion. Current research has focused primarily on quantitative data and health interventions, yet there is limited qualitative research on the overall experience of RCA. To address this gap, this study aimed to investigate the question: “What are women’s lived experiences of RCA?”. Methods Twenty women who had experienced RCA were recruited to participate in qualitative in-depth interviews. Data were analysed using interpretive phenomenological analysis. Results Three themes were developed that describe women’s lived experiences of RCA: I didn’t have a way out, where women described how their partners threatened them both with direct violence or indirectly through manipulation; I still feel guilty which centered around women’s overwhelming feelings of guilt and self blame and I don’t feel worthy, that outlined how RCA eroded women’s self-concept, particularly in relation to motherhood. Conclusions Our findings foreground the profound impacts of RCA on women’s mental health, identity and wellbeing which can linger for many years after the experience. It is vital that practitioners working with women who have experienced RCA consider these impacts and how to address and respond to them effectively.

Money, Economic Abuse, and Food Insecurity: A Qualitative Study among Young Nigerian Women with a History of Intimate Partner Violence

Intimate partner violence (IPV) occurs in high proportions among young women, with long-lasting adverse health and social outcomes. Recent research findings suggest that experiencing economic vulnerability may influence the ways in which young women experience or are at risk for IPV, including economic abuse. Economic abuse, a form of IPV, involves a partner’s control over money and other economic resources or activities. This study explored economic vulnerability and IPV, including economic abuse, among young Nigerian women reporting a recent history of IPV. In-depth interviews (n = 25) were conducted with women aged 18–30 years who had experienced IPV in the past year. Women were recruited from community and health facilities in low-income neighborhoods of Ibadan, Nigeria. A semi-structured interview guide was used to gather data on women’s economic vulnerability (e.g., food security, living situation, employment/education opportunities, family financial support, economic independence) and experiences of IPV. An analysis was conducted using a thematic analysis approach. The coding scheme was based on interview protocols, adding open codes from emergent themes identified in the interviews. On average, participants were 21 years old, most had children (68%) and reported to be cohabitating with a male partner (56%), and 48% had less than a secondary level of education. Among the emergent themes, women reported economic vulnerability as being financially dependent on a male partner for basic needs. Among this sample, economic vulnerability was exacerbated by limited education, training, and work opportunities, and a disproportionate burden of household labor. Economic vulnerability precipitated all forms of IPV, including economic abuse, as well as sexual and pregnancy coercion. Economic abuse was reported to occur when male partners controlled household finances and denied women adequate allowance to purchase household food, including food for children. Findings from this qualitative study suggest that interventions promoting educational and employment opportunities may be critical to reducing financial reliance on male partners and young women’s vulnerability to economic abuse and other forms of IPV. More research and programmatic work are needed on food deprivation as a form of economic abuse affecting women and their children.

An examination of the association between forced sex history and reproductive coercion experiences among Black women attending STD clinics in Baltimore, MD, USA

BackgroundReproductive coercion victimization (RCV) is a significant public health issue that negatively affects women’s sexual and reproductive health outcomes. Less is known about reproductive coercion perpetration (RCP). Few studies have examined these phenomena among representative samples of Black women.MethodsRetrospective data of women (n = 298) attending STD clinics in Baltimore, MD were analyzed. We calculated lifetime and 12-month prevalence reports of reproductive coercion, and reported values stratified by forced sex history. Binomial logistic regression models were used to examine the association between forced sex history and RCV, accounting for other types of violence typologies.ResultsLifetime and past 12-month RCV and RCP prevalence were higher among women with forced sex experiences than their counterparts (Lifetime RCV: 46.9% versus 17.5%; past 12-month RCV: 19.4% versus 8.5%. Lifetime RCP: 24.5% versus 17%; past 12-month RCP: 13.3% versus 10.5%). Adjusted models, lifetime reproductive coercion: Women reporting forced sex had a 3.58 times higher odds of having had experienced RCV compared to women not reporting forced sex (AOR 3.58; 95% CI 2.00, 6.46). Women reporting forced sex had a 3.66 times higher odds of having ever experienced pregnancy coercion compared to their counterparts (AOR 3.66; 95% CI 1.93, 7.03) and 4.30 times higher odds of having ever experienced condom manipulation (AOR 4.30; 95% CI 2.15, 8.86). Adjusted models, past 12-month reproductive coercion: Women reporting forced sex had a 2.72 times higher odds of having had experienced past 12-month RCV compared to women not reporting forced sex (AOR 2.72; 95% CI 1.27, 5.91). Women reporting forced sex had a 3.25 times higher odds of having experienced past 12-month pregnancy coercion compared to their counterparts (AOR 3.25; 95% CI 1.38, 7.83) and 3.41 times higher odds of having experienced past 12-month condom manipulation (AOR 3.41; 95% CI 1.14, 10.98).ConclusionsParticipants in our study reported high rates of RCV. Our novel exploration revealed significantly high rates of co-occurring forced sex experiences and RCV and initial prevalence report of RCP. Agencies have a unique opportunity to intervene by implementing screening protocols and referrals for supportive services. These findings may inform future intervention research efforts aimed at improving reproductive health outcomes among Black women.

Disability and violence: Urgent call for data to achieve equity

Disability and violence: Urgent call for data to achieve equity

Clinician views and experiences with reproductive coercion screening in a family planning service.

Reproductive coercion refers to behaviour that interferes with a person's reproductive autonomy, such as contraceptive sabotage, pregnancy coercion, controlling a pregnancy outcome or forced sterilisation. Routine screening for reproductive coercion, together with clinician education, was implemented at a family planning service in New South Wales, Australia, in December 2018. A study was undertaken to explore the views and experiences of clinicians in undertaking reproductive coercion screening at this service. Clinicians were invited to complete an online survey and interview to discuss their understanding of reproductive coercion and their views and experiences of undertaking reproductive coercion screening. Descriptive and thematic content analysis was conducted. Clinicians deemed reproductive coercion screening to be relevant and important in family planning services. Key barriers to reproductive coercion screening and responding to disclosures included time constraints and limited appropriate referral pathways. Ongoing education and training with resources such as a decision-support tool on reproductive coercion screening and management, as well as effective multi-disciplinary collaboration, were identified as strategies to improve the screening program. Findings from our study highlight that clinicians' perceived reproductive coercion screening as a relevant and important component of sexual and reproductive healthcare. Ongoing reproductive coercion education, training and support would ensure the competency and confidence of clinicians undertaking screening. Identifying appropriate referral pathways with multi-disciplinary collaboration (involving clinicians, social workers, support workers and psychologists) would support clinicians in undertaking screening and responding to disclosures of reproductive coercion in Australian health care settings which provide family planning and sexual and reproductive health services.

Pregnancy coercion, correlates, and associated modern contraceptive use within a nationally representative sample of Ethiopian women

Partner-perpetrated pregnancy coercion inhibits women’s reproductive autonomy. However, few studies have quantified pregnancy coercion and its effects on women’s health within low- and middle-income countries. Among a national sample of Ethiopian women, this study aimed to: (1) assess the prevalence of past-year pregnancy coercion and explore regional differences; (2) identify correlates; (3) examine the relationship between pregnancy coercion and modern contraceptive use. Analyses utilise cross-sectional data from Performance Monitoring for Action (PMA)-Ethiopia, a nationally representative sample of females aged 15–49 conducted from October to November 2019. Past-year pregnancy coercion was assessed via five items and analysed dichotomously and categorically for severity. Among women in need of contraception, bivariate and multivariable logistic regression examined associations between variables of interest, per aim, accounting for sampling weights and clustering by enumeration area. Approximately 20% of Ethiopian women reported past-year pregnancy coercion (11.4% less severe; 8.6% more severe), ranging from 16% in Benishangul-Gumuz to 35% in Dire Dawa. Increasing parity was associated with decreased odds of pregnancy coercion. Among women in need of contraception, experience of pregnancy coercion was associated with a 32% decrease in odds of modern contraceptive use (aOR = 0.68; 95% CI: 0.53–0.89); when disaggregated by severity, odds decreased for most severe pregnancy coercion (aOR = 0.59; 95% CI = 0.41–0.83). Results indicate that partner-perpetrated pregnancy coercion is prevalent across diverse regions of Ethiopia, and most severe forms could interrupt recent gains in contraceptive coverage and progress to sexual and reproductive health and rights. Providers must be aware of potential contraceptive interference and address coercive influences during contraceptive counselling.

Pregnancy coercion and partner knowledge of contraceptive use among Ethiopian women

ObjectiveTo examine the relationship between pregnancy coercion and partner knowledge of contraceptive use. Study designCross-sectional Performance Monitoring for Action-Ethiopia data were collected in October-November 2019 from a nationally representative sample of women ages 15 to 49. The analytical sample (n = 2,469) included partnered women using contraception in the past year. We used multinomial logistic regression to examine associations between past-year pregnancy coercion (none, less severe, more severe) and partner knowledge/couple discussion of contraceptive use (overt use with couple discussion before method initiation (reference group), overt use with discussion after method initiation, and covert use of contraception). ResultsMost women reported their partner knew they were using contraception and had discussed use prior to method initiation (1,837/2,469, 75%); 16% used overtly and discussed use after method initiation, and 7% used contraception covertly. The proportion of covert users increased with pregnancy coercion severity (4%none, 14%less severe, 31%more severe), as did the proportion of overt users who delayed couple contraceptive discussions, (14%none, 23%less severe, 26% more severe); however, overt use with couple discussion before method initiation decreased with pregnancy coercion severity (79%none, 60%less severe, 40%more severe). The risk of covert use among women experiencing less severe pregnancy coercion was four times greater than women who experienced no pregnancy coercion (adjusted relative risk ratio, (aRRR) = 3.95, 95% confidence interval (CI) 2.20–7.09) and ten times greater for women who experienced the most severe pregnancy coercion (aRRR = 10.42, 95% CI 6.14–17.71). The risk of overt use with delayed couple discussion also increased two-fold among women who experienced pregnancy coercion compared to those who did not (less severe aRRR = 2.05, 95% CI 1.39–2.99; more severe aRRR = 2.89, 95% CI 1.76–4.73). ConclusionWhen experiencing pregnancy coercion, women may avoid or delay contraceptive conversations with their partners. Increased pregnancy coercion severity has the greatest association with covert use and couple contraceptive discussions. ImplicationsThe presence and timing of couple discussions about contraception are critical for ensuring safety for women experiencing pregnancy coercion. Screening for pregnancy coercion must be included within contraceptive counseling so that women can choose methods that maximize their reproductive autonomy.

Validation of the Short-Form Reproductive Coercion Scale With Appalachian Women

(Abstracted from Contraception 2021;104:265–270) Reproductive coercion is a collection of behaviors intended to maintain power and control in a relationship, typically perpetuated by an intimate partner by interfering with autonomous reproductive decision making. Pregnancy coercion is a form of reproductive coercion wherein threats and pressuring behaviors are exhibited to promote pregnancy.

Validation of the short-form reproductive coercion scale with Appalachian women

ObjectiveThe purpose of this study was to investigate the psychometric properties of the short-form Reproductive Coercion Scale among a sample of Appalachian women. Study DesignWe recruited a purposive sample of Appalachian women, using targeted Facebook ads to collect data via an online survey in fall 2019. We randomly split our sample into two independent samples and used exploratory factor analysis on sample 1 (N = 314) and confirmatory factor analysis on sample 2 (N = 314) in order to cross-validate our findings. ResultsFindings indicated that the short-form Reproductive Coercion Scale is a valid and reliable instrument to assess reproductive coercion among this sample of Appalachian women. Our findings indicated that, in this Appalachian sample, the reduced, five-item Reproductive Coercion Scale measured a unidimensional construct and was not comprised of the multiple dimensions of pregnancy coercion and condom manipulation. As expected, intimate partner violence and pregnancy fatalism were significantly and positively associated with reproductive coercion while religious affiliation and insurance status were not significantly associated with reproductive coercion. These findings help build construct validity for the short-form Reproductive Coercion Scale with this sample. ConclusionWhile pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. ImplicationsWhile pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form Reproductive Coercion Scale measures a single latent reproductive coercion factor. Additional research may be needed to confirm the factor structure of the short-form Reproductive Coercion Scale across populations and geographic conditions.

Prevalence of Reproductive Coercion Among Male and Female Emerging Adults

Reproductive coercion (RC), or the exertion of power and control over a partner's reproductive choices and health, is gaining attention as a distinct form of intimate partner violence (IPV). The bulk of research in this area centers on female victims with an emphasis on pregnancy coercion and the disproportionate effect of pregnancy on women. Researchers conducting systematic reviews of this literature note that RC includes behaviors in addition to pregnancy coercion and the need exists to consider male RC victims and how their experiences differ from female victims. This study compares RC between male and female emerging adults (those aged 18–25 years) using the National Intimate Partner and Sexual Violence Survey (NISVS). Emerging adults are selected as a population at greater risk for IPV than other age groups. NISVS provides an opportunity to conduct this research as it is one of the only national data collections that measures RC across male and female respondents. This study finds more female than male emerging adults experience RC, but both groups experience RC with other forms of IPV. This exploratory study concludes with a discussion of future research for RC involving male victims and the emerging adult population.

Reproductive Coercion among Intimate Partner Violence Survivors in Nairobi.

Reproductive coercion (RC), or partner interference in reproductive decisions, limits women's autonomy. Little is known about RC behaviors and measurement in low- and middle-income countries (LMICs). In this mixed-methods study, we examined the transferability of the US-developed RC Scale to the Kenyan context. Through community-based sampling, recent intimate partner violence (IPV) survivors were recruited from Nairobi's informal settlements. We conducted quantitative analyses (n = 327) to assess the transferability of RC measures via exploratory factor analysis and used descriptive statistics to examine prevalence and continuous metrics. We conducted in-depth interviews (IDIs; n = 30) to contextualize results. Psychometric analyses indicated a two-factor solution comprising pregnancy coercion and condom manipulation (alpha = 0.86). Eighty-two percent of IPV survivors reported experiencing RC (pregnancy coercion = 76.6 percent; condom manipulation = 59.5 percent). IDIs highlighted women's multiple, severe RC experiences; experiences described in IDIs were largely consistent with quantitative findings. We found the RC Scale was transferable to this LMIC context, where IPV survivors face prevalent, severe RC and would benefit from linkage to woman-centered support services.

"At Least I Didn't Get Raped": A Qualitative Exploration of IPV and Reproductive Coercion among Adolescent Girls Seeking Family Planning in Mexico.

Adolescent girls who report intimate partner violence (IPV) are at an increased risk of experiencing reproductive coercion (RC); both these forms of gender-based violence (GBV) are associated with unintended pregnancy. Yet little is known about these experiences among adolescent girls in Mexico. Qualitative data were collected as part of formative research for the adaptation of an evidence-based intervention to address RC and IPV in community health centers in Tijuana, Mexico. From September, 2017 to January, 2018, adolescent girls aged 16 to 20 years old (n = 20) seeking voluntary family planning (FP) services were identified and recruited from two publicly funded community health centers. We conducted semi-structured, in-depth interviews and analyzed the transcripts using inductive and deductive techniques. Participants in this sample commonly described experiencing IPV and RC (including pregnancy coercion and contraceptive sabotage), which many girls reported resulted in unintended pregnancy. Further, participants' narratives and general lack of knowledge on how to cope with IPV or RC illuminated the acceptability of offering GBV prevention intervention within FP clinics serving this population. Findings highlight an urgent need to prevent IPV and RC, and reduce risk for unintended pregnancy among adolescent girls in this region and the potential of FP clinics to serve as a safe space for intervention delivery. Findings contribute to the limited qualitative evidence from Mexico, describing adolescent girl's experiences of IPV and RC, strategies for preventing pregnancy in the context of RC, and opportunities for support from FP providers.

Women\u2019s and girls\u2019 experiences of reproductive coercion and opportunities for intervention in family planning clinics in Nairobi, Kenya: a qualitative study

BackgroundReproductive coercion (RC), which includes contraceptive sabotage and pregnancy coercion, may help explain known associations between intimate partner violence (IPV) and poor reproductive health outcomes, such as unintended pregnancy. In Kenya, where 40% of ever-married women report IPV and 35% of ever-pregnant women report unintended pregnancy, these experiences are pervasive and co-occurring, yet little research exists on RC experiences among women and adolescent girls. This study seeks to qualitatively describe women’s and girls’ experiences of RC in Nairobi, Kenya and opportunities for clinical intervention.MethodsQualitative data were collected as part of the formative research for the adaptation of an evidence-based intervention to address reproductive coercion and IPV in clinical family planning counselling and provision in Nairobi, Kenya in April 2017. Focus group discussions (n = 4, 30 total participants) and in-depth interviews (n = 10) with family planning clients (ages 15–49) were conducted to identify specific forms of reproductive coercion, other partner-specific barriers to successful contraception use, and perceived opportunities for family planning providers to address RC among women and girls seeking family planning services. Additionally, data were collected via semi-structured interviews with family planning providers (n = 8) and clinic managers (n = 3) from family planning clinics. Data were coded according to structural and emergent themes, summarized, and illustrative quotes were identified to demonstrate sub-themes. Kenyan family planning providers and administrators informed interpretation.ResultsThe results of this study identified specific forms of pregnancy coercion and contraceptive sabotage to be common, and often severe, impeding the use of contraceptives among female family planning clients. This study offers important examples of women’s strategies for preventing pregnancy despite experiencing reproductive coercion, as well as opportunities for family planning providers to support clients experiencing reproductive coercion in clinical settings.ConclusionsReproductive coercion is a critical barrier to modern contraceptive use in Kenya. Results from this study highlight opportunities for family planning providers to play a critical role in supporting women and girls in their use of contraception when reproductive coercion is present.

Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy Among Latina Women.

Reproductive coercion (RC) describes a range of behaviors that restrict reproductive autonomy including pregnancy coercion, birth control sabotage, and controlling the outcome of a pregnancy. RC is associated with pregnancies that are mistimed and unwanted (i.e., unintended). Past research demonstrates that Latina women have higher risk for RC and for unintended pregnancy. This cross-sectional descriptive study with Latina women (n = 482) examined prevalence and risk factors for RC, evaluated the association of RC and unintended pregnancy among women with a past-year pregnancy, and explored use of safety and harm reduction strategies. A tablet survey was administered to women attending a community health center, between the ages of 15 and 45, who self-identified as Latina and who had a dating or sexual partner in the past year. Approximately one in six (16.8%) experienced past-year RC and risk factors included younger age (adjusted odds ratio [AOR] = 0.95, 95% confidence interval [CI] = [0.91, 1.00], p = .038) and concurrent intimate partner violence (IPV; AOR = 4.47, 95% CI = [2.06, 9.70], p < .001). IPV questions were specific to the partner involved with RC behaviors. For the 185 participants who reported a past-year pregnancy, RC was associated with lower pregnancy planning scores (β = -.27, 95% CI = [-0.41, -0.13], p < .001). The combination of experiencing RC and IPV appeared particularly potent in lowering pregnancy planning scores (β = -.15, 95% CI = [-0.29, 0.00], p = .052). Approximately 10.6% of participants engaged in harm reduction strategies, most commonly ending an unhealthy or abusive relationship (6.1%) and using less detectable methods of contraception so that partners would not find out (3.4%). The study articulates the risk of RC and its intersection with IPV and unintended pregnancy for Latina women. Providers working with racially and ethnically marginalized women have an important role in promoting safety and harm reduction strategies that include offering less detectable methods of contraception and support in leaving unhealthy and abusive relationships.

Influence of the Relational Context on Reproductive Coercion and the Associated Consequences.

Reproductive coercion (RC) refers to behaviors that interfere with contraception use or pregnancy and that limit reproductive autonomy. This article presents the results of a qualitative exploratory study of 21 young women in Canada who experienced RC perpetrated by an intimate partner along with the associated consequences. Results reveal that nonconsensual condom removal occurred more often in uncommitted relationships without violence, whereas pressure to become pregnant and pregnancy coercion occurred more often in committed relationships where other forms of violence were also present. Participants reported numerous repercussions on their psychological, sexual, and reproductive health and on their emotional and relational well-being.

‘I had no control over my body’: Women’s experiences of reproductive coercion in Aotearoa New Zealand

INTRODUCTION: Reproductive coercion broadly describes behaviour intended to undermine the reproductive autonomy of a victim through pregnancy coercion, contraceptive sabotage, and controlling pregnancy outcomes. This research sought to understand the experiences of victims of reproductive coercion in Aotearoa New Zealand.METHODS: Participants shared their experiences of reproductive coercion from an intimate partner through an online survey that was distributed via social media and posters that were put up primarily in Family Planning clinics across the country. Five participants subsequently participated in in-depth interviews.FINDINGS: Participants (mostly women) in this research experienced high rates of controlled access to contraceptives (83.8%), contraceptive sabotage (58.6%), and pregnancy coercion (64%) by an intimate partner. Furthermore, 40.5% of participants who had ever been pregnant had experienced a partner attempting to prevent them from accessing an abortion, and over 30% were subjected to a partner’s attempts to force an induced abortion or miscarriage. Many also expanded on their partners’ coercion regarding reproductive decisions, and abuse during, and after, labour and birth. However, they were rarely asked about reproductive coercion and abuse by health care or social service practitioners.CONCLUSIONS: Reproductive coercion is a phenomenon that is globally under-researched. Emerging evidence suggests this is a highly gendered issue, and that there needs to be greater focus on promoting how we can improve and protect women’s reproductive autonomy. Findings from this research indicate the need to incorporate discussions about reproductive autonomy and coercion in screening for intimate partner violence.

Reproductive Coercion and Interpersonal Violence Victimization Experiences Among College Students.

Reproductive coercion is behavior, typically perpetrated by a partner, that interferes with autonomous reproductive decision making, often through pregnancy coercion and/or contraceptive interference. Existing literature suggests that reproductive coercion is associated with intimate partner violence in the general population and among college women. However, there is limited research regarding the prevalence and correlates of reproductive coercion in college populations, especially regarding interpersonal violence victimization other than intimate partner violence. To fill this gap in knowledge, this study investigated the relationship between reproductive coercion and multiple forms of interpersonal violence victimization (sexual harassment, sexual abuse, physical partner abuse, psychological partner abuse, stalking, bullying, and polyvictimization). We conducted a secondary analysis of anonymous survey data, which were collected in fall 2015 with college students at a large public university in the southeast United States. The analysis sample was limited to cisgender college students endorsing at least one sexual partner in the past year (N = 431). Most (67.05%) participants indicated that they had experienced at least one form of interpersonal violence victimization, and 39.91% indicated that they had experienced polyvictimization. About 11% of the sample indicated that they had experienced reproductive coercion. Logistic regression analyses showed that reproductive coercion was associated with an increased likelihood of experiencing polyvictimization and all interpersonal violence victimization experiences except for physical partner abuse while controlling for demographic factors. Health providers, especially those working with college populations, could consider screening for reproductive coercion, to meet students' reproductive health needs and uncover associated interpersonal violence victimization experiences.

Pregnancy Coercion as a Risk Factor for HIV and Other Sexually Transmitted Infections Among Young African American Women.

Background:Pregnancy coercion (PC), defined as a restriction of women's reproductive autonomy, may be associated with increased HIV and sexually transmitted infection (STI) risk. However, there are few empirical studies defining the association between PC and HIV risk, particularly among vulnerable African American women.Setting and Methods:African American women (N = 560), ages 17–24, completed an audio computer-assisted self-interview assessing PC prevalence and its association with HIV/STI risk. Women were screened for prevalent STIs using polymerase chain reaction assays. Multivariate logistic and linear regressions evaluated the association of PC and multiple HIV/STI risk-associated outcomes.Results:Women who had experienced PC in the last 3 months, relative to those not experiencing PC, were 78% more likely to test positive for an STI [adjusted odds ratio = 1.78, 95% confidence interval (CI) = 1.10 to 2.90]. Among women who experienced PC, odds of noncondom use in their last sexual encounter were 3.45-fold greater relative to women not experiencing PC (95% CI = 1.55 to 7.85). Women who experienced PC had lower condom use intentions (coefficient, −1.31, P = 0.002), greater fear of condom negotiation, and perceived more barriers to condom use (coefficients, 3.89 and 5.74, respectively, both P < 0.001). Women who experienced PC had 1.98 (95% CI = 1.22 to 3.21) and 1.82 (95% CI = 1.09 to 3.04) odds of depression and HIV worry relative to women not experiencing PC.Conclusion:Among African American women, PC was associated with a range of adverse sexual health outcomes and HIV/STI-related behaviors and attitudes. The findings underscore the need for promoting gender-equitable social norms in HIV prevention interventions.

Young Women's Acknowledgment of Reproductive Coercion: A Qualitative Analysis.

Reproductive coercion (RC) is a form of violence perpetuated against women. It occurs when male partners adopt behaviors meant to control a woman's birth control or pregnancy despite her wishes. This amounts to interference with a woman's autonomy in reproductive decisions. The three main forms of RC are birth control sabotage (including nonconsensual condom removal), pregnancy coercion, and controlling the outcome of a pregnancy. This qualitative exploratory study examines issues in the acknowledgment of RC. Participants were 21 young women in Québec (Canada), who had experienced this form of violence. Results of individual semi-directed interviews reveal that RC can be difficult to acknowledge. A thematic analysis demonstrates that awareness is modulated by the manifestations of RC and by the emotional bond with the perpetrator. Acknowledgment of RC behavior varies according to the form that is experienced: Nonconsensual condom removal is the most readily identified, whereas acknowledgment of pregnancy pressure and pregnancy coercion takes longer, requiring repeated incidents before it is identified as a form of violence. In addition, acknowledgment is facilitated when relationships are casual and uncommitted compared with romantic and committed. Moreover, reading about the issue, confiding in a friend or acquaintance, and finding a new partner who respects one's reproductive rights facilitate RC acknowledgment. In contrast, not self-identifying as a victim, assuming responsibility for the incident, having a limited understanding of sexual violence, and experiencing other forms of violence with an intimate partner contribute to impede RC acknowledgment. Results are discussed in terms of practical implications for young adults and health care professionals.