Reproductive Coercion

An outreach person from Women in Distress came to our medical school this week. Women in Distress is the local recipient of the proceeds from our performance of The Vagina Monologues. I am going to be in my third production of it this year. This year I will be performing “I Was There in the Room”, which is the closing piece about a forceps birth.

The representative from Women in Distress did a great presentation. I did add one thing at the end for the group, considering we are all intending to be health care practitioners. I made sure that they knew how common contraceptive sabotage or reproductive coercion was a facet of domestic violence. I thought it was important to know that a patient may complain of frequently losing her birth control pills, or who gets pregnant unintentionally often, or seems very uncomfortable talking about contraception and refuses without discussing it, or outright tells you that her partner will flush it down the toilet or won’t let her use birth control, and any of these should be a red flag that there may be an abuse problem.

Well, today I decided to do something about my burgeoning blog reader. (Be prepared for lots of hat tips and a blogaround or two.) Cara at The Curvature linked to this press release from the Family Violence Prevention Fund about reproductive coercion.

From August 2008 to March 2009, researchers worked at five reproductive health clinics in Northern California, querying some 1,300 English- and Spanish-speaking 16- to 29-year-old women who agreed to respond to a survey about their experiences. They were asked about birth-control sabotage, pregnancy coercion and intimate partner violence. Approximately one in five young women said they experienced pregnancy coercion and 15 percent said they experienced birth control sabotage. Fifty-three percent of respondents said they had experienced physical or sexual violence from an intimate partner. Thirty-five percent of the women who reported partner violence also reported either pregnancy coercion or birth control sabotage.

This is not only a “little recognized form of abuse”, but it is also an important facet of the discussion of unintended pregnancy and abortion. Some people think the male partner should have a say in abortion. I think this highlights why that is not something that can nor should be enforced by the courts, and is really should not be a priority.


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14 responses to “Reproductive Coercion

  1. Maureen

    This is a really important point, and something that can’t be emphasized enough, not just to RH practitioners, but to all practitioners. Furthermore, I’m sure that the statistics don’t represent the true reality.

    While this is a problem here in the US, it is even more of a problem in developing countries, and I think that public health professionals working internationally should be constantly reminded about the impact of reproductive coercion on their beneficiary populations. It is frequently mentioned obliquely, but not generally a primary focus of interventions.

    • MomTFH

      Yes, excellent point. That is one reason why condoms, even female condoms, are not necessarily a successful strategy in some efforts to distribute contraception and STD transmission protection.

  2. doctorjen

    Since you are a future doc, I wanted to point out that docs can practice a degree of contraceptive coercion, too. Since most hormonal contraception requires a prescription, I see a lot of docs requiring things from their patients to get contraception. In particular, holding contraception hostage to pap smears seems to be a popular thing. The doctor refuses to refill a birth control prescription until the patient comes for a pap. Now that the guidelines for pap smears have been changed to encourage increasing the interval between pap screening for many patients, it’s still hard for many docs to change habits and let go of the requirement that you get a pap before you get your pills. This especially seems to prevent teen women from coming for birth control.
    I believe wholeheartedly in the importance of pap screening, don’t get me wrong, but I always make clear to my clients that it is a separate issue from birth control prescribing, and that while I strongly encourage pap screening, I won’t withhold birth control because of it. There are a few incidents where it would be inappropriate to prescribe birth control (undiagnoses breast masses, personal history of blood clotting disorder, etc.) and where close follow up is really needed, but I see docs withholding a script if the client is 1 month late for her “annual” all the time. I’ve taken care of a number of women with unintended pregnancies who couldn’t get their pills refilled and couldn’t get in for an appt in time.

    • MomTFH

      Excellent point. Especially now that the pap screening frequency recommendations has changed to once every three years for some women. Rachel at Women’s Health News was told by her practitioner that even though she was no longer required to have an annual pap smear, she was required to come in for an annual bimanual exam in order to get her contraceptive prescription filled.

      I cannot imagine why the two would be linked, if she was asymptomatic and low risk otherwise.

      • QoB

        When I go to the female GP to get my pill prescription refilled, she just checks my blood pressure, asks me if my weight is stable, and writes me the prescription. The last time, she checked when my next smear (AKA pap) was due (18 months or so) and that’s it.
        I have had to go to the male GP’s a few times when she isn’t available, and they always suggested a breast exam – once I did my own research, I realised this wasn’t necessary or particularly effective and now avoid them, not because they’re particularly unpleasant, but because I suspected their motives.
        I’ve never experienced a doctor wanting to do a pelvic exam to prescribe contraception. How evidence-based of Rachel’s doctor…

        • MomTFH

          I think Rachel looked it up, and a yearly bimanual is in line, technically, with ACOG recommendations. But, it is not linked to contraception prescribing.

          • This reminds me that I need to follow up on this wrt to individual vs. institutional policies. They ended up providing a prescription for me as soon as I actually *scheduled* an appointment (but before it happened), so I suppose I could have called and canceled as soon as that puppy was filled.

          • MomTFH

            Hooray, here’s Rachel. The first time I wrote about this, I linked to your original post on the issue. Today I was posting on the fly, so I didn’t get to. Please link to an update thread here if you do write one.

            (And, I didn’t call you “my cousin Susan” since you already shared the story under your own name on your own site, but I can change it to “my cousin Susan” if you like.)

          • By name is fine, thanks, and will do!

  3. This really needs added to the power and control wheel:

  4. MTFH
    You seriously perform in the Vagina Monologues? You are so cool I can’t stand it. I predict you will be famous one day, so please don’t forget us little people!

    Dr. Jen brought back memories of when I worked in a University Gyne Clinic back in the early 90’s. The practitioners often would not prescribe BCP unless the students showed up for a pap smear AND the female students had to attend a class, which I taught, on reproductive health. How weird to think I was contributing to reproductive coercion back in the 90’s and I didn’t even know it! ugh. In my defense, and I am sure many will think it is indefensible, this was during the beginning of the HPV epidemic, and the BCP/Pap policy was meant to try and stem the transmission of HPV. Didn’t work though, obviously.

    • MomTFH

      Yeesh, well, at least you were educating them. I am sure you would have wanted to do that even if they weren’t being coerced to be there.

      Yeah, I was in the Vagina Monologues. I am a big star! (Kidding) I was on the House of Babies Show, too. For about 5 seconds in a few episodes.

      If you follow the link above, you can see pictures from the last Monologues performance.

  5. Pingback: Weekly News Round-Up, Oral Herpes Edition « Women’s Health News

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