January 24, 2013
(USA TODAY) -- When a husband hides a wife's birth control pills or a boyfriend takes off a condom in the middle of sex in hopes of getting an unwilling girlfriend pregnant, that's a form of abuse called reproductive coercion.
Though researchers don't know exactly how common such coercion is, it's common enough -- especially among women who are abused by their partners in other ways -- that doctors should screen women for signs at check-ups and pregnancy visits, says the nation's leading group of obstetricians and gynecologists.
"We want to make sure that health care providers are aware this is something that does go on and that it's a form of abuse," says Veronica Gillispie, an obstetrician and gynecologist at Ochsner Health System in New Orleans and a member of the committee that wrote the opinion for the American College of Obstetricians and Gynecologists. It's published in the February issue of Obstetrics & Gynecology.
Reproductive coercion occurs whenever a partner tries to prevent a woman from making her own choices about pregnancy, Gillispie says. That includes trying to get a woman pregnant against her will, through forced sex or other means; it also includes using threats to get a woman to continue an unwanted pregnancy or end a wanted one.
In studies cited by the committee, "birth control sabotage" was reported by 25% of teen girls with abusive partners and by 15% of women who were physically abused. Some men go as far as to pull out a woman's intrauterine device (IUD) or vaginal contraceptive ring, the committee says.
"Often, it's about taking away choices, taking away freedom, control and self-esteem," says Rebekah Gee, an obstetrician and gynecologist in New Orleans and assistant professor at Louisiana State University. She did not work on the opinion but has studied the problem.
Though it may be rare for men to dislodge an IUD, she says, it's not uncommon for men to refuse to wear condoms, which puts women at risk for pregnancy and sexually transmitted diseases.
An abusive man may believe that getting a woman pregnant binds her closer to him, Gee says.
The opinion says obstetricians and gynecologists can help women in these relationships by directing them to agencies and hotlines, including the National Domestic Violence Hotline at 800-799-SAFE (7233). But it also says doctors can take direct action, by providing women with hard-to-detect birth control methods, including IUDs with the removal strings cut, if necessary, or a stash of emergency contraceptive pills in a plain envelope.
In clinics where doctors already have started such efforts, the results have been encouraging, says Rebecca Levenson, senior policy analyst at Futures Without Violence, a non-profit advocacy group based in San Francisco. In one small study, reports of reproductive coercion dropped 71% among women who received information and questionnaires about such abuse. Some of the information was on a card that "can fit inside a shoe," Levenson says.
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