Know More. Say More. » Blog Post

We All Have A Role To Play: Dating Violence Amongst College Students

gavin — Mon, 02 Aug 2010 18:48:35 +0000

Generally, I try at all costs to avoid reading news coverage of kidnappings and murders. Whether waiting in line by the magazines at the grocery store or reading news online, I sidestep these stories, perhaps selfishly, to protect my psyche. But my time working here at the Family Violence Prevention Fund’s kNOwMore campaign has opened my eyes to a particular case that demands universal awareness on behalf of the fight against violence against women.

In early May, 22-year old Yeardley Love, a student and lacrosse player at the University of Virginia was murdered by her ex-boyfriend, George Huguely. While this story may have seemed like an anomaly, the devastating truth is that various forms of dating or intimate partner violence (IPV) are actually quite common amongst college students. According to an anonymous survey of 910 undergrads, aged 17 to 22, by Christine M. Forke, M.S.N., C.R.N.P., of the Children’s Hospital of Philadelphia, 44.7 percent of participants experienced relationship violence either before or during college, and more than half of the violence (whether physical, sexual, or psychological) that is experienced during college is related to an intimate partner rather than a friend or acquaintance. I was shocked to learn that IPV is central to the dynamic of many couples in colleges all over the country, just like mine.

Love’s and Huguely’s relationship showed all the typical signs of IPV. Also typical of IPV situations is the idleness of their friends and other bystanders. These witnesses either did not know how to recognize IPV or thought that it wasn’t necessary to get involved. Further, on the night of Love’s death, a friend reported that people saw Huguely at a party “breaking bottles” and that “he said he was going to go to Love’s apartment to get her back”, yet nobody seemed particularly worried or tried to stop him. Social norms regarding relationships typically cause onlookers to ignore warning signs. It is so common for people to be blind to signs of abuse that are right beneath their noses. Controlling a partner’s body through reproductive coercion and birth control sabotage are other signs of abuse in relationships that often goes unnoticed. We all have a role to play in stopping violence in all its forms. We must each make a commitment to live lives free of violence (whether causing it or receiving it) and to prevent violence in the lives of others by speaking out, standing up, stepping in, and finding support for victims caught up in the cycle of fear and violence.

The Family Violence Prevention Fund’s That’s Not Cool campaign has great resources for recognizing and preventing teen dating abuse. Check it out!

Video Interview: Reproductive Coercion

carolyn — Thu, 29 Jul 2010 16:58:38 +0000

GRITtv interviews reporter Lynn Harris and Dr. Elizabeth Miller, the author of prominent studies about reproductive coercion.

New Study: Many Iowa Women Seeking Abortions Have Experienced Violence

carolyn — Wed, 28 Jul 2010 15:30:25 +0000

Nearly one in seven women who sought abortions at a large family planning clinic in Iowa (13.8 percent) reported at least one incident of physical or sexual abuse in the past year, usually by an intimate partner. The prevalence of physical and sexual violence by an intimate partner was 9.9 percent and 2.5 percent, respectively, according to the study, published in the American Journal of Public Health. It was conducted by researchers at the University of Iowa, College of Public Health and Planned Parenthood of the Heartland.
The new study finds that nearly three in four of the women who reported intimate partner violence (74 percent) identified a former partner as the perpetrator; the rest reported still being in a relationship with the perpetrator.

“Women seeking termination of pregnancy comprise a particularly high-risk group for physical or sexual assault,” said lead author of the study and University of Iowa Professor of Epidemiology Audrey Saftlas. “These findings strongly support the need for clinic-based screening with interventions. These high-risk women need resources, referrals and support to help them and their families reduce the violence in their lives.”

“We were excited about participating in this project,” said Planned Parenthood of the Heartland Chief Operating Officer and a study author Penny Dickey. “Women in violent relationships don’t speak openly about such private matters, unless they are asked. We now need to go that next step to screen all patients for intimate partner violence and get them the support they need to get out of their violent situations.”

“This study is significant because it adds to the body of data that identifies a link between partner violence and unintended pregnancy,” said Family Violence Prevention Fund President Esta Soler. “Other studies have looked at young women, and urban women, so this makes the research base more cross-sectional. The link between dating/domestic violence and poor reproductive health outcomes is increasingly clear.” The average age of women in the new Iowa study was 25.7 years; two-thirds (66.9 percent) had at least some college education; and 64.7 percent were insured. Most respondents were White; 10.6 percent were Black; and 8.4 percent were Latina.

986 women participated in the Iowa study, completing anonymous, self-administered, computer-based questionnaires to estimate physical and sexual abuse and battering (defined as chronic nonphysical abuse characterized by controlling behaviors and abuse of power) from November 1, 2007 to July 18, 2008. Of the 1,415 abortion clients seen in the clinic, 1,193 were eligible and 986 completed the ten-minute questionnaire, which was available in English or Spanish.

It is the first study to comprehensively evaluate battering (defined as chronic nonphysical abuse characterized by controlling behaviors and abuse of power) among abortion clients, with 8.4 percent of those in a current relationship screening positive for battering.

“ Prevalence of Intimate Partner Violence Among an Abortion Clinic Population” was published online June 17 in the American Journal of Public Health.

New Study Documents Sexual Coercion Among Young People

carolyn — Wed, 07 Jul 2010 16:14:58 +0000

Among the many challenges of being a teenager, one stands out: understanding your own sexuality and desire for intimate connection. With the onslaught of romantic and sexual imagery in virtually every part of popular culture, it is also becoming increasingly difficult to sort out what you think and believe from what society tells you to think and do.

With this in mind, a recent CDC study of teenage sexuality comes as little surprise, with some good news about contraceptive use and some other results that perhaps should generate a good deal of concern. Among the study’s results:

· approximately 40% of teenagers have had sexual intercourse;

· 95% of those have used a condom;

· 14% of females and 18% of males would be pleased if a pregnancy resulted from sex.

There are many topics in this study to be explored, and a variety of blog posts and mainstream media articles have been written on it. The blog Feministing notes some overlooked but troubling statistics concerning consent.

Among females aged 18-24 whose first sex was before age 20, 10% “really didn’t want it to happen at the time”, 47% had mixed feelings, and 43% “really wanted it to happen at the time”. This varied depending on the age at first sex. For those who had 1st sex at 14 years or younger, 18% really didn’t want it to happen, compared with 8% among those whose first sex was at age 18 or 19. On the other hand, more than a quarter of females aged 18-24 whose first sex was at age 14 or younger (29%) really wanted it to happen at the time. First sex with an older partner was associated with much higher percents of females reporting “really didn’t want it to happen”. Among those whose first partners were 3 or more years older, 19% reported that they didn’t really want it to happen at the time, compared with 5% among those whose first partners were the same age or younger.

These statistics are consistent with those identified by Child Trends in 2008, when it found that approximately 18% of women ages 18 – 24 report have experienced forced sexual intercourse at least once in their lives.

We’re pleased to see the CDC tracking these statistics. Its new study raises many questions. Optimistically, it could prompt the kind of additional research that we need. For policymakers, advocates, educators, parents and others, it raises important issues, including:

· How we can educate girls and boys in nurturing healthy relationships, while recognizing and getting help for those who are in abusive ones?

· How can we modify our pregnancy and HIV prevention programs to incorporate coerced sex as a possible cause, especially among young teens?

· What policies can we put in place to stop coerced sex among young people?

What’s Missing: Media Images of Teen Pregnancy

gavin — Fri, 11 Jun 2010 19:54:35 +0000

Note from the editor: Gavin Odabashian is the newest (and youngest) member of the Family Violence Prevention Fund, serving as an intern working with the kNOwMORE initiatve. Just finishing her freshman year at Scripps College in Southern California, Gavin is considering a major in Sociology and Women’s and Gender Studies. Watch for her posts throughout the summer. Welcome, Gavin! –Margaret and the kNOwMORE team

She is everywhere. The image of the pregnant single teen is a staple in many hit TV shows, national news, gossip magazines and movies. Think Glee, The Secret Life of the American Teenager, 16 and Pregnant, Bristol Palin, Juno and Britney Spears’ pregnant 15 year old sister, Jamie Lynn Spears. The image of the pregnant teen is often used to get some laughs: there’s Juno’s hilarious one-liners, “they call me the cautionary whale,” and pregnant teen character Quinn Fabray’s funk solo on last week’s episode of Glee in which she and a group of her fellow pregnant classmates called “The Unwed Mothership Connection” sing and dance around, emphasizing their protruding bellies. While the depictions of these women may have brought the issue of teen pregnancy into the public consciousness and gotten people talking, these media figures inaccurately represent the real lives of many a young pregnant woman. Besides either glorifying or making her image the brunt of a joke, the causes and effects of many young pregnancies are simply ignored by the media.

Indeed, over the past few years, we have seen again and again the media’s newfound obsession with teen pregnancy. A July 2008 Newsweek article, Teen Pregnancy, Hollywood Style, focused on this topic. According to the article, “big parts of the story are being glossed over: how that baby bump came to be in the first place, and just how hard it’ll be for a teen to raise a child.” The piece criticizes the lack of discussion of contraception by the media: “In ‘Juno,’ the word condom is used twice; the Jamie Lynn interviews skirt the issue altogether. Even ‘The Secret Life’ (a show originally pitched with the title ‘The Sex Life of the American Teenager’) only makes a few passing references to condoms…In none of these shows are the girls asked whether they used contraception, nor is there mention of STD testing…’It’s the missing three C’s: there’s little commitment, no mention of contraception and rarely do we see negative consequences,’ says Jane Brown, a journalism professor at the University of North Carolina who runs the Teen Media Project. ‘What’s missing in the media’s sexual script is what happens before and after. Why are these kids getting pregnant and what happens afterward?’”

But another important part of “what’s missing” within the Newsweek article is the direct relation between teen pregnancy and dating abuse, coercion, or violence. Rarely mentioned is the possibility that the pregnant teen was coerced into having sex and/or prevented from using her birth control because of a controlling, abusive boyfriend. The truth is that many pregnancies among young people stem from repeated instances of sexual coercion, birth control sabotage and sexual violence. In her study, Pregnancy coercion, intimate partner violence and unintended pregnancy, Elizabeth Miller found that approximately ¾ of women reporting pregnancy coercion or birth control sabotage also reported a history of partner violence (237 of the 328 women in the study reported reproductive control), with risk for unintended pregnancy doubled for this group. Further, in a nationally representative survey of 9,684 adults by the Centers for Disease Control and Prevention, 10.6% of women reported experiencing forced sex at some time in their lives. Nowhere in the shows and movies we watch or articles we read are these violent realities discussed. This glossing over of the truth by the media creates a missed opportunity to spread awareness about sexual and domestic abuse and keeps the experiences of many teens in the closet. These women’s experiences and voices must be heard if we are ever going to stop sexual violence.

Reproductive Coercion: Connecting The Dots Between Partner Violence and Unintended Pregnancy

margaret — Wed, 09 Jun 2010 14:55:17 +0000

The following editorial originally appeared in the June edition of Contraception.

By: Elizabeth Miller, Beth Jordan, Rebecca Levenson, Jay G. Silverman

Reproductive health professionals are in a critical position to reach women victimized by abusive relationships. In the general population, physical and sexual violence victimization by an intimate partner affects an estimated one in four women across the life span, with one in five adolescent girls reporting such abuse.^{1, 2, 3}The prevalence of intimate partner violence reported among women utilizing sexual health services and seeking care in gynecologic and adolescent clinics is generally double these population-based estimates.^{4, 5, 6, 7} 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.^{8, 9, 10, 11, 12, 13, 14, 15, 16}

Moreover, mounting evidence that unintended pregnancy occurs more commonly in abusive relationships highlights that victimized women face compromised decision making regarding contraceptive use and family planning, including condom use.^{17, 18, 19, 20, 21, 22} Forced sex, fear of violence if she refuses sex and difficulties negotiating contraception and condom use in the context of an abusive relationship all contribute to increased risk for unintended pregnancy and STIs. 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. We suggest that providers can actually do more than simply offering a woman victim advocacy hotline numbers, based on new research findings.

In the April issue of Contraception, we highlighted a phenomenon we labeled “reproductive coercion”: explicit male behaviors to promote pregnancy (unwanted by the woman). Reproductive coercion can include “birth control sabotage” (interference with contraception) and/or “pregnancy coercion,” such as telling a woman not to use contraception and threatening to leave her if she doesn’t get pregnant.^{23, 24, 25, 26}While reproductive coercion was associated with unintended pregnancy in our study, we found that the risk for unintended pregnancy doubled among those women reporting both partner violence and reproductive coercion. This is certainly not surprising, as women in abusive relationships are more likely to fear the consequences of resistance to such coercive behaviors.

Reproductive coercion provides a new lens on contraceptive decision making and counseling women regarding pregnancy prevention options. This evidence linking partner violence, male influences on contraceptive decision making and unintended pregnancies underscores the need to strengthen connections between family planning practices and policies with efforts to reduce intimate partner violence.²⁷ Reproductive health care providers should receive specific tools to assess for reproductive coercion and strategies to help affected clients. These tools and strategies include safety cards and posters that educate clients about reproductive coercion and methods of contraception that partners cannot interfere with (i.e., intrauterine devices, injectable contraceptives), policies that ensure clients have access to emergency contraception as well as longer acting and hidden forms of contraception, and training for providers on how to offer referrals to domestic violence hotlines and shelter resources. Planned Parenthood Federation of America has been working in tandem with the Family Violence Prevention Fund to implement these tools and strategies. This effort began with Planned Parenthood Shasta/Diablo (partner in this recent study) and has continued with affiliates in Los Angeles and Santa Barbara.

Screening and counseling related to reproductive coercion have benefits even for patients who may not currently identify themselves as being in a coercive relationship. Conversations 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.

For adolescents in particular, assessment of a male partner’s reproductive coercion may help to explain a young woman’s inconsistent contraceptive use. Education and harm reduction strategies may be especially helpful for this population, as teens may misinterpret a partner’s controlling behaviors as evidence of his love, may not recognize such behaviors as abusive or coercive and may be particularly susceptible to such tactics based on conflicting peer pressures as well as her own ambivalence regarding pregnancy. Prior to assuming that a non-adherent teen needs additional education or motivation, assessment for partner violence and reproductive coercion may help to identify those young women struggling in an unhealthy relationship.

This work also has important implications for pregnancy prevention programs. Comprehensive sexuality education curricula that integrate discussions of partner violence, reproductive coercion and the contrast with healthy relationships are desperately needed. This information might increase girls’ and women’s self-efficacy in negotiating contraceptive and condom use while providing skills and knowledge on how to seek help for an unhealthy relationship. Of course, prevention programs that directly engage men and boys in reducing unintended pregnancy and promoting healthy, respectful, gender-equitable relationships are also needed.

Many questions emerge from this initial study. Pregnancy-controlling behaviors are certainly not exclusive to abusive relationships, but women experiencing partner violence appear to be at higher risk for experiencing reproductive coercion, and the experience of partner violence amplifies the impact of such coercion on women’s risk for unintended pregnancy.^{6, 23, 24} How reproductive coercion operates in the absence of violence requires further study. In addition, does partner violence manifest before attempts to control a woman’s pregnancy and the outcomes of that pregnancy? Or do coercive behaviors that include attempts to control her body and reproductive outcomes foreshadow physical and sexual violence in the relationship? And related to this, why might men engage in such controlling behaviors? How do they recognize and understand reproductive coercion? And finally, what might we do to reduce the prevalence of this range of behaviors among young men?

In conclusion, the addition of this concept of reproductive coercion may help providers in reframing inconsistent contraceptive use, moving us away from regarding this simply as a woman’s problem with noncompliance. We in the reproductive health field must strive to create sensitive, stigma-free spaces for women struggling in unhealthy relationships and contribute concretely towards promoting their safety and reducing their risk for unintended pregnancy.

Elizabeth Miller
Department of Pediatrics
UC Davis School of Medicine
Sacramento, CA

Beth Jordan
Association of Reproductive Health Professionals (ARHP)
Washington, DC

Rebecca Levenson
Family Violence Prevention Fund
San Francisco, CA

Jay G. Silverman
Department of Society, Human Development, and Health
Harvard School of Public Health
Boston, MA

References

Tjaden P, Thoennes N. Prevalence, incidence and consequences of violence against women: Findings from the National Violence Against Women Survey. Washington, DC: Department of Justice, National Institute of Justice; 1998;.
Silverman JG, Raj A, Mucci L, Hathaway J. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA. 2001;286:572–579.
Black B, Tolman R, Callahan M, Saunders D, Weisz A. When will adolescents tell someone about dating violence victimization?. Violence Against Women. 2008;14:741–758.
Miller E, Decker MR, Raj A, Reed E, Marable D, Silverman JG. Intimate partner violence and health care-seeking patterns among female users of urban adolescent clinics. Matern Child Health J. 2009;2009 Sep 17 [Epub ahead of print].
Rickert V, Wiemann C, Harrykissoon S, Berenson A, Kolb E. The relationship among demographics, reproductive characteristics, and intimate partner violence. Am J Obstet Gynecol. 2002;187:1002–1007.
Gee R, Mitra N, Wan F, Chavkin D, Long J. Power over parity: intimate partner violence and issues of fertility control. Am J Obstet Gynecol. 2009;201(7):148.e1–148.e7.
Keeling J, Birch L. The prevalence rates of domestic abuse in women attending a family planning clinic. J Fam Plann Reprod Health Care. 2004;30:113–114.
Coker A, Derrick C, Lumpkin J, Aldrich T, Oldendick R. Help-seeking for intimate partner violence and forced sex in South Carolina. Am J Prev Med. 2000;19:316–320.
Davila Y, Brackley M. Mexican and Mexican American women in a battered women’s shelter: barriers to condom negotiation for HIV/AIDS prevention. Issues Ment Health Nurs. 1999;20:333–355.
Decker MR, Silverman JG, Raj A. Dating violence and sexually transmitted disease/HIV testing and diagnosis among adolescent females. Pediatrics. 2005;116:e272–e276.
Eisenstat S, Bancroft L. Domestic violence. N Engl J Med. 1999;341:886–892.
El-Bassel N, Gilbert L, Krishnan S, et al. Partner violence and sexual HIV-risk behaviors among women in an inner-city emergency department. Violence Vict. 1998;13:377–393.
Gazmararian J, Petersen R, Spitz A, Goodwin M, Saltzman L, Marks J. Violence and reproductive health: current knowledge and future research directions. Matern Child Health J. 2000;4:79–84.
Hathaway J, Mucci L, Silverman J, et al. Health status and health care use of Massachusetts women reporting partner abuse.. Am J Prev Med. 2000;19:302–307.
Raj A, Silverman JG, Amaro H. The relationship between sexual abuse and sexual risk among high school students: findings from the 1997 Massachusetts Youth Risk Behavior Survey. Matern Child Health J. 2000;4:125–134.
Shrier L, Pierce J, Emans S, Durant R. Gender differences in risk behaviors associated with forced or pressured sex. Arch Pediatr Adolesc Med. 1998;152:57–63.
Cripe SM, Sanchez SE, Perales MT, Gaarcia P, Williams MA. Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru. Int J Gynaecol Obstet. 2008;100:104–108.
Gao W, Paterson J, Carter S, Iusitini L. Intimate partner violence and unplanned pregnancy in the Pacific Islands Families Study. Int J Gynaecol Obstet. 2007;100:109–115.
Pallitto C, O’campo P. The relationship between intimate partner violence and unintended pregnancy: analysis of a national sample from Colombia. Int Fam Plan Perspect. 2004;30:165–173.
Silverman JG, Gupta J, Decker MR, Kapur N, Raj A. Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women. Int J Obstet Gynaecol. 2007;114:1246–1252.
Stephenson R, Koenig MA, Acharya R, Roy T. Domestic violence, contraceptive use, and unwanted pregnancy in Rural India. Stud Fam Plan. 2008;39:177–186.
Wingood GM, Diclemente R. The effects of an abusive primary partner on the condom use and sexual negotiation practices of African-American women. Am J Public Health. 1997;87:1016–1018.
Center for Impact Research. Domestic violence and birth control sabotage: a report from the Teen Parent Project: Teen Parent Project; 2000. Available at: http://www.impactresearch.org/documents/dvandbirthcontrol.pdf
Miller E, Decker MR, Mccauley H, et al. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception. 2010;81:316–322.
Miller E, Decker MR, Reed E, Raj A, Hathaway J, Silverman J. Male pregnancy promoting behaviors and adolescent partner violence: findings from a qualitative study with adolescent females. Ambul Pediatr. 2007;7:360–366.
Moore L, Frohwirth L, Miller E. Male reproductive control of women who have experienced intimate partner violence in the United States. Soc Sci Med [in press].
Watts C, Mayhew S. Reproductive health services and intimate partner violence: shaping a pragmatic response in Sub-Saharan Africa. Int Fam Plan Perspec. 2004;30:207–213.

* This commentary was produced with funding support from National Institute of Child Health and Human Development (R21 HD057814-02 to Miller and Silverman), UC Davis Health System Research Award to Miller and Building Interdisciplinary Research Careers in Women’s Health award to Miller (BIRCWH, K12 HD051958; National Institute of Child Health and Human Development, Office of Research on Women’s Health, Office of Dietary Supplements, National Institute of Aging).

Reprinted under a Creative Commons Attribution License.

New Study: Further Evidence of Link Between Domestic Violence & Reproductive Coercion

Esta Soler — Wed, 07 Apr 2010 19:11:04 +0000

The study released yesterday by the Guttmacher Institute provides even more evidence that victims of domestic and dating violence often suffer reproductive control from their dating partners. Three in four respondents (74 percent) in this new study – of 71 domestic 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. These abusive behaviors can lead to unplanned pregnancy, sexually transmitted infections, and a host of other problems.

This study adds to the growing and irrefutable body of evidence that partner violence too often leads to unplanned pregnancy. We make a mistake by putting these issues in silos and promoting solutions that ignore the connection. If we are serious about stopping unplanned pregnancy in this country, we simply must address the sexual violence and reproductive control that often cause it. If we are serious about stopping dating and domestic violence, we must recognize that many victims grapple daily with sexual violence and reproductive coercion. And if we are serious about improving women’s health, we must address the violence that too many young women experience.

Today is National Women and Girls HIV/AIDS Awareness Day

margaret — Wed, 10 Mar 2010 20:31:25 +0000

Today, on National Women and Girls HIV/AIDS Awareness Day, we want to remind people about the links between HIV transmission and intimate partner violence. Studies have shown that women who are subjected to abuse, especially sexual abuse by intimate partners, are at greater risk of HIV infection. There are several ways in which coercion and violence make it more likely that a woman will contract HIV. Violence robs a woman of her ability to refuse sex with an infected partner or to insist on using condoms. Forced sex creates physical wounds that increase the opportunities for HIV to pass from one person to the other. And there is evidence that girls who suffer sexual abuse are more prone to risk-taking behaviors when they are older. But violence does not just pave the way for AIDS; the formula also works the other way around. Revealing her HIV status or even that she was tested may entail severe consequences for an abused woman.

The problems intensify if the woman is both HIV+ and pregnant. Women who are subjected to ongoing violence by an intimate partner tend to be isolated and can have a hard time getting medical help. According to Margo Kaplan of the Center for HIV Law and Policy, complicating factors include the fear that HIV treatment drugs will harm fetal development. A woman might fear that authorities will take away her child or children when they learn she is HIV+ and in a violent relationship. She might worry that the medical professionals who provide prenatal care will reveal her HIV+ status to a violent partner or hostile community. All of these factors are barriers that prevent a woman from getting the help she desperately needs.

One new resource is the publication of a guide by The Center for HIV Law and Policy, called â€œHIV and Pregnancy: Medical and Legal Considerations for Women and Their Advocates.â€ It can be downloaded here.

Partner Violence and Unintended Pregnancy: Time to Make the Connections

margaret — Wed, 17 Feb 2010 16:25:04 +0000

By Elizabeth Miller MD PhD and Jay Silverman PhD

Originally posted at RH Reality Check blog on Feb. 8, 2010

We have known for many years that violence and abuse are more closely associated with unintended pregnancy than with pregnancies that are intended. Forced sex, fear of violence if she refuses sex, and difficulties negotiating contraception and condom use in the context of an abusive relationship all contribute to increased risk for unintended pregnancy as well as for sexually transmitted infections including HIV. Newer research now also points to the influences of male control of contraception and pregnancy pressure on unintended pregnancy.

We are lead researchers of a new study, which appeared in Contraception online in late January. The research report, “Pregnancy coercion, intimate partner violence and unintended pregnancy,” highlights a phenomenon we labeled reproductive coercion to describe explicit male behaviors to promote pregnancy. Particularly for women with a history of partner violence, these behaviors are significantly linked with unintended pregnancy.

Such reproductive coercion takes many forms, but frequently involves a male partner’s direct interference with a woman’s use of contraception (’birth control sabotage’). It includes removing condoms during sex to get her pregnant, intentional breaking of condoms, and preventing her from taking birth control pills.2,3

In addition, a male partner may utilize threats and coercion to pressure a woman to get pregnant (’pregnancy coercion’), such as telling her not to use contraception and threatening to leave her if she doesn’t get pregnant.

Our previous qualitative research has pointed to a range of reasons that a man might engage in such behaviors including wanting to leave a legacy, desiring to keep a woman connected to him in some way, as well as need for control in the relationship. Clearly, much more research with men and boys needs to be done to understand male involvement in unintended pregnancies and how to positively engage men and boys in discussions of healthy relationships.

Our new study included English- and Spanish-speaking women ages 16 to 29 who sought health care at five reproductive health clinics in California. The reasons the women sought care included annual physical exams, contraception, pregnancy testing, and testing for sexually transmitted infections.

Participants completed a confidential computerized survey (with questions read to them via headphones) before their clinic visit; the clinic providers did not see the responses. More than half of the respondents (53 percent) reported experiencing physical or sexual violence from a male partner, or someone they were dating or going out with some time in their lives. A quarter (25 percent) reported that they had ever experienced ‘reproductive coercion,’ with 19 percent reporting pregnancy coercion and 15 percent reporting birth control sabotage. Women who reported experiencing both partner violence and reproductive coercion experienced a 100 percent increase in their risk for unintended pregnancy.

Unintended pregnancy is clearly a complex phenomenon. It can be caused by a number of factors including: a mismatch of intentions and behaviors for both males and females (i.e., not wanting to get pregnant, while not using contraception or a condom, often called ‘contraceptive and pregnancy ambivalence’); limited access to contraception; lack of knowledge about the range of contraceptive options; stigma associated with asking a partner to use a condom; as well as substance use such as alcohol accompanying intercourse.

Our study adds another important piece to this puzzle: Male partners interfering with women’s reproductive autonomy. Moreover, the effect of male partner reproductive coercion on unintended pregnancy is likely to be greater in the context of partner violence, given the clear threat of violence if she tries to resist her partner’s wishes.

There are many unanswered questions around the interrelationship between reproductive coercion, partner violence, and unintended pregnancy. Our study provides preliminary findings indicating a significant connection, but it was limited to lower income women seeking care in a particular type of family planning clinic in a particular region. We need to know the prevalence of reproductive coercion when women are seeking gynecologic care in other settings such as hospitals or primary care clinics, as well as how prevalent this is across the general population. How often does reproductive coercion occur in the absence of partner violence? Does partner violence precede effective attempts to control a woman’s pregnancy and the outcomes of that pregnancy? Or do men’s coercive behaviors regarding contraception and reproductive outcomes precede physical and sexual violence in the relationship? How do men recognize and understand reproductive coercion? And, perhaps most critically, why do men engage in such controlling behaviors, and what strategies will successfully engage men and boys in preventing partner violence and reproductive coercion?

Beyond answering such research questions, we need to identify effective strategies to increase awareness about reproductive coercion among both men and women. Women may perceive reproductive coercion and physical violence in a relationship as distinct issues, and may need support and information to connect the dots between this range of behaviors and their reproductive health needs. If family planning practitioners pay attention to and address reproductive coercion, they may be more successful at identifying clients at risk both for unintended pregnancy and for harm from partner violence.

Further, such identification is likely to improve the efficacy of family planning services, because knowledge of reproductive coercion can inform counseling about contraceptive adherence and choices (women at risk can be offered methods that are not easily detected by male partners and are not reliant on male partner consent). This knowledge that a woman is experiencing reproductive coercion can trigger more intensive use of prevention strategies that can reduce unintended pregnancies, including among adolescents, and promote a woman’s safety.

It also would be wise to consider incorporating efforts to reduce reproductive coercion into comprehensive sexuality education and pregnancy prevention programs. Making discussions of healthy relationships the foundation of sexuality education would be a good start. Then incorporating discussions of abusive behaviors and partner violence into curricula that discuss contraceptive negotiation would be particularly helpful in increasing a woman’s success at contraceptive negotiation and enhancing her reproductive autonomy. Prevention programs that engage men and boys in reducing unintended pregnancies should also offer opportunities to discuss masculinities, gender equity, and reproductive justice.

Finally, vehicles like the currently authorized Violence Against Women Act’s Health Provision could assist in supporting needed health research and innovations in practice related to intimate partner violence and reproductive coercion, including efforts to promote healthy relationships. We should encourage professional health care provider organizations to recognize and develop relevant standards and competencies. For instance, family planning standards can be updated to address issues of partner violence and reproductive coercion.

Many people were stunned and alarmed by the Guttmacher Institute’s January report on teen pregnancy rates in the United States. It noted a three percent increase in pregnancies among 15- to 19-year-olds from 2005 to 2006 - the first increase in some 15 years. While teens and young women report the highest rate of unintended pregnancies, many adult women experience unintended pregnancies as well. Experts have been telling us for years that almost half of pregnancies in the United States are unintended (i.e., mistimed, unplanned, and/or unwanted).

The causes and mechanisms that underlie unintended pregnancy are numerous and complex, but one thing is clear. If we are serious about reducing unplanned pregnancies in this country, we must bridge the gap between efforts to reduce violence against women and girls and efforts to reduce unintended pregnancy. We need innovative programs for both young men and women that address both partner violence and healthy relationships.

1. Miller, E., M. R. Decker, et al. (2010 Epub ahead of print). “Pregnancy Coercion, Intimate Partner Violence, and Unintended Pregnancy.” Contraception.

2. Center for Impact Research. (2000). “Domestic Violence & Birth Control Sabotage: A Report from the Teen Parent Project.”

3. Miller, E., M. R. Decker, et al. (2007). “Male Partner Pregnancy-Promoting Behaviors and Adolescent Partner Violence: Findings from a Qualitative Study with Adolescent Females.” Ambulatory Pediatrics 7(5): 360-366.

4. Finer, L. B. and S. K. Henshaw (2006). “Disparities in rates of unintended pregnancy in the United States, 1994 and 2001.” Perspectives on Sexual & Reproductive Health 38(2): 90-96.

Study: Reproductive Coercion a Factor in Unintended Pregnancy

margaret — Wed, 27 Jan 2010 14:25:30 +0000

A groundbreaking study released this week sheds light on a little-recognized form of abuse in which men use coercion and birth control sabotage to cause their partners to become pregnant against their wills. The study, published in the January issue of Contraception, finds this kind of reproductive control to be especially common in relationships in which women experience physical or sexual partner violence.

“Pregnancy Coercion, Intimate Partner Violence and Unintended Pregnancy” is the first quantitative examination of the relationship between intimate partner violence, reproductive coercion and unintended pregnancy. It finds that young women and teenage girls often face efforts by male partners to sabotage their birth control or coerce or pressure them to become pregnant - including by damaging condoms and destroying contraceptives. These behaviors, defined as “reproductive coercion,” are often associated with physical or sexual violence.

It also finds that among women who experienced both reproductive coercion and partner violence, the risk of unintended pregnancy doubled.

The study was conducted by researchers at the University of California Davis School of Medicine and the Harvard School of Pubic Health. 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.

Key findings include:

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; and
Thirty-five percent of the women who reported partner violence also reported either pregnancy coercion or birth control sabotage.

“Those of us who work to stop dating, domestic and sexual violence have long known that many victims face threats, verbal demands and physical violence designed to interfere with their efforts to use birth control,” said Family Violence Prevention Fund (FVPF) President Esta Soler. ”It is a big part of the reason that women in abusive relationships are at higher risk for unintended pregnancy. This very important study underscores the link between violence and abuse and unintended pregnancy - and the need for providers at reproductive clinics to screen female patients for violence, as well as for pregnancy coercion and birth control sabotage. If we are serious about reducing unintended pregnancy in this country, we have to do more to stop violence and abuse, and help victims.”

“This study highlights an under-recognized phenomenon where male partners actively attempt to promote pregnancy against the will of their female partners,” said lead author Elizabeth Miller, an assistant professor of pediatrics in the UC Davis School of Medicine and a practitioner at UC Davis Children’s Hospital. “Not only is reproductive coercion associated with violence from male partners, but when women report experiencing both reproductive coercion and partner violence, the risk for unintended pregnancy increases significantly.”

“We have known about the association between partner violence and unintended pregnancy for many years,” said Jay Silverman, the study’s senior author and an associate professor of society, human development and health in the Harvard School of Public Health. “What this study shows is that reproductive coercion likely explains why unintended pregnancies are far more common among abused women and teens.”

Rebecca Levenson, a Senior Policy Analyst in the FVPF’s Health Unit, is a co-author of the new study. It was conducted in collaboration with the FVPF and the Planned Parenthood Shasta Diablo Affiliate.

The FVPF’s KnowMoreSayMore initiative is creating a dialogue about birth control sabotage and reproductive coercion, which can result in unintended pregnancy, HIV/AIDS, sexually transmitted infections, miscarriage, infertility, coerced abortion, poor birth outcomes including preterm birth and low birth-weight babies, and other serious health problems.