Today is National Women and Girls HIV/AIDS Awareness Day
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.
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Partner Violence and Unintended Pregnancy: Time to Make the Connections
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.
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Study: Reproductive Coercion a Factor in Unintended Pregnancy
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.
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Research Suggests Teens Need Programs that Encourage Strong, Healthy Relationships
Posted January 19, 2010 by margaret | No Comments | Leave a CommentA recent study published by Child Trends finds that while teens understand what it means to have healthy romantic relationships, many are pessimistic about their own chances of finding the right partner. Â Experts say that a key factor is relationship violence; other factors include infidelity and having few role models.
“The teens in our study know what they want in a relationship, but they either don’t know how to get it or don’t believe it is realistic,” said Lina Guzman, Ph.D., lead author of the study.
Male and female teens identified respect, honesty, and trust as the main components of a healthy relationship. Â But they were more likely to define “healthy” by what is not: Â cheating, disrespect, and violence.
The researchers suggest that programs aimed at teens include more mentors who can share information and experiences about strong, healthy relationships and encourage positive behavior rather than just avoiding the negative. Â ”Our findings suggest that both mentoring and teen pregnancy prevention programs may benefit from incorporating discussions and activities on how to build healthy romantic relationships,” they wrote.
Moreover, education about healthy relationships should start in the pre- and early-teen years. “[R]elationship habits, expectations, and behaviors formed in adolescence have implications for adult relationships,” the report says. Â ”Adolescence may be a key window of time to help foster positive behaviors and curtail the cycle of intimate partner violence whose seeds are often planted early.”
The Family Violence Prevention Fund encourages dating violence prevention programs and sexuality education programs to integrate information about healthy relationships.
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Access to Reproductive Health Care Essential for Women’s Health and Progress, Secretary Clinton Says
Posted January 12, 2010 by margaret | No Comments | Leave a CommentSecretary of State Hillary Rodham Clinton gave a powerful speech recommitting the United States to prioritizing women’s access to reproductive health services and programs as a path to better health and equality. The January 8 speech at the State Department commemorated the 15th anniversary of the International Conference on Population and Development (ICPD) – the first ever global forum to recognize the connection between women’s health, the quality of women’s lives and human progress.
The Secretary noted that 15 years after the landmark Cairo conference, vast inequities remain. “Too often, still today in 2010, women and girls bear the burdens of regional and global crises, whether it’s an economic downturn or climate change or political instability. They still are the majority of the world’s poor, unschooled, unhealthy, and underfed. They are rarely the cause of violent conflicts, but increasingly they bear the consequences of such conflicts. We’ve seen that from the Congo to Bosnia to Burma. And 15 years after the Cairo conference, far too many women still have little or no access to reproductive health services, including family planning and maternal health care,†she told the audience of State Department employees, advocates and experts.
“In societies where women’s rights and roles are denied,†she added, “girls are forbidden from attending school or they pay a very heavy price to try to do so. Few have the right to decide whether or when to get married or become mothers. Poverty, political oppression, and even violent extremism often follow.â€Â
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The Reality of Stupak-Pitts Amendment on a Woman in a Violent Relationship
Posted December 09, 2009 by margaret | 1 Comment | Leave a CommentThe Family Violence Prevention Fund (FVPF) is concerned about the impact of the Stupak- Pitts Amendment on a woman who is in an abusive relationship. This amendment would effectively prohibit a woman from purchasing private health insurance that would coverage abortion care. A growing body of evidence points to a much more complicated picture of unintended pregnancy and abortion than our politicians would like to admit. For many years we have known that domestic and sexual violence are widespread in this country. Nearly one-third of American women (31 percent) report being physically or sexually abused by a husband or boyfriend at some point in their lives.[i] We also know that domestic and sexual violence increase the risk of unintended pregnancy and abortion as well as STDs/HIV. For instance:
- Women seeking an abortion are 3 times more likely to be the victim of intimate partner violence compared to women who were continuing their pregnancies.[ii]
- 1 in 5 women seeking a repeat abortion disclosed a history of physical IPV.[iii]
- Among women seeking a protection order, 20% had experienced a rape related pregnancy.[iv]
But recent research shows that abusive partners go beyond physical and sexual violence alone to more subtle behaviors that we have termed “sexual and reproductive coercion.”  These behaviors include: interfering with the couple’s birth control; attempting to impregnate a partner against her will; threatening or acting violent if a partner does not comply with the other partner’s wishes regarding sexual activity, contraception or the decision whether to terminate or continue a pregnancy; and intentionally exposing a partner to STIs. We are learning that these behaviors are extremely common, rarely addressed and can have devastating consequences.
A pilot study conducted in a family planning clinic by the FVFP, UC Davis School of Medicine, and Harvard School of Public Health found:
- The lifetime prevalence of sexual and reproductive coercion by a partner was 25%.
- 1 in 5 women seeking family planning experience interference with their birth control;
- 1 in 6 experience pregnancy coercion[v]
So what do these facts mean in a real woman’s life? Consider these stories of contraceptive coercion that lead to pregnancy:
“I was on the birth control, and he ended up getting mad and flushing it down the toilet, so I ended up getting pregnant.” [vi]
“…[O]r like when I had the pill, he used to act out and ask me why I am using them, [...] I am hiding to use it and stuff like that. Then, there was another time I started using the ring and he pulled it out of me. [...] I was like, “I thought I could actually hide this one, not knowing you will come up inside of me and pull it out of me.”[vii]
Or listen to why some men refuse to wear condoms:
“…if she’s saying no, she could leave… while you’re putting the condom on. So…you don’t have time…”[viii]
“…if she doesn’t want to [have sex], then she’ll leave if you’re trying to put a condom on and, you know, she doesn’t want to do it so you don’t want her to get away.” [ix]
Or this story of a boyfriend who intentionally got his 19 year old girlfriend pregnant - not because he wanted to be a father — but because he did not want her to leave him:
“I should just get you pregnant and have a baby with you so that I know you will be in my life forever.”[x]
For every statistic, there is a real woman with a real story. Healthcare reform - something the FVPF strongly supports - should be about how we can support a woman’s health and safety.
The essence of health insurance is to plan for the unexpected.  No woman expects to have an unplanned pregnancy or to have an abortion. No woman plans to be in an abusive relationship. But if she is in such a situation, we can agree that she should have all of her options.
We need health policies that reflect the realities of a woman’s life, not someone’s political agenda. At the FVPF, we know that domestic and sexual violence lead to unintended pregnancy and abortions. When a woman is struggling to control her life the last thing she needs is to be denied all of her options.
[i] The Commonwealth Fund. Health Concerns Across a Woman’s Lifespan: The Commonwealth Fund 1998 Survey of Women’s Health. May 1998.[ii] Bourassa D, Berube J. The Prevalence of Intimate Partner Violence Among Women and Teenagers Seeking Abortion Compared with Those Continuing Pregnancy. Journal of Obstetrics & Gynaecology Canada. 2007;29(5):415-423.
[iii] Fisher WA, Sukhbir S, Singh SS, Shuper PA, Carey M, Otchet F, MacLean-Brine D, Dal Bello D, Gunter J. Characteristics of Women Undergoing Repeat Induced Abortion. CMAJ. 2005;172(5):637-641.
[iv] McFarlane J, Malecha A, Watson K, Gist J, Batten E, Hall I, Smith S. Intimate Partner Sexual Assault Against Women: Frequency, Health Consequences, and Treatment Outcomes. Obstetrics & Gynecology. 2005;105:99-108.
[v] Miller, E, personal communication, 2009
[vi] Miller, E et al. Male partner pregnancy promoting behaviors in adolescent partner violence: findings from a qualitative study with adolescent females. Ambulatory Pediatrics 2007: 360-66
[vii] Moore, A, Frohwirth, L, Miller, E, Personal communication, 2009
[viii] Silverman, J G et al. Social norms and beliefs regarding sexual risk and pregnancy involvement among adolescent males being treated for dating violence perpetration. Journal of Urban Health , 2006;83: 723-35
[ix] Silverman, J G et al Social norms and beliefs regarding sexual risk and pregnancy involvement among adolescent males being treated for dating violence perpetration. Journal of Urban Health , 2006;83: 723-35
[x] Moore, A, Frohwirth, L, Miller, E, Personal communication, 2009
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Statement on Chris Brown Plea Deal: “Chilling Reminder…”
Posted June 24, 2009 by margaret | No Comments | Leave a CommentStatement of Esta Soler, President, Family Violence Prevention Fund
“The plea deal reached today in Los Angeles in the domestic violence case involving Chris Brown and Rihanna is not an unusual outcome in a case like this. Despite what was apparently an extremely violent assault, it was a first offense. We are glad the charge remained a felony, and that Mr. Brown pleaded guilty, taking responsibility for his actions.
Time will tell whether justice was served, and that will depend in large part on whether Mr. Brown is truly repentant and takes seriously the interventions that will now be available to help him renounce violence going forward.
This case is a chilling reminder of how dangerous domestic and dating violence can be, how quickly it can escalate, how badly youth like Mr. Brown who grow up in violent homes need intervention, and how urgently victims need services.
Violence like this occurs every day in every community, and victims need our support. In addition to getting them the help they need, we must all make a commitment to teach the next generation that violence is always wrong. Only when we do that will incidents like this become part of our past, rather than part of our everyday lives.â€
Background: The Centers for Disease Control and Prevention reports 1,200 deaths and two million injuries to women from intimate partner violence each year. On average, three women are murdered by their husbands or boyfriends each day in this country. 15.5 million U.S. children live in families in which partner violence occurred at least once in the past year, and seven million children live in families in which severe partner violence occurred.
The Family Violence Prevention Fund works to end violence against women and children around the world, because every person has the right to live free of violence. More information is available at www.endabuse.org. In partnership with the Advertising Council, the FVPF has launched That’s Not Cool, a new campaign designed to help start a conversation among teens so they will connect the dots and recognize when controlling behavior becomes abuse. Learn more at www.thatsnotcool.com.
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New Study: Those in Abusive Relationships Have Higher Risk for HIV
Posted June 18, 2009 by margaret | No Comments | Leave a CommentA new study illustrates the strong link between partner violence and negative reproductive health outcomes. The study, published in this month’s issue of General Hospital Psychiatry, reveals that those who are in physically abusive relationships are at higher risk for HIV infection.
The study involved nearly 14,000 U.S. women ages 20 and older. The results showed that women who experience violence from their partners were more than three times as likely to have HIV as women who do not. Almost 12% of the HIV infection was due to intimate partner violence.
A news release on the study can be found here; the full article is here.
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Senate Committee Hears About The Link Between Violence and Unintended Pregnancy
Posted June 16, 2009 by margaret | No Comments | Leave a CommentAnn Burke, R.N., M. Ed., testified last week at the U.S. Senate Judiciary Committee hearings on “The Continued Importance of the Violence Against Women Act (VAWA).”
As part of her testimony, Ms. Burke, who is president and founder of the Lindsay Ann Burke Memorial Fund in Rhode Island, cited Dr. Jay Silverman’s research on reproductive coercion. She noted, “Recent research has found a strong connection between violence among young people and poor reproductive health outcomes. A study published in the Journal of the American Medical Association found that one in three U.S. high school girls who has been abused by a boyfriend has become pregnant. By reducing dating violence, we can reduce unintended teen pregnancies.â€
To view a webcast of the hearings, click here.
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April is STD Awareness Month
Posted April 23, 2009 by margaret | No Comments | Leave a CommentEach year, public health advocates declare April to be STD Awareness month, to bring attention to the issue and, more importantly, to encourage people to be screened for sexually transmitted diseases (STDs).
This is also an important time to talk about the connection between STDs and relationship abuse or violence. While people often attribute STD transmissions to reckless behavior, the truth is that women who experience coerced sex, birth control sabotage or rape are significantly more likely to contract an STD. Consider these facts:
- One in three adolescents tested for sexually transmitted infections and HIV have experienced domestic or dating violence.
- Women disclosing physical violence are nearly three times more likely to experience a sexually transmitted infection than women who don’t disclose physical abuse
In addition to speaking out about the link between abuse and STDs, and sharing personal stories, this is also a great time to connect with your health care provider about your own health.
MTV, Planned Parenthood and the Kaiser Family Foundation are partnering this month on a program called GYT 09 - which stands for Get Yourself Tested. The project’s website provides facts on STDs, tips on how to bring up testing with partners and health care providers, and an easy-to-use testing center locator, provided by the U.S. Centers for Disease Control and Prevention (CDC).
Learn more at www.GYT09.org
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At first he thought I had snuck and got [an] abortion until he saw the papers from the emergency room [explaining that she had a miscarriage]… He was like, ‘I knew it, I knew it, I knew you went and got an abortion. You don’t love me. You don’t care about me. You have killed my baby.’"
