Exploring Disability as a Determinant of Girl Child Marriage in Fragile States: A Multicountry Analysis.

PURPOSE: Fragile states are countries characterized by poverty, conflict, political instability, insecurity, and disaster. In such settings, there are high levels of disability and women and girls are disproportionately impacted by violence. Despite the 2030 Sustainable Development Goal's call for both the elimination of violence against women and girls and disability-disaggregated data, few studies have investigated how disability may be associated with girl child marriage (GCM) and how these two factors impact intimate partner violence (IPV). This study sought to assess the prevalence and associations of disability with GCM and IPV among currently married/cohabiting women (aged 20-24 years) in fragile states. METHODS: A secondary data analysis of pooled nationally representative data from four Demographic and Health Surveys were analyzed using multivariable regressions to examine the associations between disability, GCM, and IPV (N = 3,119). The association between disability and GCM was further analyzed by multinomial regressions. These weighted analyses accounted for complex survey designs. RESULTS: Overall, 54.4% of GCM occurred among women with disabilities. Disabled women were more likely to report GCM compared to women without disabilities (adjusted odds ratio = 1.62, 95% confidence interval = 1.16-2.28). Among disabled women with a history of GCM, 41.3% experienced past-year IPV. Disabled women with a history of GCM were more likely to report past-year IPV compared to nondisabled women and no GCM (adjusted odds ratio = 1.78, confidence interval = 1.21-2.62). DISCUSSION: GCM and IPV (e.g., past-year, lifetime) among disabled girls may be pervasive in fragile states, underscoring the need for additional research examining the mechanisms driving these observations and to inform inclusive programming and policy.

Concerned friends of intimate partner violence survivors: results from the myPlan randomized controlled trial on college campuses.

BACKGROUND: Nearly half of intimate partner violence (IPV) survivors experience their first abusive relationship at college age (18-24 years). Most often they disclose the violence to friends. Existing college campus "bystander" interventions training peers to safely intervene have been effective in sexual assault prevention; similar interventions have rarely been tested for IPV. Therefore, we evaluated the effectiveness of an interactive, personalized safety decision and planning tool, myPlan app, on decisional conflict, decisional preparedness, confidence in intervening, supportive safety behaviors, and IPV attitudes with concerned friends of abused college women. METHODS: We recruited college students (age 18-24, N = 293) of any gender who had a female-identified friend who had recently experienced IPV ("concerned friends") from 41 Oregon and Maryland colleges/universities. Participants were randomized to myPlan (n = 147) or control (usual web-based resources; n = 146). Outcomes included decisional conflict, decisional preparedness, confidence to intervene, safety/support behaviors, and IPV attitudes. RESULTS: At baseline, concerned friends described the abused person as a close/best friend (79.1%); 93.7% had tried at least one strategy to help. Most (89.2%) reported concerns their friend would be seriously hurt by the abuser; 22.7% reported extreme concern. Intervention participants had greater improvements in decisional conflict (specifically, understanding of their own values around the decision to intervene and help a friend) and decisional preparedness immediately after their first use of myPlan, and a significantly greater increase in confidence to talk with someone about their own relationship concerns at 12 months. At 12-month follow-up, both intervention and control groups reported increased confidence to intervene, and did not differ significantly in terms of percentage of safety/support strategies used, whether strategies were helpful, or IPV attitudes. CONCLUSIONS: A technology-based intervention, myPlan, was effective in reducing one aspect of decisional conflict (improving clarity of values to intervene) and increasing decisional preparedness to support a friend in an unsafe relationship. Information on IPV and related safety strategies delivered through the myPlan app or usual web-based resources both increased confidence to intervene with a friend. College students in the myPlan group were more likely to talk with someone about concerns about their own relationship, demonstrating potential for IPV prevention or early intervention. TRIAL REGISTRATION: Clinicaltrials.gov ID: NCT02236663, registration date 10/09/2014.

Future directions for reproductive coercion and abuse research.

BACKGROUND: Reproductive coercion and abuse (RCA) is a form of intimate partner violence (IPV) in which people with the capacity for pregnancy experience coercive behaviors that threaten their reproductive autonomy. Behaviors that constitute RCA include contraceptive control/sabotage, pregnancy pressure, and controlling the outcome of a pregnancy. Several areas of RCA study have emerged: associations with IPV, health outcomes resulting from RCA, and demographic and contextual factors associated with experiencing RCA. Current research in these areas is summarized and placed in a global context, including sexual and gender minority groups, use of RCA (exploring perpetration), RCA interventions, RCA in women with disabilities, and the question of whether people assigned male at birth can be RCA victims. CONCLUSION: Areas for future exploration include evolving interpretations of pregnancy intention in the setting of fewer options for abortion, RCA in people with disabilities and multiple levels of marginalization, including sexual and gender minorities; intersections between RCA and economic abuse in the context of efforts at economic justice; and community-centered approaches to intervention and prevention.

Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support.

Housing instability and intimate partner violence (IPV) compromise women's sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.

Reproductive coercion in college health clinic patients: Risk factors, care seeking and perpetration.

AIMS: Reproductive coercion is associated with poor health outcomes in women. This study examined exposure to and use of reproductive coercion and care seeking among college students. DESIGN: A cross-sectional survey was administered to 2291 college students of all genders seeking care in college health and counselling centres as baseline data for a cluster-randomized controlled trial. METHODS: Online surveys were collected (9/2015-3/2017). Descriptive statistics, chi-square, Fisher's exact and t-tests were analysed. RESULTS: Among female participants, 3.1% experienced reproductive coercion in the prior 4 months. Experience was associated with older age (p = .041), younger age at first intercourse (p = .004), Black/African American race (p < .001), behaviourally bisexual (p = .005), more lifetime sexual partners (p < .001) and ever pregnant (p = .010). Sexually transmitted infection (p < .001), recent drug use or smoking (p = .018; p = .001), requiring special health equipment (p = .049), poor school performance (p < .001) and all categories of violence (p = <.001-.015) were associated with women's reproductive coercion experience. Participants who experienced reproductive coercion were more likely to seek care for both counselling and healthcare, (p = .022) and sexually transmitted infection (p = .004). Among males, 2.3% reported recent use of reproductive coercion; these participants reported sexual violence perpetration (p = .005), less condom use (p = .003) and more sexual partners than non-perpetrators (p < .001). CONCLUSION: Although reproductive coercion was reported infrequently among college students, those students experiencing it appear to be at risk for poor health and academic outcomes. Health and counselling centres are promising settings to address RC and related health behaviours.

Birth Control Sabotage Motivation and Measurement: A Mixed-Methods Analysis among Latina Women.

Reproductive coercion (RC) is a type of intimate partner violence that includes birth control sabotage (BCS). We explored the perceived intent behind BCS to refine RC measurement, using a mixed-methods design with a clinic-based sample of Latina women (13 interviews; 482 surveys). Women perceived partners used BCS for reasons beyond pregnancy promotion. Specifically, 16.8% of participants reported any past-year RC; this decreased to 9.5% when asked if their partner used BCS with the sole intent of getting them pregnant. RC measures and assessment should separate behavior from intent in BCS questions to not underestimate the prevalence and to guide clinical response.

Safe and Stable Housing for Intimate Partner Violence Survivors, Maryland, 2019‒2020.

House of Ruth Maryland is a comprehensive intimate partner violence (IPV) service provider. Our academic‒practitioner partnership conducted a prospective, quasi-experimental evaluation (n = 70) of on-site transitional housing and community-based rapid rehousing to meet the safety and stability needs of individuals made homeless because of IPV. By 6-month follow-up, both IPV revictimization and housing instability significantly improved (P < .001). Housing supports through an IPV service provider advanced the dual goals of safety and housing stability for IPV survivors. Safe, affordable housing is an IPV prevention strategy. (Am J Public Health. 2022;112(6):865-870. https://doi.org/10.2105/AJPH.2022.306728).

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 (ß = -.27, 95% CI = [-0.41, -0.13], p < .001). The combination of experiencing RC and IPV appeared particularly potent in lowering pregnancy planning scores (ß = -.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.

Correlates of reproductive coercion among college women in abusive relationships: baseline data from the college safety study.

ObjectiveThe purpose of this study was to examine correlates of reproductive coercion (RC) among a sample of college women in abusive relationships. Participants: 354 college students reporting a recent history of intimate partner violence (IPV). Methods: This study examines baseline data from a randomized controlled trial testing effectiveness of an interactive safety decision aid (myPlan). Results: Almost a quarter (24.3%) of the sample reported RC. Associated factors included races other than White (p = 0.019), relationship instability (p = 0.022), missing class due to relationship problems (p = 0.001), IPV severity (p < 0.001), technology abuse (p < 0.001), traumatic brain injury-associated events (p < 0.001), and depression (p = 0.024). Conclusions: RC was a significant predictor of depression, with implications for providers working with abused college women regarding the need for mental health services concurrent with IPV/RC services. A larger proportion of women who experienced RC sought help from a healthcare provider for contraception, which suggests intervention opportunities for college health providers.

Organizational Readiness for Intimate Partner Violence Response among Supportive Housing Providers: A Capacity Assessment in Maryland.

Intimate partner violence (IPV) frequently leads to housing instability and homelessness among survivors. While the client populations of many housing support programs are likely to include IPV survivors who have unique safety needs, the organizational readiness of these housing providers to identify and support IPV survivors is not clear. This study assessed organizational readiness for IPV response among Rapid Re-Housing (RRH) and Transitional Housing (TH) providers in Maryland, whose client populations include women (n = 32). We adapted the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) to create the Housing provider Readiness to Manage IPV Survey (H-REMIS), inclusive of IPV-related perceptions, policies, staff training and capability, and resources. The 12-point H-REMIS demonstrated acceptable internal consistency reliability (Cronbach's α = 0.748). Descriptive and comparative analyses domains by IPV-specific (n = 4) and general (n = 28) housing providers assessed readiness and identified areas for improvement. IPV-specific providers had higher mean organizational readiness for IPV response scores relative to non-IPV specific providers (11.3 and 7.5, respectively). High readiness areas included perceiving the importance of IPV and staff having adequate time, space, and comfort level to address IPV. Areas of low readiness included development and use of IPV response policies as well as staff training on IPV. This assessment documents concerning gaps in organizational readiness for IPV response among supportive housing providers, and pinpoints areas where training and capacity building can be most valuable. The process of improving readiness in the supportive housing sector must involve capacity building and a systems-level approach in order to ensure that all supportive housing providers are prepared to meet the needs of IPV survivors among their client population.

Longitudinal Impact of the myPlan App on Health and Safety Among College Women Experiencing Partner Violence.

The objective of this study was to examine differences in change over time in health and safety outcomes among female college students randomized to myPlan, a tailored safety planning app, or usual web-based safety planning resources. Three hundred forty-six women (175 intervention, 171 control) from 41 colleges/universities in Oregon and Maryland completed surveys at baseline, 6- and 12-months from July 2015 to October 2017. Generalized estimating equations were used to test group differences across time. Both groups improved on four measure of intimate partner violence (IPV; Composite Abuse Scale [CAS], TBI-related IPV, digital abuse, reproductive coercion [RC]) and depression. Reduction in RC and improvement in suicide risk were significantly greater in the myPlan group relative to controls (p = .019 and p = .46, respectively). Increases in the percent of safety behaviors tried that were helpful significantly reduced CAS scores, indicating a reduction in IPV over time in the myPlan group compared to controls (p = .006). Findings support the feasibility and importance of technology-based IPV safety planning for college women. myPlan achieved a number of its objectives related to safety planning and decision-making, the use of helpful safety behaviors, mental health, and reductions in some forms of IPV.

Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing.

Survivors' considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women's safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013-2017). Linear regression measured associations between women's individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = -0.76, 95% CI: -1.39, -0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = -0.31, 95% CI: -0.56, -0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.

"Having a Child Meant I had a Real Life": Reproductive Coercion and Childbearing Motivations Among Young Black Men Living in Baltimore.

Despite disproportionate health outcome disparities experienced by Black women, reproductive coercion (RC), a range of behaviors to promote unwanted pregnancy and childbearing motivations among poor young Black men are underexamined in current empirical literature. We aimed to describe perceptions of RC behaviors and childbearing motivations among poor young Black men in Baltimore City. We recruited a convenience sample of young Black men aged 18 to 25 (N = 25). Data were collected using semi-structured interviews and demographic surveys. Thematic analysis was guided by Miller's Traits-Desires-Intentions-Behaviors (TDIB) framework. According to survey data (N = 23), mean age was 22 (2.1). Majority of participants reported sexual relationships with one person (74%; n = 17), almost half (48%; n = 12) were biological fathers, and six (26%) participants reported using RC toward an intimate partner; three (13%) reported experiencing RC behaviors from a female partner. According to qualitative interviews (N = 25), participants described perceived women-partner motivations for RC as entrapment. Childbearing motivations were influenced by (a) legacies and bonding and (b) escaping/correcting the past. Childbearing desires included (a) love feelings and intimacy and (b) good father. Childbearing intentions included (a) resistance to medical interventions and (b) preparation. Perceptions of RC and childbearing motivations reflected desires from participants to fulfill cultural expectations for conventional masculinity and enhance personal dreams for fatherhood. Although some perceptions and behavior patterns aligned with previous studies, RC was relatively rare in this sample. Findings demonstrated nuanced antithesis to stereotypical notions of young Black men and fatherhood. Provision of reproductive care for young men and their sexual partners should include discussions about RC, pregnancy motivations, and healthy sexual communication strategies.

Experiences of Reproductive Coercion Among Latina Women and Strategies for Minimizing Harm: "The Path Makes Us Strong".

INTRODUCTION: Latina women disproportionately report experiencing reproductive coercion (RC), a set of behaviors that interfere with autonomous reproductive decision making. Given RC's associations with intimate partner violence (IPV) and unintended pregnancy, it is critical to identify and address RC to assist women to achieve safety, autonomy, and reproductive life plans. The purpose of this study was to describe and understand the context of RC and the use of RC safety strategies among Latina women receiving services at an urban clinic, through listening to the experiences of the women in their own words. METHODS: Qualitative descriptive methodology was used. Semistructured interviews were conducted with a purposive sample of 13 Latina women recruited from a Federally Qualified Health Center in the Washington, DC, area. RESULTS: Data were organized into 3 a priori categories: (1) RC behaviors, (2) co-occurrence of RC and IPV, and (3) RC harm reduction strategies. New RC behaviors emerged, and immigration status was used as a method of coercive control. From these a priori categories emerged 4 themes: impact of immigrant and citizenship status, machismo, strength and bravery, and importance of family. Harm reduction strategies included less detectable contraception; some sought community services, but others resorted to deception and stalling as the only tools available to them. DISCUSSION: Less detectable methods of contraception remained useful harm reduction strategies for women experiencing RC. Midwives should inquire about method fit and be mindful of honoring the request when patients ask to change methods. Women's strength and resilience emerged as a vital source of power and endurance. This diverse sample and the powerful voices of the women who participated make a significant contribution to the understanding of RC experienced by Latina women in the United States.

A Meta-Synthesis of the Birth Experiences of African Immigrant Women Affected by Female Genital Cutting.

INTRODUCTION: The purpose of this qualitative meta-synthesis was to understand the labor and birth experiences of immigrant women in countries of resettlement who have a history of female genital cutting (FGC), also known as female genital mutilation or female circumcision. METHODS: We used a meta-ethnography approach to synthesize the literature on this topic. We searched PubMed, Embase, Web of Science, CINAHL, PsycINFO, and Sociological Abstracts databases from inception to May 2016 using the search terms female genital cutting, female circumcision, clitorectomy, clitoridectomy, pharaonic circumcision, genital circumcision, female genital mutilation, infibulation, and deinfibulation. Our inclusion criteria were 1) peer-reviewed, original qualitative research; 2) focused on populations affected by FGC or their health care providers; 3) conducted in a country where FGC is not documented as an indigenous practice; 4) English language; and 5) included a description of postmigratory labor and birth experiences of women affected by FGC. Fourteen articles were included. RESULTS: Two new syntheses emerged from our sample of studies including African immigrant women primarily resettled in Europe and the United States. First, birth after FGC in the context of resettlement included pain and anxiety, and has the potential to retraumatize. Second, while women experienced nostalgia for familiar traditions and perceived disrespect in their new setting, they questioned traditions, including the role of FGC, in their and their daughters' lives. DISCUSSION: The negative birth experiences of women affected by FGC highlight the need to improve care for this population. Health care professionals can serve as a source of support for women affected by FGC by acknowledging and addressing FGC in their care and actively listening to their perspectives and concerns.

Reproductive Coercion: A Systematic Review.

Reproductive coercion is a behavior that interferes with the autonomous decision-making of a woman, with regard to reproductive health. It may take the form of birth control sabotage, pregnancy coercion, or controlling the outcome of a pregnancy. The objectives of this article are to address the questions: (1) What is known about reproductive coercion, its prevalence, and correlates? (2) What strategies do women use to preserve their reproductive autonomy when experiencing reproductive coercion? (3) What interventions are effective to decrease reproductive coercion? In this review of 27 research studies, 12 contained findings regarding the general phenomenon of reproductive coercion and 19 contained findings about at least one component of reproductive coercion. Additionally, 11 studies contained findings related to the intersection of intimate partner violence (IPV) and reproductive coercion, 6 presented data on strategies women use to resist reproductive coercion, and 3 included intervention data. Variation in measurement makes synthesis of prevalence and correlate data challenging. The reviewed literature presents reproductive coercion as a phenomenon that disproportionately affects women experiencing concurrent IPV, women of lower socioeconomic status, single women, and African American, Latina and multiracial women. Women who experience reproductive coercion were found to present frequently for certain health services. Most data on reproductive coercion are descriptive, and there is need for further research to examine the co-occurrence with related phenomena such as IPV and unintended pregnancy. More research is also needed on the strategies women use to resist reproductive coercion as well as interventions aimed at survivors and perpetrators of reproductive coercion and health-care providers who encounter them.

Reproductive coercion among women living with HIV: an unexplored risk factor for negative sexual and mental health outcomes.

BACKGROUND: Unintended pregnancy is prevalent among women living with HIV, and is associated with poor health outcomes for women and babies. Reproductive coercion may be one unexplored mechanism for this elevated risk. METHODS: Past-year reproductive coercion data were obtained via self-reported survey from a sample of women receiving HIV specialty care in Baltimore, Maryland, USA. RESULTS: In total, 11 of the 67 women (16.4%) included in the sample reported past-year reproductive coercion. Almost two-thirds (64%) of women reporting reproductive coercion were also positive for recent post-traumatic stress disorder symptoms compared with 27% of women who did not report reproductive coercion (Fisher's exact P = 0.033). DISCUSSION: The prevalence of reproductive coercion among our sample of in care women living with HIV suggests that attention should be paid to the impact of partner influence and coercive behaviors regarding pregnancy intentions. Because of the many potential negative consequences of unintended pregnancy for women living with HIV, it is important that providers be aware of such abuse and steps that can be taken to identify and support patients who are experiencing reproductive coercion.

Provider Screening and Counseling for Intimate Partner Violence: A Systematic Review of Practices and Influencing Factors.

BACKGROUND: Primary care providers have an important role in identifying survivors of intimate partner violence (IPV) and providing safety options. Routine screening rates by providers have been consistently low, indicating a need to better understand providers' practices to ensure the translation of policy into clinical practice. AIM: This systematic review examines common themes regarding provider screening practices and influencing factors on these practices. METHOD: A literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search focused on research articles which met the following criteria: (1) health-care providers as participants, (2) provider reports on screening and counseling practices for IPV, and (3) were in English or Spanish. RESULTS: A total of 35 studies were included in the review. Across studies, providers commonly acknowledged the importance of IPV screening yet often used only selective screening. Influencing factors on clinic, provider, and patient levels shaped the process and outcomes of provider screening practices. Overall, a great deal of variability exists in regard to provider screening practices. This variability may be due to a lack of clear system-level guidance for these practices and a lack of research regarding best practices. CONCLUSIONS: These findings suggest the necessity of more facilitative, clearly defined, and perhaps mandatory strategies to fulfill policy requirements. Future research directions are outlined to assist with these goals.

Caring for Women Experiencing Reproductive Coercion.

Reproductive coercion is behavior that interferes with a woman's decision making regarding reproductive health. It may consist of contraception sabotage and/or pressure to either carry a pregnancy to term or to have an abortion. Reproductive coercion may coexist with intimate partner violence and be associated with higher rates of unintended pregnancy. Midwives and other women's health care providers can play an integral role in identifying reproductive coercion and implementing harm-reduction strategies.

A Systematic Review of Reproductive Coercion in International Settings.

Reproductive coercion is behavior that interferes with a woman's autonomous reproductive decision-making. It may take the form of birth control sabotage, pregnancy coercion, or controlling the outcome of a pregnancy. Perpetrators may be partners, a partner's family, or the woman's family. This article reviews the literature on reproductive coercion in international settings. In this review of 10 research studies, findings are presented on prevalence and type of reproductive coercion, associated factors, specific tactics, relationship with intimate partner violence and domestic violence (in-laws particularly), and implications for women's reproductive health. Findings highlight reproductive coercion as a subset of intimate partner violence that is poorly understood, especially in international settings. More research is needed on protective factors, how interventions can capitalize on protective factors, and the strategies women use to resist reproductive coercion. Policy implications and recommendations are discussed with particular attention to issues related to diverse social and cultural environments.