Reproductive coercion and abuse in intimate relationships: Women's perceptions of perpetrator motivations.

Reproductive coercion and abuse is a hidden and poorly recognised form of violence against women. It refers broadly to behaviours that interfere with or undermine a person's reproductive autonomy, specifically to promote or prevent pregnancy. Reproductive coercion and abuse can involve physical, sexual, financial or psychological abuse in order to achieve these aims, and is overwhelmingly perpetrated by men against women. As an emerging field of scholarship, conceptual understanding of reproductive coercion and abuse is still in its infancy; however, it is often described as being linked to coercive control. In this article, we seek to highlight the complexity of this relationship through qualitative analysis of in-depth interviews with 30 victim/survivors in Australia recruited from the community, focusing on their perceptions of the perpetrator's motivations. We developed four themes from our analysis: 1) His needs came first; 2) The illusion of a perfect father; 3) Creating a weapon of control; and 4) My body was his. Perceived perpetrator motivations ranged from entitlement and self-interest to a deep desire for domination and entrapment. Pregnancy preventing behaviour was more likely to be linked with entitlement and self-interest, whereas pregnancy promoting behaviour tended to be described by participants in relationships where there was a broader pattern of ongoing control and entrapment. Thus, we suggest that coercive control is a motivating factor for some, but not all men who perpetrate reproductive coercion and abuse. A greater understanding perpetrator motivations may be important for practitioners, particularly those working in sexual and reproductive health services, since it could be relevant to women's level of risk for coercive controlling behaviour or more extreme forms of physical or sexual violence.

How do decision making and fairness mediate the relationship between involuntary hospitalisation and perceived coercion among psychiatric inpatients?

BACKGROUND: Coercion perceived by psychiatric inpatients is not exclusively determined by formal measures such as involuntary admissions, seclusion or restraint, but is also associated with patients' characteristics and professionals' attitude. AIMS: This study examined how inpatients' involvement in the decision making process, the respect of their decision making preference, and their feeling of having been treated fairly mediate the relationship between involuntary hospitalisation and perceived coercion both at admission and during hospital stay. METHODS: Mediation analysis were performed in order to study the relationship between involuntary hospitalisation and perceived coercion among 230 patients, voluntarily and involuntarily admitted in six psychiatric hospitals. RESULTS: 32.2% of the participants were involuntarily hospitalised. Taken individually, stronger participants' involvement in decision making process, better respect for their decision making preference and higher level of perceived fairness partially mediated the relationship between involuntary hospitalisation and perceived coercion by reducing the level of the latter both at admission and during the hospitalisation. In multiple mediator models, only involvement and respect played an important role at admission. During the hospitalisation, perceived fairness was the most relevant mediator, followed by involvement in decision making. CONCLUSIONS: During psychiatric hospitalisation patients' involvement in decision making, respect of their decision making preference and perceived fairness determined the relationship between involuntary hospitalisation and perceived coercion, but not in the same way at admission and during the stay. Involving patients in decision making and treating them fairly may be more relevant than taking account of their decision making preference in order to reduce perceived coercion.

Pandemic lockdowns: who feels coerced and why? - a study on perceived coercion, perceived pressures and procedural justice during the UK COVID-19 lockdowns.

BACKGROUND: This study examined perceptions of coercion, pressures and procedural injustice and how such perceptions influenced psychological well-being in those who experienced a UK COVID-19 lockdown, with a view to preparing for the possibility of future lockdowns. METHODS: 40 individuals categorised as perceiving the lockdown(s) as either highly or lowly coercive took part in one of six asynchronous virtual focus groups (AVFGs). RESULTS: Using thematic analysis, the following key themes were identified in participants' discussions: (1) Choice, control and freedom; (2) threats; (3) fairness; (4) circumstantial factors; and (5) psychological factors. CONCLUSIONS: As the first qualitative study to investigate the psychological construct of perceived coercion in relation to COVID-19 lockdowns, its findings suggest that the extent to which individuals perceived pandemic-related lockdowns as coercive may have been linked to their acceptance of restrictions. Preparing for future pandemics should include consideration of perceptions of coercion and efforts to combat this, particularly in relation to differences in equity, in addition to clarity of public health messaging and public engagement.

Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff.

BACKGROUND: Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS: During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS: The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS: The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.

Informal coercion in inpatient mental healthcare: a scoping review protocol.

INTRODUCTION: Comprehending informal coercion, which encompasses a wide range of phenomena characterised by subtle and non-legalised pressures, can be complex. Its use is underestimated within the continuum of coercion in mental health, although its application may have a negative impact on the persons involved. A better understanding of informal coercion is crucial for improving mental healthcare and informing future research. This scoping review aims to explore the nature, extent and consequences of informal coercion in mental health hospitalisation to clarify this phenomenon, establish its boundaries more clearly and identify knowledge gaps. METHODS AND ANALYSIS: Following the methodological framework from the Joanna Briggs Institute, this scoping review will encompass 10 key steps. Literature searches will be conducted in electronic databases, including CINAHL, PubMed, MEDLINE, EMBASE, Web of Science, PsycINFO, and ProQuest Dissertation and Theses. Then, a search in grey literature sources (Open Grey, Grey Guide), psychiatric and mental health journals, government agencies and among the references of selected studies will be conducted. The research will include all literature focusing on informal coercion with inpatients aged 18 and above. Data will be extracted and analysed descriptively, mapping the available knowledge and identifying thematic patterns. The quality of included studies will be assessed using appropriate appraisal tools. An exploratory search was conducted in November 2023 and will be updated in December 2023 when the selection of relevant evidence will begin. ETHICS AND DISSEMINATION: Ethical approval is not required as this study involves the analysis of existing published literature. The findings will be disseminated through a peer-reviewed publication and presentations at relevant conferences. They will be shared with people living with mental disorders and professionals working in mental healthcare.

Psychological freedom, rationality, and the naive theory of reasoning.

To make sense of the social world, people reason about others' mental states, including whether and in what ways others can form new mental states. We propose that people's judgments concerning the dynamics of mental state change invoke a "naive theory of reasoning." On this theory, people conceptualize reasoning as a rational, semi-autonomous process that individuals can leverage, but not override, to form new rational mental states. Across six experiments, we show that this account of people's naive theory of reasoning predicts judgments about others' ability to form rational and irrational beliefs, desires, and intentions, as well as others' ability to act rationally and irrationally. This account predicts when, and explains why, people judge others as psychologically constrained by coercion and other forms of situational pressure. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Links between Aggressive Sexual Fantasies and Sexual Coercion: A Replication and Extension of a Multifactorial Model.

Current research indicates that aggressive sexual fantasies (ASF) are related to sexual aggression, above and beyond other risk factors for this behavior. There have, however, rarely been explicitly considered in multifactor models aiming to explain sexual aggression. One exception is the multifactorial Revised Confluence Model of Sexual Aggression that was replicated in two samples of male individuals who were convicted of sexual offenses and a small sample of men from the general population and evidenced a high relevance of ASF, respectively. There were, however, no further attempts to replicate the model in larger samples from the general population. We, therefore, used a subsample from the Finnish Genetics of Sexuality and Aggression project including 3269 men (age: M = 26.17 years, SD = 4.76) to do so. Cross-sectional latent structural equation models corroborated previous research and the assumption that ASF are a central component in multifactor models that aim to explain sexual aggression: ASF and antisocial behavior/aggression were equally important associates of sexual coercion when also considering adverse childhood experiences, hypersexuality, and callous-unemotional traits. Additionally, ASF mediated the links between hypersexuality, callous-unemotional traits, as well as childhood sexual abuse and sexual coercion. These links held stable when entering further risk factors, that is, distorted perceptions, rape-supportive attitudes, and violent pornography consumption into the model. Contrasting assumptions, alcohol consumption and antisocial behavior/aggression did not interact. These results illustrate the potential importance of ASF for sexual aggression. They indicate that ASF require consideration by research on sexual aggression as well as in the treatment and risk assessment of sexual perpetrators.

"Some missions can be quite emotionally painful." Paramedic´s experience exercising coercion during assignments-A qualitative study.

BACKGROUND: More than 70% of respondents in a previous survey among paramedics reported use of coercion or physical force towards patients. Coercion outside hospital is not permitted, and neither routines nor equipment intended for physical restraint is available in the Norwegian ambulance services. Paramedics carry out assignments involving use of force and coercion on unclear legal grounds, with no training in techniques or proper equipment. Attitudes and experiences of healthcare workers regarding incidents involving coercion in mental health care services are frequently reported in the research literature, yet little is known about paramedics' experiences, and which factors contribute to their moral stress. METHODS: In the period June-August 2021, almost 400 employees in the ambulance services in a county in the eastern part of Norway were invited to answer a digital questionnaire. One question had an open text field with the question "Can you say something about how you experience transporting patients where force has to be used to secure the patient during transport?". The answers were analyzed using Graneheim and Lundman's content analysis. RESULTS: We received eighty-five completed responses (response rate 21%). Force was used by 62 paramedics. Twenty-three left the text field open. The answers showed many unique responses. Content analysis resulted in two overarching themes; 1) lack of routines, equipment, and training regarding use of coercion and force in the ambulance service, and 2) paramedics were confronted with ethical dilemmas, alone and without support from legislation or management. CONCLUSIONS: The paramedics experienced discomfort related to the exercise of force and coercion during ambulance assignments due to the experience of unclear legislation, lack of training, routines, and equipment in addition to frequent ethical dilemmas and the concern about lack of support from the employer. A clearer legal basis, adapted equipment in the ambulance and regular training, will contribute to greater security in the performance of the work, which will provide safer and more caring treatment for the patients and less moral stress for the staff. With established routines, the employer will be implicitly obliged, and paramedics will be safer in the performance of their work. Ethical reflection must be offered and put into a system.

Permanent Contraception: Ethical Issues and Considerations: ACOG Committee Statement No. 8.

Permanent contraception is the most used method of contraception among women aged 15-49 years and is one of the most straightforward surgical procedures an obstetrician-gynecologist can perform. At the same time, this therapeutic option is enormously complex when considered from a historical, sociological, or ethical perspective. This Committee Statement reviews ethical issues related to permanent contraception using a reproductive justice framework. Ethical counseling and shared decision making for permanent contraception should adopt a nonjudgmental, patient-centered approach, using up-to-date information about permanent contraception procedures and alternatives. Obstetrician-gynecologists should strive to avoid bringing into the clinical encounter biases around gender, race, age, and class that affect thoughts on who should or should not become a parent. Obstetrician-gynecologists should also ensure that permanent contraception requests reflect each patient's wishes, come from a desire to permanently end childbearing, and come from a preference for permanent contraception over all reversible methods as well as permanent contraception for the male partner. When difficulties in meeting a postpartum permanent contraception request are anticipated and permanent contraception is desired by the patient, transfer of care for the remainder of pregnancy should be offered. ACOG recognizes the right of all patients to unimpeded access to permanent contraception as a way of ensuring health equity, but it is unclear how to craft policies that protect from coercion but also do not create barriers to autonomously desired care. Determining the ethical balance between access and safeguards will require a collaborative interdisciplinary approach that involves a variety of stakeholders with varying perspectives.

Comparing Perception of Sexual Intent and the Use of Sexual Coercion in Men and Women College Students.

Despite research showing that many college men and women have experienced misperception of their friendliness as sexual intent, such research has focused on this type of misperception only as a correlate of men's sexual aggression. In fact, regardless of methodology used many researchers seem to suggest women do not misperceive men's sexual intent, and in some instances may actually under-perceive it. We used a hypothetical scenario to determine whether men (n = 324) and women (n = 689) college students perceived similar sexual intent from a character who is not the same gender as they are, as depicted in a story about a man and woman on a "date." Our results revealed that men and women in our sample reported similar levels of perceived sexual intent on the part of the character with a different gender as described in the scenario, even after that character clearly indicated to the partner that they "think they do not want to have sex." In addition, the perceived level of the character's sexual intent as solicited in response to this scenario design was related to sexual coercion intentions among both men and women (though it appears more strongly related among men), and these relationships remained even after controlling for other known correlates of sexual coercion (e.g., rape myth acceptance, level of sexual arousal). Implications for the study of misperception and its origins are discussed.

Bystander Intervention in Coercive Control: Do Ethnic Identity and Acceptance of Coercive Control Influence Willingness to Intervene?

Previous intimate partner violence research and social psychological theory have highlighted that ethnicity and level of harm are both factors that have the potential to influence bystander willingness to intervene in, as well as the acceptance of intimate partner violence between couples. Little research has been conducted on the general willingness of bystanders to intervene in, or the level of acceptance of coercive control. This is the first study to explore whether the likelihood of bystander willingness to intervene is influenced by participant gender, the ethnicity of the couple involved in a hypothetical scenario of coercive control, and by differing levels of abusive behavior. In this study, we also explored the influence of participants' acceptance of coercive control. A semi-experimental design was used, utilizing an online community sample sourced through social media of 346 adult participants across Australia. The participants were randomly allocated to read a fictional coercive control scenario detailing either low or high harm instances of coercive control. Within the online survey the ethnicity of the couple was manipulated with participants' randomly allocated to read a scenario about a couple with the same ethnicity as them (Australian of British or European descent) or a couple with Indian Australian ethnicity. The results showed the participants were significantly more willing to intervene in the coercive control scenario when the couple shared the same ethnicity as them. In response to the low harm scenarios, participants were significantly more accepting of coercive control if the couple were Indian Australian. However, males responding to high harm scenarios were more accepting of coercive control if the couple shared the same ethnic identity as them. The implications from these findings for theory and future bystander intervention programs are discussed.

Rape and Sexual Coercion Related Pregnancy in the United States.

INTRODUCTION: Sexual violence is a major public health problem in the U.S. that is associated with numerous health impacts, including pregnancy. U.S. population-based estimates (2010-2012) found that three million women experienced a rape-related pregnancy during their lifetimes. The current study presents more recent estimates of rape and sexual coercion-related pregnancy and examines prevalence by demographic characteristics. METHODS: Data years 2016/2017 were pooled from the National Intimate Partner and Sexual Violence Survey, a random-digit-dial telephone survey of U.S. non-institutionalized adults 18 years and older. The analysis, conducted in 2023, examined lifetime experience of rape-related pregnancy, sexual coercion-related pregnancy, or both among U.S. women. Authors calculated prevalence estimates with 95% CIs and conducted pairwise chi-square tests (p-value<0.05) to describe experiences by current age, race/ethnicity, and region of residence among U.S. women overall and among victims. RESULTS: One in 20 women in the U.S., or over 5.9 million women, experienced a pregnancy from either rape, sexual coercion, or both during their lifetimes. Non-Hispanic Multiracial women experienced a higher prevalence of all three outcomes compared with non-Hispanic White, non-Hispanic Black, and Hispanic women. Among victims who experienced pregnancy from rape, 28% experienced a sexually transmitted disease, 66% were injured, and over 80% were fearful or concerned for their safety. CONCLUSIONS: Pregnancy as a consequence of rape or sexual coercion is experienced by an estimated six million U.S. women. Prevention efforts may include healthcare screenings to identify violence exposure and use of evidence-based prevention approaches to reduce sexual violence.

Coercive Parent-Adolescent Interactions Predict Substance use and Antisocial Behaviors Through Early Adulthood: A Dynamic Systems Perspective.

This study revisits the association between coercive parent-adolescent interactions and adolescent externalizing behaviors. Specifically, we investigate the moment-to-moment coercive exchanges between parents and adolescents and how these dynamic processes map to the long-term development of substance use and antisocial behavior from middle adolescence to early adulthood. We collected videotaped observations with 794 adolescents (ages 16-17 years) and their parents during interactions and coded their real-time behavioral exchanges. State Space Grid analyses were used to measure the proportion of time in which each parent-adolescent dyad engaged in the Dyadic Coercion region as an indicator of rigidity in dyadic coercion. We also measured adolescents' substance use and antisocial behavior at ages 16-17, ages 18-19, and ages 21-22. The enduring impact of parent-adolescent coercive interaction on substance use and antisocial behavior was tested using categorical latent growth curve models and path models. Adolescents with more coercive interactions with parents showed higher rates of increase in alcohol use and higher levels of antisocial behavior through early adulthood. The findings highlight the unique contribution of using intensive data to understand coercive interactions on a micro-timescale and how these dynamics influence long-term development in externalizing behaviors. Implications for intervention studies are discussed.

Preliminary Efficacy of a Brief Cognitive Restructuring Intervention to Reduce Sexual Coercion Intentions: Roles of Alcohol and Emotion Regulation.

Sexual coercion (SC), the use of nonphysical tactics to obtain sexual contact with a nonconsenting partner, is a prevalent form of sexual misconduct that is associated with several physical and psychological health concerns. Therefore, effective preventative interventions to reduce SC prevalence are needed. Alcohol consumption and difficulties in emotion regulation (ER) are two risk factors that contribute to SC. Cognitive restructuring (CR) has the potential to reduce SC intentions by improving ER through actively challenging one's thoughts to modify emotions. This study represents a secondary data analysis to examine the effectiveness of a brief, web-based CR intervention in reducing SC intentions. To test whether the intervention would remain beneficial in the presence of alcohol, we tested effects among intoxicated versus sober participants. Young, male, heavy episodic drinkers with a history of sexual aggression (N = 137) were randomized into a CR intervention versus control condition as well as alcohol consumption versus no alcohol condition. Then, participants completed a sexual aggression analog scenario. General linear regression analyses showed that intoxicated men reported stronger SC intentions than sober men. Additionally, relative to controls, men in the CR condition who had better preexisting ER cognitive reappraisal skills had significantly lower SC intentions. Our findings provide preliminary support for CR as an effective strategy to reduce SC intentions among sexually aggressive, heavy episodic drinking men with better cognitive reappraisal skills. If findings are replicated, this brief, web-based CR intervention could overcome potential challenges in dissemination and be easily applied in clinical settings.

Use of coercion in mental healthcare services in Nigeria: Service providers' perspective.

BACKGROUND: There is increasing advocacy to reduce coercive practices in mental healthcare. Little research has been done on the topic in developing countries. AIMS: To explore what mental health professionals in Nigeria think about coercion, why it is used, and what contextual factors influence its use in mental healthcare services. METHODS: Semi-structured interviews were carried out with 16 doctors and 14 nurses from two psychiatric hospitals in two regions of Nigeria. The audio-recorded interviews were analyzed thematically with the aid of MAXQDA software. RESULTS: Three broad categories relating to the perception of, reasons for, and barriers/facilitators to the use of coercion were derived. Coercion was viewed as being for the best interests of patients, a means to an end, and effective for achieving desired outcomes. Safety was both a reason to use a coercive measure and a deterrent to using specific coercive measures thought to be unsafe. The socio-cultural context, obsolete mental health legislation, staff shortages, and attitudes were factors influencing the use of coercion in mental healthcare. CONCLUSION: Coercion was perceived to be ultimately beneficial in mental health practice. There is need for a new mental health legislation and more resources for mental health care in Nigeria to address the problem of coercion.

Understanding Intimate Partner Violence: Why Coercive Control Requires a Social and Systemic Entrapment Framework.

How intimate partner violence (IPV) is conceptualized affects what we see when we look at situations involving IPV and what we think the solutions to the problem of IPV are-either in individual cases or in the development of broader legal and policy responses. In this article, it is suggested that while conceptualizing IPV as coercive control is an improvement over previous understandings, it does not go far enough. Coercive control must be located within a broader conceptualization of IPV as a form of social and systemic entrapment if it is not to operate in a harmful manner for victim-survivors.

Interparental Coercive Control and Child and Family Outcomes: A Systematic Review.

Coercive control (CC) is a core facet of intimate partner violence (IPV) and involves asserting power, dominance, and control over another person. Although the adverse impacts of childhood exposure to interparental IPV have been well documented, the outcomes of childhood exposure to interparental CC have not been systematically examined. This study aimed to address this gap by reviewing available empirical evidence on interparental CC and child and family outcomes. Articles were identified by searching electronic databases using keywords relating to CC, children and parents, and child wellbeing outcomes. The final review included 51 studies that reported on adverse outcomes pertaining to parenting and family relationships (k = 29), child internalizing and externalizing problems (k = 7), social-emotional development (k = 5), and physical/health development (k = 17). Specifically, studies reported that CC was associated with increased parental psychopathology, poorer family functioning, harsher parenting and higher levels of child abuse, strained parent-child relationships, children used as tools and co-victims of CC, increased risk of child internalizing and externalizing problems, limited socializing opportunities, increased bullying, poorer perinatal outcomes, limited access to healthcare, and increased risk of child mortality. Evidence identified CC as a unique contributor to adverse child wellbeing outcomes, independent of exposure to IPV more broadly. Results indicated that the impacts of childhood exposure to CC are complex, far reaching, and, in some cases, devastating. The limitations of the findings, as well as implications for practice, policy, and research are discussed.

Sexual Coercion, Intimate Partner Violence, and Homicide: A Scoping Literature Review.

The specific relationship between sexual coercion, intimate partner violence (IPV) during pregnancy, and intimate partner homicide (IPH) is poorly understood. Through a scoping literature review, we identified 101 studies on sexual coercion, IPV during pregnancy, and IPH and created a conceptual model suggesting unintended pregnancies may serve as both a risk factor for and a product of IPV that may escalate to IPH. We illustrate a healthcare systems intervention implication of this model in the context of the Colorado Family Planning Initiative (CFPI). Descriptive statistics suggest an inverse association between contraception access and IPH, which declined by 62% during the first 4 years of the CFPI. Interventions aimed at improving reproductive agency, including improving contraception access and reducing unintended pregnancy, may be a useful opportunity for clinician and health systems to contribute to reducing both lethal and nonlethal IPV.