(Content note: this article contains mentions and descriptions of intimate partner violence and reproductive coercion.)
Removing a condom mid-intercourse without consent (or stealthing), getting rid of someone else’s birth control pills, or poking a hole in a condom are examples of a specific kind of abuse that aims to control people’s reproductive lives using coercive and controlling tactics.
These examples are referred to as reproductive coercion (RC), a term first coined by Dr. Elizabeth Miller in 2010. Reproductive coercion is a form of intimate partner violence (IPV) used to undermine a person’s reproductive decision-making through tactics that coerce pregnancy or manipulate contraceptive use. Pregnancy coercion may include telling a partner not to use birth control, preventing birth control access, and repeated requests to have sex without a condom to achieve pregnancy. A 2019 study found that one in four women have facing reproductive coercion.
According to Dr. Charvonne Holliday Nworu, an assistant professor in the Department of Population, Family, and Reproductive Health at Johns Hopkins Bloomberg School of Public Health, reproductive coercion is rooted in the need for power and control.
“What differentiates reproductive coercion from sexual violence or sexual coercion is the intention to achieve pregnancy,” Holliday Nworu said. “Tactical forms of reproductive coercion span coercion, deception, and manipulation.” These can also be categorized as pregnancy coercion, condom manipulation, and birth control sabotage.
Reproductive coercion can take many forms. Other examples include threatening to have a baby with someone else if the person does not conceive, using physical violence to coerce a pregnancy, breaking a condom on purpose, forcing a partner to terminate a pregnancy when they do not want to or injuring them in a way that may cause a miscarriage, destroying contraceptives, creating barriers to a person getting to a healthcare appointment to obtain birth control, or forcibly removing vaginal rings, contraceptive patches, or intrauterine devices.
Identifying reproductive coercion
Like other forms of abuse, reproductive coercion is often normalized and dismissed. In 2018, Saturday Night Live comedian Pete Davidson made a joke about his then-girlfriend, pop singer Ariana Grande, during the show’s Weekend Update segment.
“Last night I switched her birth control with Tic Tacs,” he said. “I believe in us and all, but I just want to make sure that she can’t go anywhere.”
When comments such as this are excused, reproductive coercion is minimized. There is an urgent need to have a better understanding of reproductive coercion in a way that empowers victims to recognize it and healthcare professionals to screen for it.
A 2010 study found that the prevalence of intimate partner violence reported among women seeking care in gynecologic clinics is much higher than population-based estimates. This may be because intimate partner violence is associated with increased pregnancy and sexually transmitted infection. Further, studies have shown links between “RC and IPV, unwanted pregnancies, poor mental health, decreased contraceptive self-efficacy, and increased risk of sexually transmitted infections.” This is where reproductive health professionals are uniquely positioned to reach people victimized by abusive relationships. Reproductive healthcare providers are in a critical position where they can identify patterns in a person’s record and conduct screenings for reproductive coercion, which can prevent many from getting trapped in a cycle of abuse.
The pandemic has also exacerbated domestic violence, and the highest rates of this are seen in domestic violence survivors. Limited access to reproductive health care due to social distancing and fear of infection among health-seeking populations contribute to reproductive coercion going unchecked.
The disproportionate effect on marginalized communities
In most research on reproductive coercion, gender and sex are still conflated. However, people who can become pregnant are likely to experience this form of power and control differently than people assigned male at birth, and these gaps in research can have consequences.
“RC experiences across the spectrum of gender such as trans men and non-binary people have not been studied to my knowledge and is a very big gap in our knowledge of how to support those individuals,” said Dr. Kamila A. Alexander, a nurse clinician and researcher who focuses on promoting healthy relationships among adolescents and young adults.
According to Dr. Elizabeth Miller, the director of adolescent and young adult medicine at UPMC Children’s Hospital of Pittsburgh, it is critical to consider reproductive coercion through an intersectional lens.
“We found that Black and Latina women (and adolescents who identify as female) report experiencing RC more than their white counterparts,” Miller said. “We have highlighted that this has to be understood in the context of structural inequities and systemic racism.”
Studies have shown that the prevalence estimated for reproductive coercion for Black women is around 37%, and roughly 29%, and 24% for multiracial and Latinx women, respectively—with about 18% for both AAPI and white women.
Further, many undocumented migrants and immigrants are often kept from accessing the health care they need due to language and insurance barriers. Alexander said that if people already have challenges accessing what they need to protect their reproductive health, it can be exploited by a partner who seeks to control their relationship. Studies have shown that citizenship status and other factors can be manipulated in ways that specifically increase the risk of reproductive coercion toward Latinx women. For example, threats of reporting undocumented status are used to control a partner.
Kate Amber, an expert in the psychology of coercive control and founder of ECCUSA, explained that coercive control starts with things like a raised eyebrow or a degrading comment, and builds up to a total sense of control over another person, control which is maintained through fear.
“When fear is present, consent cannot be present,” Amber said. “Many people are being coerced without realizing it because their fear mechanism is what is making the decisions for them.”
Efforts to combat RC
Sexual violence is often perpetrated with impunity. The burden of proof is placed on the survivor, which is challenging to prove for incidences of sexual violence, particularly for reproductive coercion, when physical evidence may not be apparent. Federal policy on intimate partner violence focuses on a person’s use, attempted use, or threats of physical violence, failing to include reproductive coercion. Similarly, policies on sexual violence center on non-consensual sex acts, which do not cover the full scope of reproductive coercion, Nworu said.
In November 2021, California became the first state to ban stealthing, which refers to the non-consensual removal of a condom during intercourse, a civil offense. There is an urgent need for other states to follow for people to have a legal basis for reporting this form of reproductive coercion. Further, The Affordable Care Act requires health insurance coverage for domestic violence survivors, before which people with preexisting conditions (including survivors) were often denied coverage. Advocates say more needs to be done to ensure that intimate partner violence and reproductive coercion victims have ways to seek health care.
There is also a need to ensure healthcare professionals and physicians are equipped to screen and counsel survivors of intimate partner violence, including reproductive coercion. Policies requiring training for physicians on identifying and assessing reproductive coercion will increase patients’ reproductive coercion awareness and facilitate harm reduction strategies such as offering patients more discreet forms of contraception.
Until policy changes are implemented to support people affected by reproductive coercion, resources are available for immediate guidance and care like the National Domestic Violence Hotline, which can be reached at 1-800-799-SAFE (7233) or via text 741741 to get in touch with a crisis counselor.
