Doctors Should Ask About Reproductive Coercion, ACOG Advises

January 24, 2013 — Ob-gyns should screen women for signs that they are being coerced into pregnancy and offer "discreet and confidential contraception" to those who are, according to an opinion released by the American College of Obstetricians and Gynecologists' Committee on Health Care for Underserved Women, MedPage Today reports.

The ACOG panel defined reproductive coercion as "behavior that interferes with contraception use," such as when an intimate partner hides or withholds contraception from a woman or makes threats to force her to become pregnant (Struck, MedPage Today, 1/23).

Committee member Veronica Gillispie, an ob-gyn at New Orleans' Ochsner Health System, elaborated that reproductive coercion occurs whenever a partner tries to stop a woman from making her own decisions about pregnancy, including forcing sex, or pressuring her to continue or end a pregnancy.

Discreet birth control methods that doctors can provide include intrauterine devices with the removal strings cut or a supply of emergency contraception in an unmarked envelope, according to ACOG. The opinion also recommends that ob-gyns direct women to counseling and hotlines (Painter, USA Today, 1/23).

Reasons for Recommendation

The committee noted that there is a "known link" between reproductive coercion and violence, adding that the most common cause of pregnancy-related death is homicide, most likely committed by an intimate partner (Struck, MedPage Today, 1/23).

The group also cited research showing that "birth control sabotage" was reported by 25% of female teenagers with abusive partners and 15% of adult women who were physically abused.

In one study, reports of reproductive coercion fell by 71% when women were given information and questionnaires about such abuse (USA Today, 1/23). Similarly, a study of the National Domestic Violence Hotline found that 25% of callers had experienced reproductive coercion.

Jay Silverman, who researches violence against women at the University of California-San Diego School of Medicine and was not involved with the committee, said it is "incredibly important" that patients are asked about possible coercion "because if we don't understand the context in which a woman is attempting to contracept, then we are not often giving her the tools to be effective to do that" (Pittman, Reuters, 1/23).