Birth Control Sabotage Prevalent Among Abused Women

Nearly a quarter of adolescent girls who say a male partner abused them also say they were victims of birth-control sabotage, according to a new report by a gynecologists’ group.

The report by the Committee on Health Care for Underserved Women of the American College (CQ) of Obstetricians and Gynecologists, which was released in February, found that birth-control sabotage by abusive male partners, including forced unprotected sex and tampering with birth-control methods, is relatively common in relationships where violence occurs.

“Reproductive coercion is an under-recognized occurrence,” says Dr. Eve Espey, a medical doctor and public-health expert at the University of New Mexico School of Medicine, who was a lead author of the report. “We, as women’s health providers, should be aware that it exists and screen all women for intimate partner violence, of which reproductive coercion is a subset,” she wrote in an email interview.

The physicians’ group is urging women’s health professionals to routinely screen patients for signs of reproductive and sexual coercion, which is defined as behavior intended to maintain power and control in a relationship, including attempts to impregnate a woman against her will.

Some examples of screening questions include: Has your partner ever forced you to do something sexually that you did not want to do or refused your request to use condoms? Has your partner ever tried to get you pregnant when you did not want to be pregnant? And, are you worried that your partner will hurt you if you do not do what he wants with the pregnancy?

The group also is asking health-care providers to offer less detectable forms of birth control to abuse victims, such as some types of intrauterine devices or IUDs, to help abused women protect themselves.

Numerous studies show violence and poor health outcomes are strongly linked and that intimate partner violence increases a woman’s risk from unintended pregnancies, according to the committee. In a 2010 study “a quarter of adolescent females reported that their male partners were trying to get them pregnant through interference with planned contraception.” The figure was even higher among teen mothers on public assistance, where among those who experienced intimate partner violence, 66 percent also experienced birth control sabotage by a dating partner, according to a 2005 study. The prevalence of intimate partner violence was three times higher among women seeking abortion than among those who were continuing their pregnancies in a 2007 study.

Males who perpetrated violence against their female partners were also more likely than others to say they had forced sexual intercourse without a condom, increasing the risk of unintended pregnancy and sexually transmitted infections such as HIV.

“Deliberate infection is part of the spectrum of reproductive coercion which is motivated by power and control,” Dr. Espey said.

Even more alarming, previous studies going back to the late 1990s have found that homicide is one of the leading causes of death in pregnant women in the U.S.

Counseling and other interventions in family planning clinics, however, were able to reduce pregnancy coercion among victims of intimate partner violence by 71 percent, the committee report states.

Dr. Gale Blakley

Dr. Gale Blakley,  a board-certified gynecologist and public health expert in New York City says she has encountered victims of sexual and reproductive coercion many times in her clinical practice. She says some red flags that patients may be suffering coercion include repeated unintended pregnancies, complaints about “lost” birth control pills, repeated requests for emergency contraception, or a frequent need for treatment for sexually transmitted infections.

Dr. Blakley says she has seen patients with male partners who were so controlling that they knew their menstrual cycles better than the patient themselves. Such women may feel they are powerless in their relationships, and some come from cultures and countries where women have little control over their reproductive rights.

“Often women that I encounter in these relationships are dependent on the male figure as a source of financial and physical support,” Dr. Blakley said.

Clinicians can help patients by referring them to social workers and support groups for intervention, she says. They can also help patients choose methods of contraception that are less detectible and less subject to tampering, such as injections and some IUDs.

“This doesn’t have to be your lot in life, we can help you,” she says.

For more information, see Committee Opinion #554, “Reproductive and Sexual Coercion.” It is published in the February 2013 issue of Obstetrics & Gynecology. To obtain copies of the safety cards, send requests by e-mail to underserved@acog.org.

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