Pregnancy Coercion and Birth Control Sabotage by Partner Are Common
Birth control sabotage and pregnancy coercion are experienced by 1 in 3 women in western North Carolina, according to survey results presented at the 2011 American College of Obstetricians and Gynecologists meeting.
“Reproductive control is a new concept that is a component of intimate partner violence. The vast majority of women had never realized that this kind of behavior was a type of control found in such relationships,” said lead investigator Jessica L. Versage, MD, Mountain Area Health Education Center, Asheville, NC.
“Reproductive control” is used when a woman’s partner demands or enforces a certain reproductive outcome that is in conflict with a woman’s interests. It involves pregnancy promotion, contraceptive sabotage, or the controlling of pregnancy outcomes by economic, physical, emotional, or sexual violence or threats, Dr Versage said.
“Examples include refusing to pay for birth control pills, flushing pills, poking holes in condoms, not withdrawing, or forcing sex without birth control with the intent of pregnancy,” she said. This leads to unsafe sex, unintended pregnancy, and poor pregnancy outcomes.
According to Dr Versage, only 1 study conducted in California has examined the issue (Miller E, et al. Contraception. 2010;81:316-322). “We became curious about this situation in our population, which is much more conservative and less educated than the California population, and we found even higher rates,” she said. “We believe that this behavior is probably more prevalent than we have realized.”
Dr Versage included patients (aged ≤45 years) seen in the past year for gynecologic or postpartum visits at her center; 328 patients responded to the survey. Patients were mostly white (69%) or black (21%); 38% were single, 22% were married, 30% had a partner, and 10% classified their status as “other.” Educational status was high school or beyond for the majority; 20% did not complete high school. More than 33% reported having a previous unwanted pregnancy.
Male Sabotage
Survey responses indicated that 37% of the women experienced some type of coercion or sabotage; 15% reported both types of reproductive control, 19% reported sabotage, and 3% reported coercion.
In one case, a patient indicated that her partner had yanked out the string of her intrauterine device (IUD). “Things like this have happened,” Dr Versage said. “I have read that some gynecologists will cut the IUD string very short if they know this kind of behavior exists in the relationship.”
Sabotage related to male birth control (eg, failure to withdraw, condom failure) was 3 times more common than sabotage of female birth control. Sabotage was least likely with long-acting reversible contraceptives. “This was, hands down, much less than we saw with pills and patches,” she said.
Responses to questions regarding coercion are shown in the Table. Many of the respondents said that this was the first time they had heard of the concepts of reproductive sabotage or coercion, adding that this helps them in their relationships.
“Taking this survey seemed to raise their awareness,” Dr Versage added. “In the long run, we hope to take advantage of this information to change how we counsel women about birth control.”