Reproductive Coercion

1. Reproductive Coercion

2. Prevalence • 1 in 4 women have been physically and/or sexually assault by a current or former partner • 45.9% of women experiencing physical abuse also disclose forced sex by their partner • 1 in 4 women report lifetime coerced sex

3. Reproductive Coercion Behaviors that a partner uses to maintain power and control in a relationship related to reproductive health

4. Reproductive Coercion • Types of reproductive coercion • Birth Control Sabotage • Pregnancy Pressure • Pregnancy Coercion

5. Birth Control Sabotage

6. Birth Control Sabotage • Hiding, withholding, or destroying • Breaking condoms • Refusing to withdraw • Forcing removal of rings, IUD’s, and suppositories Campbell et al, 1995; Coggins et al, 2003; Fanslow et al, 2008; Lang et al, 2007; Miller et al, 2007; Wingood et al, 1997

7. Birth Control Sabotage “ Like the first couple of times, the condom seems to break every time. You know what I mean, and it was just kind of funny, like, the first 6 times the condom broke. Six condoms, that’s kind of rare I could understand 1 but 6 times, and then after that when I got on the birth control, he was just like always saying, like you should have my baby, you should have my daughter, you should have my kid” 17 yr. old female who started Depo-Provera without partner’s knowledge Miller et al, 2007

8. Birth Control Methods

9. Pregnancy Pressure • “I’ll leave you unless you get pregnant.” • “I’ll have a baby with someone else.” • “I’ll hurt you if you don’t try and get pregnant”

10. Pregnancy Coercion • Forcing a woman to carry to term • Forcing a woman to terminate a pregnancy • Injuring a partner to cause miscarriage

11. Reproductive Risks:STI’s and HIV • Multiple sex partners • Inconsistent or nonuse of condoms • Unprotected anal sex • Partner with HIV • Sex for money, drugs or shelter • Injury from sexual assault

12. Creating a Safe Environment • Have a written policy and provide training on IPV and reproductive and sexual coercion • Have a private place to talk with patients • Display educational posters • Have information available to patients

13. Having a Conversation • Scenario: • A provider seeing a client who is seeking contraceptive care should ask: • If it is safe for her to talk with her partner about birth control. • If the client says it is not safe to talk with her partner about birth control or • She discloses birth control sabotage • The provider should focus the discussion on long-acting, reversible birth control methods that are less vulnerable to partner detection and interference.

14. Questions • “Has your partner ever messed with your birth control or tired to get you pregnant when you didn’t want to be?” • “Does your partner refuse to use condoms when you ask him to?” • “Has he ever tried to force or pressure you to become pregnant when you didn’t want to be?” • “Are you afraid your partner will hurt you if you tell him you have an STI and he needs to be treated?” • Family Violence Prevention Fund

15. What if they say? • Yes to pregnancy pressure or birth control sabotage • Yes to having difficult time negotiating condom use with their partner • Don’t know how to handle telling their partner about a positive STI test result

16. Responding • Validate patient’s experience • Ask patient if they would like to talk to someone, such as an advocate • Provide referrals and safety cards • Determine if there are any safety concerns • Remember to Document, Document, Document • Follow up with patient

17. Offering Options National Domestic Violence Hotline 1-800-799-SAFE (7233) Idaho Domestic Violence Hotline 1-800-669-3176 National Teen Dating Abuse Hotline 1-866-331-9474 RAINN (Rape, Incest National Network) 1-800-656-4673 Women's and Children's Alliance (WCA) 208-343-3688 Calling friend/relative

18. Thank You! • Kimberly Matulonis • Idaho Coalition Against Sexual • and Domestic Violence • (208) 384-0419 ext. 307 • kimberly@engagingvoices.org