Many women victims of 'contraceptive sabotage,' experts say

The American College of Obstetricians and Gynecologists (ACOG) lays out guidelines for detecting sexual and reproductive "coercion"—which it calls an under-recognized form of violence against women—in the February issue of the journal Obstetrics & Gynecology.

"Most ob/gyns are probably unfamiliar with sexual and reproductive coercion as an entity and probably don't ask about it," said Dr. Eve Espey, chairwoman of the ACOG's Committee on Health Care for Underserved Women.

The abuse includes hiding or destroying a woman's birth control method of choice; poking holes in a condom or removing it during sex; coercing a woman to carry out or end a pregnancy against her will through violence or threats; and intentionally exposing her to a sexually transmitted disease.

It's not clear how common this type of abuse is, Espey said. One study of teenagers on public assistance found that of those who said they were victims of any type of domestic violence, two-thirds said it included birth-control sabotage.

"It's hard to determine the prevalence of this form of abuse, and it's understood that most [domestic] violence is under-reported," Espey said.

A 2011 government survey found that one in four U.S. women has been physically abused by a partner.

"Given how prevalent [domestic] violence is, reproductive coercion is probably not uncommon," Espey said.

Rita Smith, executive director of the National Coalition Against Domestic Violence, praised the ACOG's move. Encouraging doctors to regularly ask women about such abuse is "a great addition to women's health care needs," Smith said.

"Chronic health care issues can be avoided, and women can manage the needs of their families and themselves much better if their reproductive decisions are not interfered with by an abuser," Smith said.

The ACOG said doctors should ask women about potential reproductive coercion when they screen for domestic violence in general—something ob/gyns already know to ask about, Espey said.

Futures Without Violence, a nonprofit organization based in San Francisco, has developed wallet-sized "safety cards" with information on reproductive coercion that doctors can give to women. Doctors also can use those cards as a starting point for talking to their patients, said Rebecca Levenson, a senior policy analyst at Futures Without Violence.

The term "reproductive coercion" was coined several years ago after researchers began recognizing it as a distinct form of violence that some women suffer independent of other types of abuse, Levenson explained.

She said the ACOG is on the "cutting edge" in making its new recommendations, and it is important for ob/gyns to specifically ask about reproductive coercion because they can help women directly.

Espey agreed. Giving a woman a birth-control method that is not obvious to her abuser is one way.

"For example, an IUD with the strings cut off would protect against pregnancy but would not be felt by the partner during intercourse," Espey explained.

IUDs, or intrauterine devices, are implanted in the uterus, where they release small amounts of either copper or the hormone progestin to prevent pregnancy. Espey said the copper IUD might be preferable for women who are victims of abuse because they do not usually keep a woman from menstruating, and some abusers monitor their partner's periods.

Espey said the takeaway for women is that they have the right to decide whether and when to have children, and what to do about an unplanned pregnancy.

"Most women involve their partners in these decisions, but in some circumstances, it is unsafe to do so," Espey said. "If a woman feels that she is experiencing reproductive coercion, there is help."

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Learn more about preventing partner abuse from the National Coalition Against Domestic Violence.

Journal reference: Obstetrics & Gynecology

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