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Helping doctors spot "reproductive coercion:" when men sabotage birth control

Oct 12, 2016

Yes, this is a real thing.

But if you've never heard of reproductive coercion before, you're not alone.

It's a dimension of domestic and intimate partner violence that's only recently been recognized by the American Congress of Obstetricians and Gynecologists. And researchers just started studying it in the last 15 years or so.

Heather McCauley, an epidemiologist and an assistant professor at Michigan State University, says she first heard about it through a colleague.

“This work started 10 years ago,” she says. “My colleague Dr. Elizabeth Miller, she’s a pediatrician and adolescent medicine specialist, and she was starting to hear stories from women that were something she’d never heard before. She heard stories of women describing partners breaking condoms on purpose, or flushing birth control pills down the toilet.

“And she came to our team of researchers and said, ‘Hmm, have you ever heard of anything like this? What is going on?’ And that was really the first time we ever documented reproductive coercion in adolescent women.”

Nearly 20% "reported experiencing pregnancy coercion and 15% reported birth control sabotage" during their lifetimes.

Next came a study in California in 2010, where they polled more than 1,200 patients across five family planning clinics. Nearly 20% “reported experiencing pregnancy coercion and 15% reported birth control sabotage” during their lifetimes, according to the study.

They then looked at more than 3,500 women across two dozen clinics in Pennsylvania, and asked them whether they’d experienced reproductive coercion in just the last three months. Five percent said yes, and the rates were highest among women between the ages of 16 to 20.

“The most common question that women endorsed, across studies, is they say their partners told them not to use any birth control – like the pill, the shot, NuvaRing, etc,” McCauley says. “The second thing we hear is that women describe their partners taking their birth control pills away, or preventing them from going to the clinic, and that’s a red flag.”

Then there’s condom manipulation.

“And that’s less coercive, and more obviously physically abusive,” she says. “So it’s when there’s this active manipulation of condoms. So breaking condoms on purpose, putting holes in condoms, taking condoms off during sex to promote a pregnancy.”

But it’s not necessarily that these young men are planning to raise a child at a very young age.

“It is about control,” she says. Women who experience reproductive of coercion are also “more likely to report that once they get pregnant, their partners are more likely to pressure them about what to do when they do get pregnant, whether that’s have an abortion or carry the pregnancy to term.”  

Now McCauley is focused on helping doctors spot reproductive coercion. First, she says, that requires them not to rush to judgment about their patients.

“So if a young woman is coming in three times in a couple months to change her birth control, or because she needs to get a pregnancy test, instead of making assumptions about why she’s coming in, asking more questions – specifically about what might be going on in her relationship – will help shift the conversation,” she says. “And potentially uncover that a young woman is experiencing abuse and coercion in her relationship.”

Parents and families, meanwhile, have an even more important role, McCauley says: talking to their kids about what a healthy romantic and sexual relationship looks like.

Her most recent study, published in the journal Contraception, recommends doctors use the following questions to determine whether patients have recently experience reproductive coercion:

"In the past three months, has someone you were dating or going out with:

  1. Told you not to use any birth control (like the pill, shot, ring, etc?)
  2. Taken your birth control (like pills) away from you or kept you from going to the clinic to get birth control?
  3. Made you have sex without a condom so you would get pregnant?
  4.  Taken off the condom while you were having sex, so you would get pregnant?
  5.  Put holes in the condom or broken the condom on purpose so you would get pregnant?"

Parents and families, meanwhile, have an even more important role, McCauley says: talking to their kids about what a healthy romantic and sexual relationship looks like.