US doctors back routine screening for "reproductive coercion"

Michael Cook
27 Jan 2013
Reproduced with Permission

Doctors should routinely screen women and teenagers for "reproductive coercion", says a committee of the American College of Obstetricians and Gynecologists. In its official opinion paper, it paints a sombre picture of coercive and domineering men who force partners to have sex and become pregnant. "The most common forms of reproductive coercion," it says, "include sabotage of contraceptive methods, pregnancy coercion, and pregnancy pressure." Some male partners go so far as to forcefully remove intrauterine devices and vaginal rings, poke holes in condoms, or destroy birth control pills.

Since reproductive and sexual coercion often end in intimate partner violence, doctors need to counsel women about harm-reduction strategies and discreet methods of contraception. This should be done at annual examinations, new patient visits, and during obstetric care. Unintended pregnancies and STI and HIV infections in women may be red flags because both are highly related to abusive relationships. The committee lists questions which doctors should ask.

The College focuses exclusively on harm-reduction strategies rather than advising women to change their lifestyle or to leave abusive relationships. Its recommended strategies include: long-acting contraceptives such as IUDs, the implant, and the injection, which are more difficult to detect by partners than other contraceptives. IUD strings can be trimmed short to avoid detection and forced removal. Doctors can advise women to put emergency contraceptive into a plain envelope to disguise them.

It is difficult to gauge the urgency of the committee's recommendations. The words "married", "wife" or "husband" are not mentioned at all in the report. As a result, recommendations meant for women in a wide variety of sexual relationships, from casual hook-ups to long-term cohabitation, would be applied to married women as well.

Furthermore, as NPR points out , statistics from the Centers for Disease Control and Prevention (page 48) suggest that more women than men are guilty of reproductive coercion. For women, 8.6% reported that an intimate partner had tried to get them pregnant when they did not want to at some point in their lives. For men, 10.4% reported that an intimate partner had tried to get pregnant when they did not want to.