National Partnership for Women & Families

Monthly Women's Health Research Review

Study Assesses Relationship Between Reproductive Coercion, Pregnancy Behaviors

Summary of "Race and Reproductive Coercion: A Qualitative Assessment," Nikolajski et al., Women's Health Issues, Dec. 9, 2014.

"Unintended pregnancy, which disproportionately affects low-income and African American (AA) women, is a substantial public health issue associated with numerous adverse health and social consequences," wrote Cara Nikolajski of the University of Pittsburgh's Center for Research on Health Care's Department of Medicine and colleagues.

The researchers noted that while such pregnancies can be prevented by "consistent and correct use of effective contraception," AA women are more likely than white women to "have higher rates of contraceptive nonuse, incorrect use, and discontinuation." According to the study, research has found that male partner reproductive coercion, among other factors, could "influence women's use of contraception and may impact AA women differentially."

The researchers defined reproductive coercion as occurring when an individual directly interferes with a woman's contraceptive use, pressures a female sexual partner to become pregnant when she does not desire pregnancy, or pressures or threatens a woman to either continue or end a pregnancy.

In this study, the researchers assessed "women's experiences with contraceptive sabotage and pregnancy-promoting behaviors by male partners and how ... these experiences [may] vary by race."

Methods

For the study, researchers interviewed low-income AA and white women ages 18 through 45 between June 2010 and January 2013 who were recruited via flyers posted in reproductive health clinics in Western Pennsylvania. Overall, 36 AA women and 30 white women participated in the study.

According to the study, the interviews included questions about the contextual factors that affected women's contraceptive behaviors. The first 20 interviews did not include questions on reproductive coercion, but the issue spontaneously emerged in many of the initial interviews, leading researchers to add additional questions to the interview guide in order to fully explore the topic.

Findings

Of the 66 women interviewed, 25 women (38%) reported instances of reproductive coercion. Of those women, 21 reported having at least one personal experience with reproductive coercion, while four of the women described reproductive coercion that occurred to "other women in their social networks."

According to the study, reproductive coercion occurred more frequently and with greater severity among AA women than white women, with 19 of the 36 AA participants (53%) and six of the 30 white participants (20%) reporting instances of reproductive coercion. In addition, a larger portion of AA women than white women noted that their current or past pregnancies resulted from reproductive coercion.

Birth Control Sabotage and Pregnancy Pressure

The researchers noted that study participants "described male partners' behaviors around contraceptive control across a spectrum, from condom refusal or purposeful misuse/deception ... to overt sabotage of women's contraceptive efforts."

Specifically, women described instances in which their male partners refused to use condoms, or deceived women about condom use, either as part of male partners' "general refusal to use a barrier method (most commonly to enhance sexual pleasure)" or because the male partner wanted the woman to become pregnant. Others said their male partners were upset when asked to use condoms because they felt the request showed a lack of trust "or that the women did not consider their relationship as serious enough to forgo condom use."

Meanwhile, some women -- particularly AA women -- "described verbal and emotional pressure by a male partner to get pregnant."

Control of Pregnancy Outcomes

Some respondents also reported instances of male partners' attempts to ensure a pregnancy either was continued or terminated, in contrast to women's desired pregnancy outcomes. For example, women described situations in which they felt coerced to discontinue a pregnancy "because of their male partner's consistent pressure or threatening behavior." However, both AA and white women said pressure from their male partners to continue a pregnancy did not indicate that the partner "would remain present in the life of his partner or his child."

Potential Reasons for Reproductive Coercion

Researchers also "explored women's perceptions about reasons that men might want their female partners to get pregnant." However, the researchers noted that only AA women described "specific social and structural factors that might motivate men's pregnancy-promoting behaviors."

Specifically, AA women noted that "incarceration, lack of social support, and structural barriers to stable housing and employment seemed to motivate men to secure connections with their female partner via pregnancy." Meanwhile, white women largely linked male partners' reproductive coercion with "love or maintenance of the relationship."

Discussion

The researchers noted that their findings "add to the growing body of evidence that reproductive coercion may be commonly experienced by women and may contribute to the high rate of unintended pregnancy in this country." Further, they wrote that as "[s]ignificantly more AA participants also attributed pregnancy to reproductive coercion, suggesting that reproductive coercion may play a role in observed racial disparities in unintended pregnancy."

The researchers urged further research "of the prevalence and impact of reproductive coercion on disparities in unintended pregnancy in large, population-based samples," because such research "will have implications for pregnancy prevention programs which do not typically address male-pregnancy promoting behavior."

Further, the researchers wrote that their "study also sheds light on contextual and structural factors that might shape fertility behaviors, including the role of disproportionate incarceration of men and social instability in low-income, AA communities." The study urged more research to better understand the effect of a high incarceration rate "on unintended pregnancy and family formation," which could find that intervention strategies require "a more focused effort to incorporate structural interventions as well as pregnancy prevention efforts that target men in these communities."

According to the researchers, their findings are "clinically relevant" because "they highlight the fact that male partner reproductive coercion may be one explanation for contraceptive nonadherence." They noted that health care providers should question women about their male partners' reproductive goals "and consider the possibility of coercive behaviors," particularly "when women's stated pregnancy intentions are incongruent with her contraceptive behavior, when she expresses ambivalence, or for women who make frequent visits for pregnancy testing or emergency contraception." Clinicians can then use such differences in pregnancy intentions to help women identify ways to reduce their risk of unintended pregnancy while also respecting their relationship choices.