Intimate partner violence or abuse can take the form of birth control sabotage, pregnancy pressure or coercion, which can have devastating consequences including unintended pregnancy, abortion and psychological trauma, according to a new review.
This type of intimate partner violence is called 'reproductive coercion,' and health care providers should know how to screen for it and intervene effectively, the authors write.
"Ultimately, (reproductive coercion) is about power and control - the perpetrators get off on that feeling of having complete power over their partners, even to the point of controlling a bodily function exclusive to women: pregnancy," said lead author Dr. Jeanna Park of the University of Illinois in Chicago.
"And although it seems irrational to threaten, coerce or trick a woman into acts that lead to pregnancy, perpetrators will then often force their partners to abort the pregnancy, further perpetuating the cycle of partner violence," Park told Reuters Health by email.
Most often, women are the victims of reproductive coercion, but men can be victimized as well, the authors write. It often goes unrecognized by doctors or victims themselves.
Birth control sabotage can include hiding or destroying contraceptive pills, removing vaginal rings, patches or intrauterine devices (IUDs) without a partner's permission, removing or breaking condoms, or not withdrawing when that was the agreed upon method of contraception.
Coercion can also include threatening to leave or to hurt a partner who does not agree to become pregnant, or who does not agree to terminate a pregnancy, depending on the desires of the perpetrator.
Between 15 and 25 percent of women may experience reproductive coercion at some point, according to other studies.
"Screening can be performed in conjunction with, or independent of, intimate partner violence screening with an open ended question like, "what challenges have you had with your current or previous contraceptive methods?'" Park said.
A more detailed screening and assessment script is provided by the National Health Resource Center on Domestic Violence in partnership with The American Congress of Obstetricians and Gynecologists that a provider can request online, she said.
Pediatricians, family practitioners, obstetrician/gynecologists, internists, and nurse practitioners should all be aware of reproductive coercion, she said.
Future studies should also investigate if and how men or people in the LGBT community experience reproductive coercion, the authors write in the American Journal of Obstetrics and Gynecology.
"Intimate partner violence happens (to women in) all races, socioeconomic classes, all levels of education," said Dr. Rebekah Gee, associate professor of Health Policy and Management and Obstetrics and Gynecology at Louisiana State University, who was not part of the new review. "It doesn't spare anyone, and I ask every single patient."
Women who are poorly educated, have low economic means or rely on partners for income are more vulnerable and have a harder time leaving or becoming independent, Gee told Reuters Health by phone.
"Providers may suspect (reproductive coercion) when a patient has a known history of intimate partner violence, expresses a desire to obtain contraception but repeatedly loses her prescription or changes her contraceptive method frequently, presents with frequent unintended pregnancies or sexually transmitted infections, or appears apprehensive of her partner discovering her contraceptive or pregnancy choices," Park said.
If a patient says yes, they are being victimized, the next steps will depend on where in the country they live and what the patient desires -- ideally she can immediately be referred to a shelter or social services, Gee said. But this process can be complicated and take hours to sort out, and those hours are not reimbursed by insurance companies, she noted.
If a woman chooses to stay with the perpetrator, discrete methods of contraception that are less susceptible to tampering, such as an intrauterine device, subdermal implant or contraceptive injection should be discussed, Park said.