Q&A: How to address reproductive coercion in practice

A new article published in The BMJ provides clinicians with guidance on identifying patients who are victims of reproductive coercion and how best to help them.

According to a press release, reproductive coercion is a form of abuse leveraged by partners or family members to manipulate women’s reproductive choices. It often involves psychological and emotional pressure, as well as physical abuse and sexual violence.

“Although this has been known to happen for a long time, it is only in the last decade that the extent of reproductive coercion has been studied,” Sam Rowlands, LLM, MD, FRCGP, FFSRH, a visiting professor in the department of medical sciences and public health at Bournemouth University, U.K., said in the release.

In this interview, Rowlands discusses the key indicators of reproductive coercion and how clinicians should ensure the well-being of patients experiencing it.

Healio: What prompted this article?

Rowlands: This article was commissioned by The BMJ. I have had a keen interest in reproductive coercion and abuse since 2018. I have co-authored a review article for specialists in sexual and reproductive health, been interviewed for a national radio program and co-authored a book chapter on this subject. It was identified that an educational article directed at general practitioners was needed.

Healio: What are the key signs of reproductive coercion that clinicians should be on the lookout for?

Rowlands: Reproductive coercion is common but often hidden. It is inflicted most often, but not exclusively, on heterosexual, cisgender women. It consists of interference with a woman’s reproductive decision-making. It can either be coercion to have a pregnancy or not to have a pregnancy — the former is more common. Survivors may be reluctant to disclose what is happening to them. Heightened awareness and an ability to ask specific questions is necessary. Situations that may raise suspicion include repeated requests for pregnancy testing, emergency contraception or testing for sexually transmitted infections. Also, women having more than one abortion may raise suspicion.

Healio: What should clinicians do once a patient confides in them about reproductive coercion?

Rowlands: This is not straightforward, especially if there is associated intimate partner violence and children in the family. Also, it may take time before a patient is ready to make a disclosure. The main thing is to give the patient information, demonstrate an understanding and gain trust. Some cases may need safeguarding assessment and specialist referral.

Healio: How can clinicians ensure that victims of reproductive coercion stay safe after leaving the office?

Rowlands: In many cases of reproductive coercion, the main feature is coercive control rather than violence. In a fair proportion of cases, the patient may have little insight into the partner’s abnormal behavior and it becomes a way of life. Clinicians can help with gaining insight into their relationship and in thinking about ways of resisting the control, such as using contraception covertly. All the while, there needs to be care that any interventions do not trigger retaliation by the partner.

Healio: Is there anything else you would like to add?

Rowlands: This is not a new phenomenon, but it is increasingly being recognized. Sex and relationship education needs to include information on healthy relationships. Relationships may start off seeming to be going well, but the control begins to set in. It is easier to extricate oneself from an unhealthy relationship early on, especially before children have been born.

References:

• New advice for doctors on how to identify and respond to reproductive coercion. e3.eurekalert.org/news-releases/965759. Published Sept. 23, 2022. Accessed Oct. 5, 2022.
• Rowlands S, et al. BMJ. 2022;doi:10.1136/bmj-2021-069043.