Racial Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration

Coerced Condomless Sex: A Scoping Review of Qualitative Studies

Coerced condomless sex is a prevalent form of sexual coercion that is associated with severe negative health consequences. This scoping review addresses the current lack of synthesized qualitative evidence on coerced condomless sex. Our systematic literature search yielded 21 articles that met review eligibility criteria. Themes of coerced condomless sex were organized into three categories (tactics, motives, and sequelae) and presented separately for studies based on whether researchers stipulated pregnancy promotion intent as underlying the behavior. Coerced condomless sex perpetration tactics ranged from verbal pressure to physical assault. Besides pregnancy promotion, perpetration motives included control, dominance, entrapment, enhancing sexual experiences, and avoiding conflict. Following coerced condomless sex, victims reported developing protective strategies. They also reported experiencing various negative emotional, relational, and physical health effects. Interventions that specifically address coerced condomless sex perpetration and provide supportive programs for those who have experienced coercive condomless sex may be beneficial.

A qualitative exploration of reproductive coercion experiences and perceptions in four geo-culturally diverse sub-Saharan African settings

Reproductive coercion (RC) is any intentional behavior that interferes with another's reproductive decision-making or pregnancy outcome. This study aims to qualitatively examine RC experiences and perceptions among women and men in Ethiopia, Nigeria (Kano and Anambra States), and Uganda. This is a secondary analysis utilizing qualitative data from the Women's and Girls' Empowerment in Sexual and Reproductive Health study. Across sites, focus group discussions (38 groups; n=320 participants) and in-depth interviews (n=120) were conducted, recorded, and transcribed. Transcripts were loaded into Atlas.ti, and quotes describing experiences of reproductive control or abuse were coded as "reproductive coercion." RC quotes were input into a matrix for thematic analysis. Emergent RC themes included indirect reproductive pressures, direct family planning interference, concurrent experiences of violence, and responses to RC. Indirect reproductive pressures included tactics to both promote and prevent pregnancy, while direct interference centered on pregnancy promotion. Women who were not compliant with their partners' reproductive demands were often subjected to violence from multiple actors (i.e., parents, in-laws, community members) in addition to their partners. Despite concurrent forms of violence, women across sites resisted RC by using contraceptives covertly, choosing to abort, or leaving their abusive partnerships. Women and men across sites indicated that men were highly influential in fertility. RC behaviors were a mechanism of control over desired reproductive outcomes, which were often rooted in perceptions of childbearing as social status. Findings indicate a need for more nuanced community interventions targeting social norms, as well as improved RC screening and response within health services.

Reproductive Coercion by Intimate Partners: Prevalence and Correlates in Canadian Individuals with the Capacity to be Pregnant

OBJECTIVES

Despite the large body of research on violence against women, violence that specifically targets women's reproductive autonomy and control over their reproductive health, called reproductive coercion (RC), is poorly documented in Canada. The purpose of this study is to determine the prevalence of RC behaviors in an adult Canadian community sample and to explore associated factors.

STUDY DESIGN

A self-report online questionnaire was administered from September 2020 to April 2021 in Quebec and Ontario, Canada. Participants were recruited via social media, sexual and reproductive health clinics, community-based anti-violence organizations, and the project's partner organizations. The questionnaire contained validated RC questionnaire items and new items drawn from previous qualitative work. The sample comprised 427 participants, mostly self-identified as women (92%), aged 18 to 55 years (M = 29.01; SD = 6.64). Descriptive analyses and binary logistic regressions were conducted using SPSS 27.

RESULTS

The results of this study show that 63.9% of participants reported at least one lifetime experience of RC. According to our data, contraceptive sabotage was the most common form (62.8%). Of the participants who had been pregnant, 9.8% reported control of pregnancy outcomes. Each RC category shows a different pattern of correlates. The findings also reveal that intimate partner violence (IPV) increases the likelihood of contraceptive sabotage. Moreover, the study suggests that low education level and IPV increase the risk for control of pregnancy outcomes.

CONCLUSION

These findings underscore the importance of RC in the lives of many Canadian individuals with the capacity to be pregnant, and they highlight certain factors that place individuals at greater risk for RC. This knowledge can inform the development of prevention efforts and clinical interventions.

Canadian service providers' perspectives on reproductive coercion and abuse: a participatory action research to address their needs and support their actions

Reproductive coercion and abuse (RCA) is a form of violence that affects sexual and reproductive health. Women and individuals who experienced RCA in an intimate relationship frequently consult service providers (SPs), such as health professionals or violence counselors. The objective of this article, which is the result of a participative action research project targeting RCA perpetrated by in an intimate partner, is twofold: (1) to better understand the practices as well as the barriers and facilitators encountered by SPs and (2) to develop information and awareness tools with them that meet their needs. To this end, we first held focus groups with 31 SPs. The use of thematic analysis revealed intervention strategies that focus on caring and listening, identifying signs of RCA, and creating a safe environment for disclosure. Their practices also focused on harm-reduction strategies and effective referrals. Despite the importance they gave to this issue, lack of time, inappropriate settings, and inadequate training hindered them from intervening effectively with individuals who were victims of RCA. They also indicated the need for easy-to-follow practice guidelines and patient education tools. Based on these findings and the best practices identified in the grey and scientific literature, we developed a practice guide for SPs and a booklet on RCA. The development of these guide and booklets involved a lot of back and forth to meet the needs expressed by the community and health professionals.

Reproductive Autonomy in Appalachia: An Investigation into Perceived Contraceptive Pressure

The reproductive autonomy of persons who can give birth can be impeded through forms of interpersonal violence and coercion. Moreover, macro-level factors (e.g., poverty, discrimination, community violence, legislative policies) may impede the reproductive autonomy of entire communities. This study investigates a form of violence we term perceived contraceptive pressure in Appalachia, an understudied region of the Eastern U.S., regarding reproductive health and decision-making. Through targeted Meta advertising, participants (N = 632) residing in Appalachian zip codes completed an online survey on reproductive health. The focus of this study was to investigate the prevalence of perceived contraceptive pressure, who was at increased risk of experiencing pressure, and the source(s) of perceived pressure. Binomial regressions were conducted on three different dependent variables: perceived pressure to be sterilized, perceived pressure to use birth control, and perceived pressure not to use birth control. Approximately half of all respondents (49.5%) reported experiencing at least one type of pressure targeting contraceptive decision-making. The most prevalent source of perceived pressure to use birth control was from the healthcare provider (67.4%), and the most prevalent source of perceived pressure not to use birth control was the respondent's partner (51.1%). Recommendations for providers serving clients in the Appalachian region include pursuing education regarding contraceptive pressure at the individual level and macro-level. In addition, Appalachian residents may benefit from educational programming on reproductive autonomy, healthy relationships, and how to navigate pressure in relationships.

Developmental pathways from child maltreatment to adolescent pregnancy: A multiple mediational model

Adolescent pregnancy (AP) is a significant public health issue. Child maltreatment (CM) represents an established risk factor, yet little is known about the explanatory mechanisms linking the phenomena. Informed by developmental theory, this study prospectively tested seven multi-level, indirect pathways that could plausibly explain the relationship between CM and AP: (1) substance use (polysubstance use and frequency); (2) sexual risk behavior; (3) depressive symptoms; (4) posttraumatic stress disorder symptoms; (5) cognitive dysregulation; (6) pregnancy desire and difficulty expectancies; and (7) age at menarche. Data came from a prospective, longitudinal cohort study of 469 ethnically diverse, nulliparous adolescent females, designed to examine the impact of substantiated CM on reproductive outcomes such as pregnancy and childbirth (265 maltreated and 204 demographically matched comparison adolescents). A multiple-mediator structural equation model was conducted to simultaneously test multiple indirect effects while accounting for confounding variables. Maltreatment had an indirect effect on pregnancy via substance use and higher pregnancy desire/lower perceived difficulty. Findings represent a step towards elucidating pathways linking CM with AP. Recommendations are offered to prevent pregnancy by addressing the pregnancy-specific mechanisms that are part of the maltreatment sequelae.

Reproductive coercion as a form of family violence against immigrant and refugee women in Australia

Reproductive coercion (RC), generally considered a form of intimate partner violence (IPV), refers to perpetrator behaviours and actions that are intended to interfere with and control the autonomous decision-making of a person regarding their reproductive health. To date there are few studies that document RC as experienced by immigrant and refugee women. In this article, we explore cases of RC as described by women who were part of a larger qualitative study investigating violence against immigrant and refugee women in southern Australia. The study aimed to identify the types of RC detailed in immigrant and refugee women’s narratives, and to illustrate the contexts in which these experiences occurred. Analysis followed Baxter and Jack’s (2008) case study methodology; whereby particular “cases” are used to describe a phenomenon in context. Thirteen women from seven countries described experiences that fit definitions of RC. The cases describe various types of RC including violence during pregnancy with the intent of causing miscarriage, forced abortion, contraception sabotage and forced pregnancy. As well as intimate partners, some women described multiple perpetrators being complicit in their experience of RC, especially in regard to controlling women’s access to, and interactions with health services. More information is needed about immigrant and refugee women’s experiences of RC, and how vulnerability to multi-perpetrator violence affects health service access. In particular knowledge about how multi-perpetrator RC can affect consent processes for women who already face barriers to health care requires attention. Further research is required to address knowledge gaps about appropriate prevention and advocacy work about RC in refugee and migrant communities, and what training is needed for professionals in the family violence sector, women’s health services, women’s organisations, multicultural and ethno-specific services.

Racial Disparities in Pregnancy-associated Intimate Partner Homicide

Pregnancy-associated femicide accounts for a mortality burden at least as high as any of the leading specific obstetric causes of maternal mortality, and intimate partners are the most common perpetrators of these homicides. This study examined pregnancy-associated and non-pregnancy-associated intimate partner homicide (IPH) victimization among racial/ethnic minority women relative to their non-minority counterparts using several sources of state-level data from 2003 through 2017. Data regarding partner homicide victimization came from the National Violent Death Reporting System, natality data were obtained from the Centers for Disease Control and Prevention's National Center for Health Statistics, and relevant sociodemographic information was obtained from the U.S. Census Bureau. Findings indicated that pregnancy and racial/ethnic minority status were each associated with increased risk for partner homicide victimization. Although rates of non-pregnancy-associated IPH victimization were similar between Black and White women, significant differences emerged when limited to pregnancy-associated IPH such that Black women evidenced pregnancy-associated IPH rates more than threefold higher than that observed among White and Hispanic women. Relatedly, the largest intraracial discrepancies between pregnant and non-pregnant women emerged among Black women, who experienced pregnancy-associated IPH victimization at a rate 8.1 times greater than their non-pregnant peers. These findings indicate that the racial disparities in IPH victimization in the United States observed in prior research might be driven primarily by the pronounced differences among the pregnant subset of these populations.

Correlates of reproductive coercion among college women in abusive relationships: baseline data from the college safety study

ObjectiveThe purpose of this study was to examine correlates of reproductive coercion (RC) among a sample of college women in abusive relationships. Participants: 354 college students reporting a recent history of intimate partner violence (IPV). Methods: This study examines baseline data from a randomized controlled trial testing effectiveness of an interactive safety decision aid (myPlan). Results: Almost a quarter (24.3%) of the sample reported RC. Associated factors included races other than White (p = 0.019), relationship instability (p = 0.022), missing class due to relationship problems (p = 0.001), IPV severity (p < 0.001), technology abuse (p < 0.001), traumatic brain injury-associated events (p < 0.001), and depression (p = 0.024). Conclusions: RC was a significant predictor of depression, with implications for providers working with abused college women regarding the need for mental health services concurrent with IPV/RC services. A larger proportion of women who experienced RC sought help from a healthcare provider for contraception, which suggests intervention opportunities for college health providers.

Parity and Pregnancy Intention related to the Use of Contraceptives in Women of Reproductive

Background: The use of contraceptives in reproductive women is still a problem today. The association between contraceptive use and parity and pregnancy intention amongs legally married reproductive women has never been studied  Objectives: To determine the relationship between parity and pregnancy intention with contraceptive use among legally married women.  Methods: A cross-sectional study was conducted with the involvement of 262 legally-married reproductive women, aged 15-49 years, in Bantul District, Indonesia.  Socio-demographic data including age, education, income, parity, pregnancy intentions, and use of contraceptives were collected using a structured questionnaire by trained enumerators. Chi-square test was used to test the association between socio-demographic data and parity and pregnancy intention, while simple logistic regression models were used to examine the relationship between contraceptive use and parity and pregnancy intention. Data analysis was performed using statistical software by SPSS.   Results: Thirty-eight point five per cent of women of reproductive age who have ≥ 3 children and 16.5% of women of reproductive age who do not want to have children do not use contraception. Parity in women of childbearing age was not related to contraceptives (OR=2.58; 95%:0.67-1.76). Women of reproductive age who had intention of getting pregnant were 61% less likely (OR= 0.39; 95%: 0.37-0.74) to use contraceptives than those who did not have intention of getting pregnant.  Conclusions: The pregnancy intention is associated with a low contraceptive use in reproductive-age women. Thus, it is necessary to educate women in the reproductive age, their partners and family regarding the importance of birth spacing.  

INTERGENERATIONAL TRANSMISSION BETWEEN QUILOMBOLA MOTHERS AND DAUGHTERS: REPRODUCTIVE AUTONOMY AND INTERVENING FACTORS

ABSTRACT Objective: to analyze reproductive autonomy in quilombola women and the intervening factors of intergenerational transmission between mothers and daughters. Method: a cross-sectional and analytical study developed with 160 women, mothers and daughters from quilombola communities in the municipality of Vitória da Conquista, Bahia. The National Health Survey questionnaire was used to verify sociodemographic characteristics and intervening factors; and the Reproductive Autonomy Scale was also employed. The Chi-square, Mann-Whitney and Wilcoxon tests were applied. The data were analyzed by means of simple and multiple linear regression. Results: the group of mothers presented higher frequency of women that are married or live with a partner (66.2%), who worked (51.2%) and who had higher incomes (358.00 ± 663.00). The daughters presented more years of study (10.50 ± 5.00). Reproductive autonomy and intergenerational transmission between mothers and daughters mainly occur in the Absence of coercion (ICC=0.70; p=0368) and Communication (ICC=0.69; p=0694) domains. The mother's age (β-adjusted=-0.027; p=0.039) and the daughter's skin color/race (β-adjusted=0.423; p=0.049) were intervening factors in intergenerational transmission related to Decision-making, associated with the mother's age and with the daughter's self-recognition as black-skinned. Conclusion: the daughters do not follow the same choice as their mothers, which can be understood due to greater accessibility to reproductive planning services and increased schooling levels. Intergenerational transmission among quilombolas presents important specificities for reproductive decisions and enables a better understanding of the information and qualification of the health professionals' assistance in the care provided to these women.

Association between rural workers’ sociodemographic and reproductive characteristics and their reproductive autonomy

ABSTRACT Objectives: to verify the association between sociodemographic and reproductive characteristics with rural workers’ reproductive autonomy. Methods: a cross-sectional study, with a sample of 346 women and application of the Reproductive Autonomy Scale. Multinomial regression was performed to analyze associations between independent variables and outcomes. Results: in the analysis of subscales “Decision-making”, “My sexual partner or someone else such as a parent”, “Both me and my partner” and “Me”, women experienced greater reproductive autonomy in relation to their partners. For outcomes “Decision about which method to use”, “When to have a baby” or “About unplanned pregnancy”, the highest prevalence was for category “Me”, with statistically significant associations. Conclusions: the sociodemographic and reproductive characteristics among the most vulnerable women, in terms of the social, economic and cultural context in which they are inserted, may be associated with greater difficulties in exercising reproductive autonomy.

Associação entre as características sociodemográficas e reprodutivas com a autonomia reprodutiva das trabalhadoras rurais

RESUMO Objetivos: verificar a associação entre as características sociodemográficas e reprodutivas com a autonomia reprodutiva das trabalhadoras rurais. Métodos: estudo transversal, com amostra de 346 mulheres e aplicação da Escala de Autonomia Reprodutiva. Foi realizada regressão multinomial para análises de associações entre as variáveis independentes e desfechos. Resultados: na análise das subescalas “Tomada de decisão”, “Meu parceiro sexual ou alguém da família tem mais a dizer”, “Eu e meu parceiro sexual” e “Eu decido”, as mulheres experimentaram maior autonomia reprodutiva em relação aos parceiros. Para os desfechos “Decisão sobre qual método utilizar”, “Quando ter um bebê” ou “Sobre gravidez não planejada”, as maiores prevalências foram para a categoria “Eu decido”, com associações estatisticamente significante. Conclusões: as características sociodemográficas e reprodutivas entre mulheres mais vulneráveis, tratando-se do contexto social, econômico e cultural que estão inseridas, podem estar associadas a maiores dificuldades para exercerem a autonomia reprodutiva.

Prevalence of Intimate Partner Reproductive Coercion in the United States: Racial and Ethnic Differences

Reproductive coercion (RC) is a specific type of intimate partner violence (IPV). Although clinical studies have highlighted women's experiences of RC, we know little about its national prevalence and differences in prevalence by sex category and race/ethnicity. Data are from the National Intimate Partner and Sexual Violence Survey (NISVS), years 2010 to 2012. NISVS is an ongoing, nationally representative random-digit-dial telephone survey of the noninstitutionalized English- or Spanish-speaking U.S. adult population. This article reports the national lifetime and 12-month prevalence of two RC victimization measures, and proportions among IPV victims. T tests were used to examine differences in estimates across racial/ethnic groups. In the United States, 9.7% of men and 8.4% of women experienced any RC by an intimate partner during their lifetime. Men reported more commonly than women that a partner tried to get pregnant when the man did not want her to; women reported higher prevalence of partner condom refusal. Examination by race/ethnicity revealed that non-Hispanic (NH) Black women and men had significantly higher lifetime prevalence of both RC types than all other groups; in the last 12 months, NH Blacks had significantly higher prevalence across the board than NH Whites. Hispanics had significantly higher lifetime and 12-month prevalence of any RC and partner condom refusal than NH Whites. RC is at the intersection of two public health concerns-IPV and reproductive health. Documenting its prevalence and differences by sex and race/ethnicity may inform prevention efforts to reduce occurrence and negative health outcomes among specific populations.

Exploring experience of and engagement in coercive pregnancy behaviors among sexually active young men from five clinics in Baltimore, MD

OBJECTIVES

To explore young men's perceived experience of coercive pregnancy behaviors by female partners, and engagement in and behavioral overlap of these occurrences in this sample.

STUDY DESIGN

Heterosexually active young men aged 15 to 24 (n = 39), recruited from 3 primary care and 2 sexually transmitted disease clinics in Baltimore, MD city over a 2-week period, were surveyed on their perceived experience of and engagement in coercive pregnancy behaviors, attitudes about women, and background characteristics.

RESULTS

Of 130 invited, 66 (51%) agreed to participate, 39 of whom were heterosexual young men; 87% were non-Hispanic Black and 59% were aged 20 to 24. Eleven (28%) perceived one or more coercive pregnancy behaviors by a partner and nine (23%) engaged in one or more coercive behavior. Most (58%) agreed women are responsible for birth control decisions, but 55% believed women could not be trusted to tell the truth about contraceptive use and 68% believe women would like to get pregnant.

CONCLUSIONS

Over one-third of young men in this sample perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings have implications for promoting healthy relationships among young people.

IMPLICATIONS

This study found over one-third of young men perceived experience of coercive pregnancy behaviors by partners and/or engaged in these behaviors. Findings highlight the need for research to include young men in examining coercive pregnancy behaviors. Findings also highlight the need to develop strategies to support educational and clinical approaches to address young men's role as partners in healthy contraceptive practices.

"I'm not Gonna Die Because of an STD": Female African American Adolescents' Perspectives on how they Protected Themselves from Sexual Risks While in Foster Care

PURPOSE

Youth in foster care are at greater risk for engaging in sexual behaviors that increase their odds of experiencing negative sexual and reproductive health (SRH) outcomes. The purpose of this qualitative study was to describe challenges faced by female African American adolescents in foster care as they tried to protect themselves from SRH risks and protective beliefs and behaviors to avoid these risks.

DESIGN AND METHODS

Semi-structured interviews were conducted with 16 female African American adolescents, ages 18-20 years, with a history of foster care placement during adolescence. Purposive sampling was done to recruit participants from a metropolitan area in Virginia. Transcribed interviews underwent inductive thematic analysis. This paper focuses on the theme of protection from SRH risks and its subthemes of challenges that made it difficult to avoid sexual risks and protective beliefs and behaviors that facilitated avoidance of those risks.

RESULTS

Participants reported yearning for connection, partners' desire to not use condoms, and judgmental caregivers as challenges. Protective beliefs and behaviors included open communication with their caregivers about SRH, abstinence, contraceptive use, and participants' desire to be healthy.

CONCLUSIONS

Study findings shed light on protective beliefs and behaviors female youth in foster care used to safeguard themselves from negative SRH outcomes. Youth at times lacked agency in sexual decision-making and contraceptive use.

PRACTICE IMPLICATIONS

Findings highlight the importance of sexual relationships and partner communication related to contraceptive use, and offering trauma-informed interventions, including culturally sensitive counseling regarding long acting reversible contraception.

Reproductive coercion, intimate partner violence, and pregnancy risk among adolescent women with a history of foster care involvement

BACKGROUND

The current study is the first to explore the prevalence of reproductive coercion among adolescent women currently or previously involved in the U.S. foster care system. Reproductive coercion (RC), a form of intimate partner violence (IPV) involving exertion of power over a partner by controlling their reproductive health and decision making, is a significant public health concern. Existing research on RC has primarily been conducted in either healthcare settings or on college campuses. Foster youth are disproportionately impacted by both adolescent pregnancy and interpersonal violence. RC may contribute to this elevated risk.

METHODS

We conducted a cross-sectional survey in 2015 and 2016 of adolescent women (n=136), ages 16-24 years old, seeking services from youth-serving agencies affiliated with a child welfare system in Pennsylvania, United States. Participants completed measures assessing RC, experiences of physical and sexual violence, sexual behaviors, and pregnancy. We used multivariable logistic regression to assess associations between RC and study outcomes.

RESULTS

The sample was predominantly African American (67.4%) and largely identified as something other than heterosexual (46.6%). Nearly one-third of the sample (30.1%) reported a history of RC, with the most common being male partners telling them not to use birth control. High rates of IPV (62.1%), lifetime pregnancy (43.4%), and unwanted pregnancy (30.9%) were also reported. RC was associated with significantly higher odds of IPV (Adjusted Odds Ratio (AOR) = 4.22, 95% Confidence Interval (CI): 1.60, 11.13), multi-perpetrator rape (AOR 3.56, 95% CI: 1.04, 12.24), pregnancy (AOR = 5.39, 95% CI: 2.14, 13.60), and unintended pregnancy (AOR 5.39, 95% CI: 2.04, 14.25). Young women reporting RC also had elevated odds for using alcohol or drugs before sex (AOR = 4.34, 95% CI: 1.72, 10.97) and having sex with a male partner 5 years or more older (AOR = 7.32, 95% CI: 2.84, 18.87). No significant differences emerged between RC and sociodemographic characteristics.

IMPLICATIONS

These data suggest women involved in the U.S. foster care system, particularly women of color and/or LGBTQ+ identified who comprised the majority of participants in the current study, may be at an increased risk for experiencing RC and other forms of IPV associated with adolescent pregnancy. In addition to efforts to prevent IPV and sexual violence, assessment for RC, healthy relationships education, and access to sexual and reproductive health care may mitigate these risks and improve outcomes for these young women.

Adverse Childhood Experiences on Reproductive Plans and Adolescent Pregnancy in the Gulf Resilience on Women's Health Cohort

We investigated if adverse childhood experiences (ACEs) and ACE sub-types were associated with increased odds of planning to have children and adolescent pregnancy. The Gulf Resilience on Women’s Health (GROWH) is a diverse cohort of reproductive-age women living in southeastern Louisiana during the 2010 Deepwater Horizon oil spill. In our sample of 1482 women, we used multinomial logistic regression to model odds ratios of wanting future children and assessed effect measure modification by educational attainment. We also estimated odds ratios of adolescent pregnancy with binomial logistic regression. Exposure to ACEs increased odds of wanting future children across all ACE sub-types. Among women with lower educational attainment, three or more ACEs (overall, childhood, and adolescence) had over two times the odds of wanting future children. History of ACE and the various sub-types, except for emotional abuse, were associated with increased risk of adolescent pregnancy. ACEs may be linked to adolescent pregnancy and reproductive plans, and variations by educational status highlighted social discrepancies and importance of social context in evaluation and intervention.

Racial/Ethnic Differences in Unwanted Pregnancy: Moderation by Sexual Orientation

OBJECTIVE

To explore sexual orientation disparities in unwanted pregnancy by race/ethnicity.

BACKGROUND

Previous research has documented that sexual-minority women (SMW) are more likely to report unplanned pregnancy than heterosexual women, and that Black and Latina women are more likely to report unplanned pregnancy than White women. No research has examined how pregnancy intention varies at the intersection of these two identities.

METHOD

Data come from the pregnancy roster data in Waves IV and Wave V subsample in the National Longitudinal Study of Adolescent to Adult Health. We used pregnancy as the unit of analysis (n=10,845) and multilevel logistic regression models to account for clustering of pregnancies within women. Per pregnancy, women were asked if they "wanted" to be pregnant at the time of pregnancy. We conducted models stratified by race/ethnicity, as well as models stratified by sexual identity.

RESULTS

Among White women, sexual-minority women were more likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Conversely, among Black and Latina women, sexual-minority women were less likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Results stratified by sexual identity underscore these contrasting patterns: Among heterosexual women, White women were less likely to describe their pregnancies as unwanted compared to Black and Latina women; among sexual-minority women, White women were more likely to describe their pregnancy as unwanted than were Black and Latina women.

CONCLUSION

Traditional race/ethnicity trends in pregnancy intention (i.e., greater unwanted pregnancy among Black/Latina than White women) are reversed among sexual-minority women.

Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers

Reproductive coercion and female relationship abuse are prevalent and associated with poor sexual health; health care providers should assess for harmful partner behaviors among all patients who are adolescents or young women.

OBJECTIVE:

To investigate demographic differences and evaluate how reproductive coercion and relationship abuse influences young females' care-seeking and sexual health behaviors.

METHODS:

We conducted a secondary analysis of cross-sectional baseline survey data from sexually active female students (aged 14–19 years) who sought care from school health centers. Outcomes included recent (previous 3 months) reproductive coercion, physical or sexual adolescent relationship abuse, and nonpartner sexual violence victimization. Cluster-adjusted χ² tests compared demographics and generalized linear mixed models estimated associations among reproductive coercion, adolescent relationship abuse (physical and sexual abuse in romantic relationships), and care-seeking and sexual health behaviors.

RESULTS:

Of 550 sexually active high school females, 12% reported recent reproductive coercion and 17% reported physical or sexual adolescent relationship abuse, with no significant demographic differences. Prevalence of recent nonpartner sexual violence was 17%. There were no observed significant differences in care-seeking behaviors among those with recent reproductive coercion compared with those without. Physical or sexual adolescent relationship abuse was associated with increased odds of seeking testing or treatment for sexually transmitted infections (adjusted odds ratio [aOR] 2.08, 95% CI 1.05–4.13). Females exposed to both adolescent relationship abuse and reproductive coercion had higher odds of having a partner who was 5 or more years older (aOR 4.66, 95% CI 1.51–14.4), having two or more recent sexual partners (aOR 3.86, 95% CI 1.57–9.48), and using hormonal contraception only (aOR 3.77, 95% CI 1.09–13.1 vs hormonal methods with condoms).

CONCLUSION:

Almost one in eight females experienced recent reproductive coercion. We did not observe significant demographic differences in reproductive coercion. Partner age and number of sexual partners may elevate risk for abusive relationships. Relationship abuse is prevalent among high school students seeking care, with no clear pattern for case identification. By failing to identify factors associated with harmful partner behaviors, our results support universal assessment for reproductive coercion and relationship abuse among high school–aged adolescents, involving education, resources, and harm-reduction counseling to all patients.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT01678378.

Experiences of Reproductive Coercion Among Latina Women and Strategies for Minimizing Harm: "The Path Makes Us Strong"

INTRODUCTION

Latina women disproportionately report experiencing reproductive coercion (RC), a set of behaviors that interfere with autonomous reproductive decision making. Given RC's associations with intimate partner violence (IPV) and unintended pregnancy, it is critical to identify and address RC to assist women to achieve safety, autonomy, and reproductive life plans. The purpose of this study was to describe and understand the context of RC and the use of RC safety strategies among Latina women receiving services at an urban clinic, through listening to the experiences of the women in their own words.

METHODS

Qualitative descriptive methodology was used. Semistructured interviews were conducted with a purposive sample of 13 Latina women recruited from a Federally Qualified Health Center in the Washington, DC, area.

RESULTS

Data were organized into 3 a priori categories: (1) RC behaviors, (2) co-occurrence of RC and IPV, and (3) RC harm reduction strategies. New RC behaviors emerged, and immigration status was used as a method of coercive control. From these a priori categories emerged 4 themes: impact of immigrant and citizenship status, machismo, strength and bravery, and importance of family. Harm reduction strategies included less detectable contraception; some sought community services, but others resorted to deception and stalling as the only tools available to them.

DISCUSSION

Less detectable methods of contraception remained useful harm reduction strategies for women experiencing RC. Midwives should inquire about method fit and be mindful of honoring the request when patients ask to change methods. Women's strength and resilience emerged as a vital source of power and endurance. This diverse sample and the powerful voices of the women who participated make a significant contribution to the understanding of RC experienced by Latina women in the United States.

Intimate partner violence, reproductive coercion, and unintended pregnancy in women with disabilities

BACKGROUND

Women with disabilities experience higher rates of intimate partner violence (IPV) than the general population. Reproductive coercion, a type of intimate partner violence, is associated with an increased risk of unintended pregnancy (UIP), yet little is known about this relationship among women with disabilities.

OBJECTIVE

This qualitative descriptive study explored perspectives of women with disabilities who had experienced an UIP as a result of reproductive coercion.

METHOD

In-depth, semi-structured telephone interviews were conducted with nine women living with diverse disabilities across the United States as part of a larger study examining facilitators and barriers to UIP among women with disabilities.

RESULTS

Analysis revealed three broad themes related to the ways in which physical violence and reproductive coercion elevated women's risk of UIP. They included (1) inadequate health care provider or system response, (2) disability-related risks for IPV, and (3) resource needs to optimize safety.

CONCLUSIONS

This is the first in-depth exploration of ways in which reproductive coercion may lead to an increased risk of UIP among women with disabilities. Health care providers must screen for IPV and reproductive coercion and provide the necessary supports and resources for women with disabilities experiencing unintended pregnancy as a result of violence.

"If You Don't Ask, I'm Not Going to Tell You": Using Community-Based Participatory Research to Inform Pregnancy Intention Screening Processes for Black and Latina Women in Primary Care

BACKGROUND

Public health and medical professional organizations recommend screening women of reproductive age for pregnancy intention (PI) routinely in primary care. Existing PI screening tools may not address the complexity of intentions for women of color or lower socioeconomic status or be well-suited to primary care settings. This study sought to inform recommendations for carrying out PI screening meaningfully in primary care settings.

METHODS

This community-based participatory research project united staff from a research institution, community health organization, and federally qualified health center in a predominantly Latina community in New York City. The Community Advisory Board members designed the research question, developed qualitative interview guides, and conducted in-depth interviews with 30 English- and Spanish-speaking female federally qualified health center patients ages 15 to 49. Community Advisory Board members developed an initial codebook using an inductive approach and refined themes throughout the coding process. After coding, Community Advisory Board members created a conceptual map representing relationships between key themes, and generated data-informed recommendations for PI screening practices that are relevant and feasible in the community context.

RESULTS

Participants expressed a range of experiences with PI screening processes, depending on medical histories, attitudes, norms, and perceived benefits of screening. Three central themes emerged through frequency of occurrence, consistency in content, and relevance as reflected in concept mapping: agency, judgment and shame, and expertise versus authority. Recommendations included specific strategies and wording providers could use to explain the rationale and context for discussing PI.

CONCLUSIONS

Future work should examine the experience and effectiveness of implementing these community-based participatory research-derived recommendations in primary care.

Women's Contraceptive Perceptions, Beliefs, and Attitudes: An Integrative Review of Qualitative Research

INTRODUCTION

Unintended pregnancy rates will remain high until researchers explore the lived experience of women's relationships with contraception. This integrative review examines the extant qualitative literature on women's contraception to illuminate common themes in women's perspectives through the lens of the feminist poststructuralist framework.

METHODS

A literature review of PubMed and CINAHL databases was completed for English-language studies conducted in the United States from January 2008 through September 2018 that qualitatively examined women's perceptions, beliefs, and attitudes regarding contraception. Reports, dissertations, mixed-methods research, and literature reviews were excluded. The sample, methods, and findings of 19 studies were reviewed. Themes were identified using the 5 major tenets of the feminist poststructuralist framework: discourse, power, language, subjectivity, and agency.

RESULTS

Themes of power imbalance between partners and health care providers; societal and communal discourses on femininity and motherhood; distrust of hormonal contraception; the ability to enhance personal agency through contraceptive decision making; and a need for open, patient-focused communication arose from the 19 studies included in the review.

DISCUSSION

Using a feminist poststructuralist framework to examine women's contraceptive perceptions illuminates and magnifies the many ways in which contraceptive beliefs and use are dependent on gender roles and power dynamics. Gaps in knowledge specific to older women and exploration of women's subjectivity should be addressed. Clinicians should evaluate the power structures inherent to their practice while providing woman-focused, evidence-based contraceptive education.

Predictors of contraceptive switching and discontinuation within the first 6 months of use among Highly Effective Reversible Contraceptive Initiative Salt Lake study participants

BACKGROUND

Nearly half of women will switch or discontinue using their selected contraceptive method in the first year. Research on early switching or discontinuation provides important clinical and public health insights, although few studies have assessed associated factors, particularly among longitudinal cohorts.

OBJECTIVE

The current study explores attributes associated with early contraceptive method switching or discontinuation (<6 months of initiation) among participants enrolled in the intervention cohorts of the Highly Effective Reversible Contraceptive Initiative Salt Lake Contraceptive Initiative (Utah, United States).

MATERIALS AND METHODS

Highly Effective Reversible Contraceptive Initiative Salt Lake participants have access to no-cost contraception for 3 years. This includes both the initial selection and the ability to switch or to discontinue methods without cost. Methods available included the following: nonhormonal behavioral methods (male/female condoms, withdrawal, diaphragms, cervical caps, and fertility awareness); short-acting methods (pill, patch, ring, and injectable); and long-acting methods (intrauterine devices and contraceptive implants). Participants completed surveys at baseline and at 1, 3, and 6 months. We collected data on participant demographics, contraceptive continuation, switching, and discontinuation, as well as factors associated with these changes, including established measures of pregnancy intention and ambivalence and reasons for switching or discontinuing. We conducted descriptive statistics, univariable, and multivariable Poisson regression analyses to assess predictors of both discontinuation and switching. We also conducted χ2 analyses to compare reported reasons for stopping between switchers and discontinuers.

RESULTS

At 6 months, 2,583 women (70.0%) reported continuation of their baseline method, 367 (10%) reported at least 1 period of discontinuation, 459 (12.4%) reported switching to a different method, and 279 (7.6%) did not provide 6-month follow-up. Factors associated with discontinuation included selection of a short-acting method (incidence rate ratio [IRR], 2.49; 95% confidence interval [CI], 1.97, 3.12), report of Hispanic ethnicity (IRR, 1.45; 95% CI, 1.12, 1.89) and nonwhite race (IRR, 1.48; 95% CI, 1.08, 2.02), and having any future pregnancy plans, even years out. Participants with some college education were less likely to report discontinuation (IRR, 0.73; 95% CI, 0.57, 0.94). Selecting a short-acting method at baseline was also associated with increased likelihood of method switching (IRR, 2.29, 95% CI, 1.87, 2.80), as was having 2 or more children (IRR, 1.37; 95% CI, 1.08, 1.74). Women were less likely to switch if they were on their parents' insurance (IRR, 0.74; 95% CI, 0.56, 0.99). Among participants who switched methods, 36.9% switched to a long-acting reversible method, 31.7% switched to a short-acting hormonal method, and 31.1% switched to a nonhormonal behavioral method, such as condom use. Of participants providing a reason for stopping, 454 women (73.2%) reported side effects as 1 reason for switching or discontinuing their initial method.

CONCLUSION

Early contraceptive method switching and discontinuation are frequent outcomes of contraceptive use. These changes are common even with removal of contraceptive access barriers.

Rape-Related Pregnancy and Association With Reproductive Coercion in the U.S

INTRODUCTION

Rape-related pregnancy is a public health problem where sexual violence and reproductive health intersect; yet, there is a dearth of research to inform public health practice. The authors examined the prevalence and characteristics of rape-related pregnancy in U.S. women and its association with intimate partner reproductive coercion.

METHODS

Data years 2010-2012 are pooled from the National Intimate Partner and Sexual Violence Survey, a telephone survey of U.S. adults. Accounting for complex survey design, in 2017, authors estimated the prevalence of vaginal rape-related pregnancy for U.S. women overall and by race/ethnicity. The authors also examined the proportion of rape-related pregnancy among victims of vaginal rape overall, by perpetrator type and by presence of reproductive coercion in the context of intimate partner rape.

RESULTS

Almost 2.9 million U.S. women (2.4%) experienced rape-related pregnancy during their lifetime. Among rape victims, 77.3% reported a current/former intimate partner perpetrator, and 26.2% of intimate partner rape victims reported rape-related pregnancy compared with those raped by an acquaintance (5.2%) or stranger (6.9%). Women raped by an intimate partner and reporting rape-related pregnancy were significantly more likely to have experienced reproductive coercion compared with women who were raped by an intimate partner but did not become pregnant.

CONCLUSIONS

This paper reports the first national prevalence of rape-related pregnancy by any perpetrator in two decades. The high proportion of rape-related pregnancy committed by intimate partner perpetrators and its association with reproductive coercion suggest the need for primary prevention of intimate partner violence and access to trauma-informed reproductive health services for rape/intimate partner violence victims.