Reproductive coercion in college health clinic patients: Risk factors, care seeking and perpetration

Reproductive Coercion: Prevalence and Risk Factors Related to Relationship Health Knowledge and Skills

Reproductive coercion is any behavior that limits a person's reproductive decision-making and can lead to negative health and safety outcomes. Previous research has explored reproductive coercion prevalence rates in clinical samples, as well as demographic risk factors for experiencing reproductive coercion. The purpose of this study is to assess the prevalence rates of two specific forms of reproductive coercion, pregnancy coercion and condom manipulation, in an ethnically and racially diverse sample of young females. We also explore the association between relationship health knowledge and skills with reproductive coercion. We used a sample of 143 females with previous sexual activity. Participants were diverse in terms of race, ethnicity, sexual orientation, and family immigration status. Descriptive statistics and logistic regression analyses were used to determine prevalence rates of pregnancy coercion and condom manipulation and the likelihood of experiencing reproductive coercion based on participants' knowledge and skills related to relationship health. Results revealed that 16.1% of the sample had experienced reproductive coercion, with all participants in this group reporting lifetime experiences of pregnancy coercion. Lifetime experiences of condom manipulation were reported by 6.3% of the sample. The most common form of reproductive coercion experienced by participants was being told by a partner not to use any birth control. Furthermore, results indicate that higher relationship health knowledge may be a protective factor for pregnancy coercion and condom manipulation. Likewise, higher decision-making skills in relationships and higher confidence in relationships may also protect against condom manipulation. Results from this study suggest implications for sexual and relationship health programming that expands education around consent, choice, decision-making, and communication around the use of contraception.

Sexual health variation among gang-involved youth in Washington state: Social ecological implications for research and practice

INTRODUCTION

Gang-involved youth experience greater disparities in sexual health compared to non-gang-involved youth. Yet, little is known about how and why sexual behaviors vary within the youth gang population. Developing relevant and effective service approaches requires an understanding of this variation and the environmental factors that influence patterns of sexual health risk.

METHODOLOGY AND RESULTS

Using latent class analysis, we identified four sexual behavior classes within a school-based sample of gang-involved youth in Washington State (N = 2060): Non-Sexually Active (54%), Limited Partners with Condom Use (14%), Multiple Partner with Sexting (19%), and High Sexual Vulnerability (13%). These classes were distinguished by age at sexual debut, number of sexual partners, condom use, and sexting. Interpersonal and macrosocial factors differentiated the classes, including multiform violence exposures, limited social support, and socioeconomic instability. We also found differences according to sexual identity and substance use.

DISCUSSION

Findings highlight the need for service approaches that are responsive to both the individual needs of gang-involved youth and the factors that shape their living environments. We discuss the implications for research and practice, including the potential utility of a harm reduction framework to promote sexual health and reduce disparities in the youth gang population.

Reproductive Coercion and Intimate Partner Violence Perpetration Among Young Adult Males

Reproductive coercion is any behavior that attempts to control the autonomous reproductive decision-making of an intimate partner. Very little research has focused on males who perpetrate reproductive coercion. Using a diverse community sample of young adults, we examined the prevalence of lifetime reproductive coercion perpetration and its relationship with other forms of intimate partner violence (IPV). Results demonstrated that approximately 6.4% of the men reported perpetrating reproductive coercion in their lifetime. Chi-square analyses demonstrated that men who reported sexual (16.2%), physical (11.1%), or psychological (59.1%) IPV perpetration, relative to men who did not, reported a significantly higher prevalence of reproductive coercion perpetration.

Reproductive Coercion Among College Students: An Extension and Test of Routine Activity Theory

The current study is guided by routine activity theory to explore the risk of experiencing reproductive coercion among a sample of sexually active college students (N = 1,515). Findings indicate that being in an exclusive relationship was associated with lower odds of reproductive coercion, yet prior victimization, including emotional abuse and sexual violence, was associated with higher odds of reproductive coercion. This study supports other research that finds reproductive coercion does not occur in isolation from other victimization experiences, and multifaceted prevention strategies are needed. Implications relating to autonomous reproductive decision-making are discussed.

Reproductive Coercion Victimization and Associated Mental Health Outcomes Among Female-Identifying Young Adults

Reproductive coercion is a serious public health problem. Victimization has been associated with poor mental health outcomes, including symptoms of posttraumatic stress disorder (PTSD) and depression in clinical and college samples. We build on these findings by examining the association between reproductive coercion victimization and mental and behavioral health outcomes, including depression, PTSD symptoms, anxiety, and drinking behaviors in a diverse community-derived sample of female-identifying young adults (mean age = 20; SD=.72). Participants (n = 368) were originally recruited as part of a study on dating violence in seven Texas public high schools. Participants completed an online study that included demographic questions and measures that assessed the variables of interest. Results of regression analyses showed that reproductive coercion victimization predicted depression, anxiety, and PTSD symptoms, after controlling for race, sexual orientation, and age. The findings also revealed that victims of reproductive coercion were more likely consume more drinks per drinking occasion compared to their non-victimized counterparts. These results add to the growing literature that experiencing reproductive coercion is a risk marker for poor mental and behavioral health. To develop targeted prevention and intervention programs, future research should examine potential mechanisms underlying this relationship.

Future directions for reproductive coercion and abuse research

BACKGROUND

Reproductive coercion and abuse (RCA) is a form of intimate partner violence (IPV) in which people with the capacity for pregnancy experience coercive behaviors that threaten their reproductive autonomy. Behaviors that constitute RCA include contraceptive control/sabotage, pregnancy pressure, and controlling the outcome of a pregnancy. Several areas of RCA study have emerged: associations with IPV, health outcomes resulting from RCA, and demographic and contextual factors associated with experiencing RCA. Current research in these areas is summarized and placed in a global context, including sexual and gender minority groups, use of RCA (exploring perpetration), RCA interventions, RCA in women with disabilities, and the question of whether people assigned male at birth can be RCA victims.

CONCLUSION

Areas for future exploration include evolving interpretations of pregnancy intention in the setting of fewer options for abortion, RCA in people with disabilities and multiple levels of marginalization, including sexual and gender minorities; intersections between RCA and economic abuse in the context of efforts at economic justice; and community-centered approaches to intervention and prevention.

"This has definitely opened the doors": Provider perceptions of patient experiences with telemedicine for contraception in Illinois

CONTEXT

The COVID-19 pandemic increased the provision of contraception through telemedicine. This qualitative study describes provider perceptions of how telemedicine provision of contraception has impacted patient care.

METHODS

We interviewed 40 obstetrics-gynecology and family medicine physicians, midwives, nurse practitioners, and support staff providing contraception via telemedicine in practices across Illinois, including Planned Parenthood of Illinois (PPIL) health centers. We analyzed interview content to identify themes around the perceived impact of telemedicine implementation on contraception access, contraceptive counseling, patient privacy, and provision of long-acting reversible contraception (LARC).

RESULTS

Participants perceived that telemedicine implementation improved care by increasing contraception access, increasing focus on counseling while reducing bias, and allowing easier method switching. Participants thought disparities in telemedicine usage and limitations to the technological interface presented barriers to patient care. Participants' perceptions of how telemedicine implementation impacts patient privacy and LARC provision were mixed. Some participants found telemedicine implementation enhanced privacy, while others felt unable to ensure privacy in a virtual space. Participants found telemedicine modalities useful for counseling patients considering methods of LARC, but they sometimes presented an unnecessary extra step for those sure about receiving one at a practice offering same day insertion.

CONCLUSION

Providers felt telemedicine provision of contraception positively impacted patient care. Improvements to counseling and easier access to method switching suggest that telemedicine implementation may help reduce contraceptive coercion. Our findings highlight the need to integrate LARC care with telemedicine workflows, improve patient privacy protections, and promote equitable access to all telemedicine modalities.