Reproductive Coercion, Intimate Partner Violence, and Unintended Pregnancy Among Latina Women

Contraceptive Use Among Women Experiencing Intimate Partner Violence and Reproductive Coercion: The Moderating Role of PTSD and Depression

Women experiencing reproductive coercion (RC) report more unintended pregnancies and mental health symptoms that can influence contraceptive use patterns. We examined associations between RC and contraceptive use among intimate partner violence (IPV) exposed women aged 18-35 (N = 283). We tested depression, post-traumatic stress disorder (PTSD), and co-morbid depression and PTSD as effect modifiers. Though no association was found between RC and contraception, PTSD significantly modified this relationship. Among Black women (n = 112), those reporting RC and either PTSD or comorbid PTSD and depression were less likely to use partner-independent contraception compared to those reporting RC without mental health symptoms. PTSD could be a barrier to contraceptive choice among this population.

Birth Control Sabotage Motivation and Measurement: A Mixed-Methods Analysis among Latina Women

Reproductive coercion (RC) is a type of intimate partner violence that includes birth control sabotage (BCS). We explored the perceived intent behind BCS to refine RC measurement, using a mixed-methods design with a clinic-based sample of Latina women (13 interviews; 482 surveys). Women perceived partners used BCS for reasons beyond pregnancy promotion. Specifically, 16.8% of participants reported any past-year RC; this decreased to 9.5% when asked if their partner used BCS with the sole intent of getting them pregnant. RC measures and assessment should separate behavior from intent in BCS questions to not underestimate the prevalence and to guide clinical response.

"At the End of the Day it's Their choice": An Exploratory Qualitative Study of Pregnancy Options Counseling

This study's purpose was to explore the current models and approaches of pregnancy options counseling across three types of agency settings in a Northeastern state. Additionally, this study aimed to determine if individuals who receive pregnancy options counseling obtained medically factual, non-directive, and non-biased information needed to make informed decisions related to their pregnancy decisions. Using qualitative research methodology, semi-structured interviews were conducted with 10 participants across three different agency settings in one state in the Northeastern United States. Results indicated agencies shared a definition of pregnancy options counseling. Outcomes also suggest agency type impacted how pregnancy options counseling was delivered, as variations were found in education provided to patients. Lastly, the interviews imply no standardized model or training for pregnancy options counselors is currently being used.

Reproductive Coercion and Abuse: The Potential Protective Scope of Existing Family Violence Legislation in Australia

Reproductive coercion and abuse (RCA) removes or reduces reproductive autonomy and decision-making. RCA-focused research is mostly situated within a health care perspective, with much less focus on sociolegal or criminological considerations. This article reports a summary of findings from an examination of existing Australian family violence legislation to discern whether these provisions could facilitate improved responses to RCA. The study analyzed whether and how RCA is reflected within legislative definitions of family violence across Australia, to determine their potential protective scope. The state of South Australia is the only jurisdiction to provide explicit reference to behaviors regarded as RCA, but many definitions within the family violence legislation in other jurisdictions implicitly cover RCA. While such implicit coverage may hinder the recognition of RCA as a form of family violence, it may also provide sufficient flexibility to enable RCA to be addressed through the legal application of current family violence policy and legislation-with consequential potential benefits for the identification and support of victim-survivors.

A Scoping Review of Nonconsensual Condom Removal ("Stealthing") Research

Nonconsensual condom removal (NCCR; also known as "stealthing") involves the removal of a condom before or during sexual intercourse without a partner's sexual consent. Within the past several years, nations across the globe have codified NCCR as a form of sexual violence penalized by civil and/or criminal penalties. Given the recent legal attention to this behavior, we performed a scoping review of the peer-reviewed, empirical, English-language studies conducted on NCCR in order to summarize the current state of this field of research. Our scoping review yielded 27 articles meeting study inclusion criteria. Data on NCCR victimization and perpetration prevalence rates and correlates, as well as perceptions of NCCR, were extracted. The majority of the reviewed studies were conducted within the past 5 years and pertained to NCCR victimization. Rates of NCCR victimization ranged from 7.9% to 43.0% for women and 5.0% to 19.0% for men who have sex with men; rates of NCCR perpetration ranged from 5.1% to 9.8% for men and 0% for women. NCCR correlates included sociodemographic variables, relationship type, psychological factors, and sexual health concerns. Perceptions of NCCR were largely negative. The nascent field of NCCR research provides empirical evidence from several countries regarding concerning rates of NCCR. Building upon this foundation, continued research regarding NCCR is imperative. Studies that further delineate NCCR prevalence, risk factors, and outcomes would provide critical information beneficial to the development of evidence-based prevention and intervention programs targeting reductions in NCCR.

Contraceptive Sabotage and Contraceptive Use at the Time of Pregnancy: An Analysis of People with a Recent Live Birth in the United States

Contraceptive sabotage and other forms of intimate partner violence (IPV) can interfere with contraceptive use. We used 2012 to 2015 Pregnancy Risk Assessment Monitoring System data from 8,981 people residing in five states who reported that when they became pregnant, they were not trying to get pregnant. We assessed the relationships between ever experiencing contraceptive sabotage and physical IPV 12 months before pregnancy (both by the current partner) and contraceptive use at the time of pregnancy using multivariable logistic regression. We also assessed the joint associations between physical IPV 12 months before pregnancy and ever experienced contraceptive sabotage with contraceptive use at the time of pregnancy. Few people ever experienced contraceptive sabotage (1.8%; 95% confidence interval [CI]: 1.4, 2.3) or physical IPV 12 months before pregnancy (2.8%; 95% CI: 2.3, 3.3). In models adjusted for age, race/ethnicity, marital status, education, and state of residence, ever experiencing contraceptive sabotage was associated with contraceptive use at the time of pregnancy (adjusted odds ratio [aOR]: 1.73; 95% CI: 1.06, 2.82), but not with physical IPV 12 months before pregnancy (aOR: 0.69; 95% CI: 0.46, 1.02). When examining the joint association, compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy, ever experiencing contraceptive sabotage was significantly related to contraceptive use at the time of pregnancy (aOR: 1.72; 95% CI: 1.00, 2.95). However, it was not associated with experiencing physical IPV 12 months before pregnancy (aOR: 0.68; 95% CI: 0.45, 1.04) or with experiencing both contraceptive sabotage and physical IPV 12 months before pregnancy (aOR: 1.21; 95% CI: 0.42, 3.50), compared to not ever experiencing contraceptive sabotage or physical IPV 12 months before pregnancy. Our study highlights that current partner contraceptive sabotage may motivate those not trying to get pregnant to use contraception; however, all people in our sample still experienced a pregnancy.

Reproductive autonomy associated with the use of contraceptive methods among reproductive aged women

OBJECTIVE

To assess the sociodemographic aspects associated with reproductive autonomy among urban women, with special regard to the relationship with the use of contraceptive methods.

METHOD

Cross-sectional study with 1252 women, conducted between April and June 2021, using the Brazilian version of the Reproductive Autonomy Scale. Data were analyzed using multiple linear regression.

RESULTS

Mean scores for the subscales were 2.5 (SD=0.3) (Decision-making), 3.8 (SD=0.3) (Absence of Coercion) and 3.6 (SD=0.4) (Communication). Compared to women who reported no use of contraceptive methods, women using barrier or behavioral methods and those using LARC had higher level of reproductive autonomy on all dimensions of the Scale (p<0.001). Other aspects associated with reproductive autonomy were education, race/ethnicity, religion, socioeconomic status and cohabitation living with a partner, depending on each subscale.

CONCLUSION

The type of contraceptive method used was statistically associated with reproductive autonomy in all subscales.

Different Types of Intimate Partner Violence Among Latinx Women: A Call for Expanded Measurement, Screening, and Safety Planning

Despite increased attention on intimate partner violence (IPV) among Latinx women in the United States, measurement often overlooks economic abuse, reproductive coercion, institution-related threats, and technology-facilitated abuse. Using a broad range of measures, this paper examines prevalence and correlations between different types of IPV among a sample of 38 Latinx women enrolled into a pilot study. Results indicate consistently high prevalence of IPV types and significant correlations between several types of abuse (including sexual abuse, technology-facilitated abuse, and institution-related threats). Findings emphasize the need for comprehensive IPV measurement, screening, expanded safety planning, and research on the impact of these types of abuse.

The Use of Chemical Control Within Coercive Controlling Intimate Partner Violence and Abuse

This paper explores the use of chemical control by perpetrators as part of coercive controlling intimate partner violence and abuse, defined as the nonconsenting use of prescribed and nonprescribed medication (including vaccines), and/or other substances to coerce or control, reducing the victim-survivor's capacity for independence, freedom, and health. Based on testimonies of 37 victims-survivors and nine domestic abuse practitioners in the UK we identify varying tactics used to chemically coerce and control, deepening our understanding about the continually changing forms of domestic violence and abuse and enhancing the potential for a more robust response through better informed policy and practice.

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.

An examination of the association between forced sex history and reproductive coercion experiences among Black women attending STD clinics in Baltimore, MD, USA

BACKGROUND

Reproductive coercion victimization (RCV) is a significant public health issue that negatively affects women's sexual and reproductive health outcomes. Less is known about reproductive coercion perpetration (RCP). Few studies have examined these phenomena among representative samples of Black women.

METHODS

Retrospective data of women (n = 298) attending STD clinics in Baltimore, MD were analyzed. We calculated lifetime and 12-month prevalence reports of reproductive coercion, and reported values stratified by forced sex history. Binomial logistic regression models were used to examine the association between forced sex history and RCV, accounting for other types of violence typologies.

RESULTS

Lifetime and past 12-month RCV and RCP prevalence were higher among women with forced sex experiences than their counterparts (Lifetime RCV: 46.9% versus 17.5%; past 12-month RCV: 19.4% versus 8.5%. Lifetime RCP: 24.5% versus 17%; past 12-month RCP: 13.3% versus 10.5%). Adjusted models, lifetime reproductive coercion: Women reporting forced sex had a 3.58 times higher odds of having had experienced RCV compared to women not reporting forced sex (AOR 3.58; 95% CI 2.00, 6.46). Women reporting forced sex had a 3.66 times higher odds of having ever experienced pregnancy coercion compared to their counterparts (AOR 3.66; 95% CI 1.93, 7.03) and 4.30 times higher odds of having ever experienced condom manipulation (AOR 4.30; 95% CI 2.15, 8.86). Adjusted models, past 12-month reproductive coercion: Women reporting forced sex had a 2.72 times higher odds of having had experienced past 12-month RCV compared to women not reporting forced sex (AOR 2.72; 95% CI 1.27, 5.91). Women reporting forced sex had a 3.25 times higher odds of having experienced past 12-month pregnancy coercion compared to their counterparts (AOR 3.25; 95% CI 1.38, 7.83) and 3.41 times higher odds of having experienced past 12-month condom manipulation (AOR 3.41; 95% CI 1.14, 10.98).

CONCLUSIONS

Participants in our study reported high rates of RCV. Our novel exploration revealed significantly high rates of co-occurring forced sex experiences and RCV and initial prevalence report of RCP. Agencies have a unique opportunity to intervene by implementing screening protocols and referrals for supportive services. These findings may inform future intervention research efforts aimed at improving reproductive health outcomes among Black women.

Experiences of Exploitation and Associations With Economic Abuse in Adolescent Dating Relationships: Findings From a U.S. Cross-Sectional Survey

Adolescent relationship abuse (ARA) (i.e. physical, sexual, psychological, or economic abuse in the context of romantic relationships) is associated with adverse health outcomes, including anxiety, depression, suicidality, unintended pregnancy, and substance misuse. A related phenomenon, reproductive coercion involves interference with the reproductive decision making of a partner with the intention of promoting pregnancy or controlling outcomes of a pregnancy. Reproductive coercion is associated with unintended pregnancy, partner violence, and sexually transmitted infections. Little is known about the intersection between economic ARA, sexual exploitation, and reproductive coercion. This paper explores the intersections between reproductive coercion, transactional sex, and economic abuse victimization in adolescent dating relationships. In an online survey, 1,752 adolescents (ages 13-17) were asked about economic adolescent relationship abuse (educational, employment and financial interference), transactional sex, reproductive coercion, and contraceptive access within their relationships. We assessed associations with chi-square tests and logistic regression analysis. Youth who experienced economic ARA (70%, 1,232) reported financial dependence on their partner, contraceptive access, and reproductive coercion (74-83%; p-values<0.001) more often than their counterparts without economic ARA. Adolescents experiencing economic abuse were more likely to report transactional sex (aOR = 2.76, CI [2.12, 3.60], p < .001), depending on a partner to pay for contraception or birth control (aOR = 2.20, CI [1.71, 2.84], p < .001), and reproductive coercion (aOR = 3.20, CI [2.37, 4.32], p < .001). Youth-serving providers and agencies should be aware of intersections between economic ARA, transactional sex, financial dependence, and reproductive coercion, particularly for adolescents with health-related social needs.

Relationship Between Dating Violence and Contraceptive Use Among Texas Adolescents

The recent overturning of Roe v. Wade has the potential to adversely impact reproductive health among adolescents experiencing unplanned pregnancies from dating violence. We examined the associations between contraceptive use and dating violence among Texas high schoolers in the years leading up to this new law. Youth Risk Behavior Surveillance System data from Texas 9th to 12th graders from 2011, 2013, 2017, and 2019 were analyzed. Multinomial logistic regression analyses examined the association between contraceptive use and key descriptive predictors (physical and/or sexual dating violence, survey year, age, sex, and race/ethnic group). Eleven percent of Texas adolescents surveyed reported experiencing either physical or sexual dating violence and 2% reported experiencing both types of violence. Those who experienced any dating violence were significantly more likely to report not using contraception versus those who did not experience violence (12.5% vs. 68.3%, p = 0.01). Adolescents who experienced any type of dating violence were more likely to report using hormonal contraception, condom use, or withdrawal versus those who did not experience dating violence. Hispanic adolescents were 63% more likely than their ethnic group counterparts to use no contraception (odds ratio [OR] 1.63; 95% confidence interval [CI] [1.11-2.40]). A significant proportion of Texas adolescents reported experiencing dating violence, and this group also reported higher noncontraception use versus those not experiencing dating violence. Given new strict Texas antiabortion laws, dating violence prevention and contraceptive use promotion to prevent unwanted reproductive outcomes such as sexually transmitted infections or unplanned pregnancies are imperative in this age group.

Clinician views and experiences with reproductive coercion screening in a family planning service

BACKGROUND

Reproductive coercion refers to behaviour that interferes with a person's reproductive autonomy, such as contraceptive sabotage, pregnancy coercion, controlling a pregnancy outcome or forced sterilisation. Routine screening for reproductive coercion, together with clinician education, was implemented at a family planning service in New South Wales, Australia, in December 2018. A study was undertaken to explore the views and experiences of clinicians in undertaking reproductive coercion screening at this service.

METHODS

Clinicians were invited to complete an online survey and interview to discuss their understanding of reproductive coercion and their views and experiences of undertaking reproductive coercion screening. Descriptive and thematic content analysis was conducted.

RESULTS

Clinicians deemed reproductive coercion screening to be relevant and important in family planning services. Key barriers to reproductive coercion screening and responding to disclosures included time constraints and limited appropriate referral pathways. Ongoing education and training with resources such as a decision-support tool on reproductive coercion screening and management, as well as effective multi-disciplinary collaboration, were identified as strategies to improve the screening program.

CONCLUSIONS

Findings from our study highlight that clinicians' perceived reproductive coercion screening as a relevant and important component of sexual and reproductive healthcare. Ongoing reproductive coercion education, training and support would ensure the competency and confidence of clinicians undertaking screening. Identifying appropriate referral pathways with multi-disciplinary collaboration (involving clinicians, social workers, support workers and psychologists) would support clinicians in undertaking screening and responding to disclosures of reproductive coercion in Australian health care settings which provide family planning and sexual and reproductive health services.

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.

Reproductive Coercion and Intimate Partner Violence Victimization Among a Racially and Ethnically Diverse Young Adult Sample

Reproductive coercion is an understudied form of intimate partner violence (IPV) that occurs when a person attempts to control the autonomous reproductive decision making of their intimate partner. Previous research has demonstrated that individuals who experience reproductive coercion are more likely to experience other forms of IPV (e.g., physical and sexual). Research has also shown that Black/African American and Latinx/Hispanic individuals are at an increased risk of experiencing reproductive coercion compared to their White/Non-Hispanic peers. However, most of the research on reproductive coercion has been conducted in family-planning clinics where IPV is reported at a higher rate than in community samples. Thus, using a diverse community sample of female-identifying young adults (N = 370) who were recruited as part of an ongoing longitudinal study on dating violence, we examined the prevalence of lifetime reproductive coercion and its relationship with other forms of IPV, as well as the differences in prevalence among racial and ethnic groups. Lifetime prevalence of being victimized by any form of reproductive coercion was 11.4%. Results indicated that individuals who experienced reproductive coercion were more likely to experience physical and sexual IPV relative to those who did not experience reproductive coercion. With respect to race/ethnicity, 5.6% of White participants, 10.5% of Black/African American participants, and 14.8% of Hispanic/Latinx participants reported experiencing reproductive coercion. Chi-square analyses showed Hispanic/Latinx participants had a significantly higher prevalence of reproductive coercion when compared to White/Non-Hispanic participants. These findings suggest a need for additional research on culturally-specific risk and protective factors related to reproductive coercion among Hispanic/Latinx individuals to identify potential intervention and prevention strategies.

Coerced Choice: Resigned Contraceptive Usership Among Individuals Affected by Reproductive Coercion

INTRODUCTION

Partner-mediated reproductive coercion is a common form of violence that affects individuals' sexual and reproductive health goals. Clinicians' understanding of the scope of reproductive coercion continues to grow with direct implications for clinical interventions. The purpose of this study was to generate a more comprehensive set of reproductive coercion tactics used by intimate partners for recognition in a clinical setting.

METHODS

This was a qualitative study using grounded theory. Individuals were recruited through an established statewide community network to participate in videoconferencing focus groups regarding reproductive coercion. Discussions were moderated and recorded. Data were coded and then subjected to qualitative content analysis.

RESULTS

Twenty community members participated. Participants described partner interference with reproductive and sexual health goals, including limitation of their contraceptive options. Although participants were able to access health care and use contraception as part of a goal to avoid pregnancy, they also reported dissatisfaction with their methods. Some participants described being forced to use an undesired form of contraception in the setting of reproductive coercion from abusive partners.

DISCUSSION

Individuals affected by reproductive coercion may be able to access and exercise limited choice over their contraceptive options, but some may be unable to use the preferred method because of partners' behavior. Clinician awareness of the diversity of presentations of reproductive coercion, including individuals using long-acting reversible contraceptives, may facilitate individualized counseling and realignment of care with patient preferences.

Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support

Housing instability and intimate partner violence (IPV) compromise women's sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.

Interpersonal Violence and Contraceptive Method Use by Women Sex Workers

OBJECTIVE

More than one-half of women sex workers (sex workers) in the United States experience interpersonal violence, defined as physical or sexual violence, by sexual partners, including clients or intimate partners. Women experiencing interpersonal violence by intimate partners often choose hidden, woman-controlled contraception (e.g., intrauterine devices, pills, or sterilization) because fear of violence can impede condom negotiation. Yet, little is known about how interpersonal violence relates to contraception among sex workers who may have different sexual partner perpetrators (clients and intimate partners). The purpose of this study was to examine associations between interpersonal violence perpetrated by clients or intimate partners and contraceptive use.

STUDY DESIGN

Data are from an observational, prospective cohort of sex workers, aged 18 to 49 in Baltimore, Maryland (N = 218). Bivariate and multivariable logistic regression were used to assess associations between lifetime interpersonal violence and past 3-month contraceptive use. The outcome was any woman-controlled contraceptive use versus partner-controlled or no contraception.

RESULTS

Nearly all sex workers (96.5%) reported contraceptive use, with most using male condoms (69%), nearly one-half using woman-controlled methods (43%), and 25% using dual methods (e.g., condoms and a woman-controlled method). Lifetime experiences of interpersonal violence by clients (58%) and intimate partners (52%) were prevalent. Sex workers who experienced interpersonal violence by intimate partners had over twice the odds of woman-controlled contraceptive use (adjusted odds ratio, 2.48; 95% confidence interval, 1.36-4.54).

CONCLUSIONS

Findings highlight the importance of relationship context in the associations between interpersonal violence and use of woman-controlled contraceptive methods among sex workers, because only violence experiences by intimate partners were associated with increased odds of woman-controlled contraceptive method use.