An abusive relationship can manifest in intentional sabotage of birth control methods and instilling pressure to conceive, according to a new study. Researchers found that this can then lead to unplanned and unwanted pregnancies, abortions and psychological distress, ultimately resulting in traumatising consequences to the victim.

However, while most victims of reproductive coercion are women, men can be victimised as well and can often slip unnoticed.

“This study helps clinicians provide better care for their patients, particularly their adolescent patients,” said Heather McCauley, assistant professor in the human development and family studies department at Michigan State University, who added that the issue was not that doctors did not want to talk about reproductive coercion to their patients.

They were unaware of how to do so, she explained.

“Ultimately, (reproductive coercion) is about power and control – the perpetrators get off on that feeling of having complete power over their partners, even to the point of controlling a bodily function exclusive to women: pregnancy,” said Dr. Jeanna Park of the University of Illinois who was involved in a similar study in 2015.

Reproductive coercion: A phenomenon in relationship abuse

Cauley was involved in a medical research team in 2010 that identified the occurrence of reproductive coercion in abusive relationships, leading to the development of clinical practice guidelines that recommend doctors to incorporate screening of intimate partner violence during the routine sexual and reproductive health assessment.

To begin with, doctors need to step over the awkward phase of asking personal questions in order to establish a rapport. Giving patients the alternative of a personal consultation without their partner in the room is always a good way to start.

“Screening can be performed in conjunction with, or independent of, intimate partner violence screening with an open ended question like, ‘what challenges have you had with your current or previous contraceptive methods?’” Park said.

“Providers may suspect (reproductive coercion) when a patient has a known history of intimate partner violence, expresses a desire to obtain contraception but repeatedly loses her prescription or changes her contraceptive method frequently, presents with frequent unintended pregnancies or sexually transmitted infections, or appears apprehensive of her partner discovering her contraceptive or pregnancy choices.”

To enhance recognition of reproductive coercion, a collaborative study was conducted by Johns Hopkins University, the University of Pittsburgh, Harvard University and the University of California to refine the psychometric properties of the Reproductive Coercion Scale (RCS) for use in clinical practice.

The study involved nearly 5,000 women aged 16 and 29 years who completed questionnaires on reproductive coercion including pressure to become pregnant as well as prevention or sabotage in the use of birth control.

Nearly 7% of the group reported recent experience in reproductive coercion and findings revealed there were two distinct characteristics of reproductive coercion: pressure into pregnancy and manipulation of condoms.

Awareness and empowerment needed for victims at home and abroad

Closer to home in Asia, intimate behaviour is an uncommonly discussed topic, especially if patients associate it as a taboo that is linked with judgment that will reflect poorly on them, even if they may be victims of reproductive coercion.

According to Dr Chong Tuck Fah, obstetrician and gynaecologist from a hospital in Bukit Mertajam, “Our non-confrontational Asian ways makes it extremely challenging to impose such questions upon our patients, especially given that majority of these women come in for consultations with their partners and not alone.”

“The fear of losing the relationship as emotional dependence has been developed seem to be one of the biggest reasons for the select few who admit to such behaviour,” Chong added.

“Also many of these young girls do not know it is wrong.”

Notably so, awareness of intimate partner abuse needs to be created to empower victims and prevent more incidences from happening. If these unsuspecting individuals are unaware that they are being exploited, they would not know to seek help in the first place.

Additionally, the role of a health care practitioner in addressing such issues may be limited due to a void in knowledge and awareness, which such studies hope to address. MIMS

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