Global Perspectives on Reproductive Coercion and Abuse

Published in Social Sciences

 Reproductive coercion and abuse (RCA) describes behaviours intended to control or dictate a person’s reproductive choices. It has two main forms: pregnancy promoting behaviour (forced pregnancy; contraceptive sabotage; threats or coercion to prevent abortion), and pregnancy preventing behaviour (forced contraception; forced abortion). It is typically perpetrated by an intimate partner or close family member and, unsurprisingly, has strong links with intimate partner or family violence (Grace et al. 2016) and sexual violence. Studies suggest that it may be associated with a range of poor mental, sexual and reproductive health outcomes. Despite this, RCA is an under-researched form of violence against women (and other people who can become pregnant), only formally recognised within the literature as recently as 2010 (Miller et al. 2010). Robust studies of prevalence and qualitative examinations of its context and dynamics are lacking, particularly outside of the United States family planning context. Furthermore, the existing evidence base has been troubled by conceptual murkiness which has led to problems with measurement, clouding our understanding of risk and protective factors and associations with other forms of violence.

The aim of this special collection is to increase conceptual understanding of RCA, particularly in the Global South and in low-and-middle income contexts. The six articles we have included each make a valuable contribution towards this goal, whilst also highlighting how much work there is still ahead of us to understand this complex phenomenon.

 Wollum and colleagues, in the first paper in the collection, examined the freedom from coercion and communication dimensions of the Reproductive Autonomy Scale, and their relationship with contraceptive use in Malawi. Previous literature from other low-and middle-income countries is suggestive of the links between reproductive coercion and poor contraceptive use, and this paper adds to the evidence base in the context of rural Malawi. Given the high rates of IPV reported in this setting, the importance of addressing RCA as part of sexual and reproductive healthcare provision is emphasised. The findings also support the utility of these substances of the Reproductive Autonomy Scale with this population.

 In their participatory action research study on RCA in the Canadian context, Levesque et al. highlight the need for service providers to be able to identify signs of RCA, enact strategies for caring and listening, and provide an environment that is safe for disclosure. They also identified numerous barriers to an effective response, including lack or time, inadequate training about RCA specifically, and pressure not to go outside their designated scope of practice. Their study – which drew on focus groups with 31 service providers – highlights the need for best practice guidelines and education. In consultation with experts and the community, an intervention guide for service providers and a reflective booklet for women and individuals consulting for healthcare services were developed, focused specifically on RCA. These resources are available as part of the article.

 Boyce and colleagues explore social norms around wife agency, sexuality and reproductive autonomy and their relationship with intimate partner violence among husband-wife dyads in rural Niger. Their research assesses a new social norms measurement tool (the IPV-ASRA Scale), finding that it had strong reliability and validity in this population. The paper highlights some of the challenges around measurement of social norms and reproductive autonomy/RCA, suggesting directions for future research in this area and the need to strengthen measurement.

 The fourth paper in the collection by Campbell and colleagues investigates associations between forced sex and reproductive coercion in the USA and is one of the first papers to attempt to disentangle forced sex, other forms of intimate partner violence, and RCA. This paper also bravely introduced the concept of reproductive coercion perpetration and presents unique findings on the co-occurrence of RCA victimisation and perpetration. While the methodology only allowed for examination of associations of these constructs via secondary analysis of data collected for another purpose, the findings raise interesting questions about victimisation and perpetration that will spurn future research.

 Wood and Colleagues’ paper ambitiously explored prevalence and correlates of RCA across ten sites, including eight low- and middle-income countries in sub-Saharan Africa and South Asia. There comparison of pregnancy coercion across countries highlights the variability in the prevalence across regions, cautioning against generalising experiences from one country to another and emphasizing the importance of context specific factors that contribute to RCA. While further research is needed to understand pregnancy preventing forms of RCA, such as forced abortion and forced use of family planning, this study provides important information about risk profiles that may be helpful to local service providers, and those designing prevention and response interventions.   

 Concluding the collection is the paper by Grace and Miller who discuss the future of reproductive coercion and abuse research, highlighting the need for more research on marginalised populations including those with a disability, sexual and gender minorities and those with multiple levels of marginalisation. This paper also suggests community-centred approaches to intervention and prevention are needed and that our understanding of RCA in the context of other forms of abuse (such as economic) is lacking. Importantly, Grace and Miller propose a move away from check-list screening, which can conflate RCA rates by not elucidating perceived intent of the perpetrator, instead proposing a trauma-sensitive model of care that provides strategies and resources to all.  

 This collection brings together perspectives from across the globe, helping to highlight the various facets of RCA as they are experienced in low- and middle-income countries. However, as highlighted by each of the papers, more research on RCA is needed. Further, there is an urgent need to strengthen measurement and develop practice guidelines for use across sectors and countries.

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Domestic and Sexual Violence
Humanities and Social Sciences > Society > Social Work > Social Work Consulting > Domestic and Sexual Violence

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