The old stereotype of the gold-digging hussy who gets pregnant to trap a man into marriage seems to have faded, probably because women are not as economically dependent on men as they once were. But that's not to say that pregnancy is no longer being wielded as a weapon: researchers who work in family planning and with victims of domestic violence say it is women who are now being threatened with pregnancy by their partners.
Reproductive coercion, as it's known, takes several forms. Partners may verbally or physically threaten women if they use birth control or seek abortions, or they may throw away or damage birth control and remove condoms during sex. It usually takes place within an already abusive relationship, especially those that are emotionally abusive.
"It's another way a male partner tries to control a female partner," says Elizabeth Miller, associate professor of pediatrics at the U.C. Davis School of Medicine, who has led much of what little research there is on the issue. "Women say their partner tells them he wants to leave a legacy or have them in his life forever."
In a study Miller published in January, involving about 1,300 female patients ages 16 to 29 at family-planning clinics in Northern California, about a third of those who reported being in violent relationships said they had experienced reproductive coercion. But while the problem seems to be most acute among the young, it isn't exclusively so. In a study Miller co-authored in April, as many as 75% of women between the ages of 18 and 49 who had a history of being in an abusive relationship also reported some form of reproductive coercion.
Now, in her latest research, co-authored with Jay Silverman of the Harvard School of Public Health and others, Miller concludes that there may be a simple and cost-effective way to help women who are in danger of being intimidated into pregnancy. Simply asking women who visit family-planning clinics if their partner has ever tried to force them to get pregnant, and providing them with information on how to deal with it, can help spur women to get out of abusive relationships or take measures to protect themselves.
The pilot study, published online by Contraception, included about 900 patients, most of whom were ages 24 or younger, who visited four Northern California family-planning clinics between May 2008 and October 2009. Counselors and clinicians at two of the clinics were trained to ask women about reproductive coercion. (Questions included, Has your partner tried to force you to become pregnant when you didn't want to be? Does your partner mess with your birth control? and Does your partner refuse to use condoms when you ask?) Women who responded "yes" to any question were offered advice on tamper-proof methods of pregnancy protection, including IUDs and Depo-Provera shots, and given emergency contraception. At the two other clinics, women were simply offered standard domestic-violence and sexual-assault screening.
At the sites where advice on contraception was offered, the odds of subsequent pregnancy coercion dropped by 70%; there was no change at the other two clinics. Moreover, it seemed that the probing about coercive reproduction served as a wake-up call to some women. "In the intervention clinics, women were 60% more likely to have left a relationship because it felt unsafe," says Miller.
While the study was just a pilot, Miller is hoping to conduct a follow-up to find out exactly what triggered the profound changes in behavior among the women. It's not clear how common reproductive coercion is, but estimated figures and anecdotal evidence suggest it may be quite widespread, especially among women in abusive relationships. That would help to explain the higher rates of unwanted pregnancy in relationships involving violence.
The clinics in Miller's latest study gave patients cards with information about what a healthy relationship looks like. "We told the women to pass them along to their friends," she says. "One woman asked, 'Can I have 10 of them?' "