Male reproductive control of women who have experienced intimate partner violence in the United States

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Abstract

Women who have experienced intimate partner violence (IPV) are consistently found to have poor sexual and reproductive health when compared to non-abused women, but the mechanisms through which such associations occur are inadequately defined. Through face-to-face, semi-structured in-depth interviews, we gathered full reproductive histories of 71 women aged 18–49 with a history of IPV recruited from a family planning clinic, an abortion clinic and a domestic violence shelter in the United States. A phenomenon which emerged among 53 respondents (74%) was male reproductive control which encompasses pregnancy-promoting behaviors as well as control and abuse during pregnancy in an attempt to influence the pregnancy outcome. Pregnancy promotion involves male partner attempts to impregnate a woman including verbal threats about getting her pregnant, unprotected forced sex, and contraceptive sabotage. Once pregnant, male partners resort to behaviors that threaten a woman if she does not do what he desires with the pregnancy. Reproductive control was present in violent as well as non-violent relationships. By assessing for male reproductive control among women seeking reproductive health services, including antenatal care, health care providers may be able to provide education, care, and counseling to help women protect their reproductive health and physical safety.

Introduction

Intimate partner violence (IPV) is associated with unwanted pregnancy, women not using their preferred contraceptive method, sexually transmitted infections including HIV/AIDS, miscarriages, repeat abortion, a high number of sexual partners, and poor pregnancy outcomes (Alio et al., 2009, Center for Impact Research, 2000, Coker, 2007, Fisher et al., 2005, Maman et al., 2000, Taggart and Mattson, 1996, Williams et al., 2008). The proximal determinants of unwanted pregnancy—forced sex and partner’s unwillingness to use contraception—have been documented in relationships that include IPV (Campbell et al., 2000, Lathrop, 1998). Other behaviors that further undermine women’s ability to prevent an unwanted pregnancy in abusive relationships include women’s lack of negotiating power to insist on contraceptive use, abusive partners’ interference with women’s use of contraception, and partners’ refusal to pay for contraception (Branden, 1998, Heise et al., 1995). While these behaviors expose women to the risk of pregnancy, this body of work has not focused on whether men’s intentions were to make the woman pregnant.

Pregnancy itself is a vulnerable time for women in abusive relationships. Previous work has documented the increased risk of violence during pregnancy (Gelles, 1988), with unintended pregnancies carrying an even greater risk of violence than intended pregnancies (Gazamararian et al., 1995). This violence may be the result of the partner’s jealousy and resentment towards the unborn child (Campbell et al., 1993, Mezey, 1997), and/or the partner’s increased feelings of insecurity and possessiveness during the pregnancy (Bacchus, Mezey, & Bewley, 2006). Women report that financial worries and their reduced physical and emotional availability during pregnancy may lead their partners to physical violence (Bacchus et al., 2006). Another reason for violence that has not been systematically explored in the pregnancy and IPV literature is whether the partner may be using violence to make a woman resolve a pregnancy the way that he desires.

While many reproductive health correlates of IPV are known, and male control over various aspects of women’s reproductive autonomy have been identified within as well as outside of physically violent relationships, the extent of male involvement in explicitly promoting pregnancies and controlling the outcomes of such pregnancies has not been conceptualized as a type of abuse. We posit that it is ideal for women to have reproductive autonomy which we use to mean a woman’s ability to make independent decisions about her reproduction. We define interference with this autonomy reproductive control. Reproductive control can be exerted upon women from sources other than their partners including parents, peers, and the medical establishment. Reproductive control by a partner is the present focus of inquiry.

Reproductive control occurs when women’s partners demand or enforce their own reproductive intentions whether in direct conflict with or without interest in the woman’s intentions, through the use of intimidation, threats, and/or actual violence. It can take numerous forms: economic (not giving the woman money to buy contraception or obtain an abortion), emotional (accusing her of infidelity if she recommends contraception or denying paternity of the pregnancy), as well as physical (beating her up upon finding her contraception or threatening to kill her if she has an abortion). This masculine exercise of power crosses the three main domains of gendered relations as described by Connell (1987): labor, as coerced childbearing reifies women’s domestic responsibilities; power, through exerting authority over women’s sexual experiences and biologic vulnerability; and cathexis, through men’s appropriation of women’s sexual, emotional and intimate experiences and mandating child-rearing.

An analysis of violence against women conducted in ten countries by the World Health Organization (WHO) recently defined IPV as physical (having been slapped, pushed, hit, kicked, choked, burned, or threatened with a weapon; singling out violence during pregnancy as having been beaten, punched or kicked in the abdomen while pregnant), sexual (having experienced forced sex, coerced sex out of fear of her partner, or having been forced to do something sexually humiliating), emotional (having been insulted, belittled, scared, intimidated, or threatened), and controlling (isolating, monitoring, ignoring, demonstrating jealousy, acting suspicious, or demanding that the woman need permission to do basic day to day activities) (García-Moreno, Jansen, Ellsberg, Heise, & Watts, 2005). This same study defined poor reproductive health outcomes of IPV to include unsafe sexual behavior, pregnancy complications, unwanted pregnancy and unsafe abortion (Ellsberg et al., 2008). In a summary piece, Coker (2007) reviewed 51 articles published between 1966 and 2006 which examine the association between IPV and sexual health. Based on this body of work, she modeled the direct as well as indirect causal mechanisms through which IPV affects sexual health indicators documented to date in the literature. Identified mechanisms include decreased control over one’s sexuality as well as decreased contraceptive use which can lead to increased unplanned pregnancy and increased sexually transmitted infections.

The WHO study and Coker’s review treat reproductive correlates of IPV as indirect consequences of abuse rather than as measurable dimensions of abusive behavior. Specifically, their models do not account for pregnancy promotion, birth control sabotage, and coerced abortion. Pregnancy promotion has been defined as messages and behaviors that lead females to believe their partner was actively trying to impregnate them (Miller et al., 2007). The Center for Impact Research has defined birth control sabotage as verbal or behavioral sabotage of the woman’s use of birth control by her partner (2000). Other literature has shown that this sabotage can be direct (interfering with her contraceptive use) as well as indirect (causing the woman to fear violence if she does use contraception or even brings up the topic) (Blanc et al., 1996, Clark et al., 2008, Njovana and Watts, 1996, Watts and Mayhew, 2004, Wingood and DiClemente, 1997). Abusive men coercing their partners to have abortions has also been documented (Coggins and Bullock, 2003, Hathaway et al., 2005), as has males forcing their partners to become sterilized (Hathaway et al., 2005). As coercive control of women is a central motivation of abuse (Campbell & Humphreys, 1993), we argue that reproductive control is another component of power and control in abusive relationships.

This study adds to previous work on reproductive correlates of IPV by defining the different types of reproductive control perpetrated by men, examining the behaviors along a temporal continuum. Those three temporal periods are before sexual intercourse, during sexual intercourse, and post-conception. Pre-sexual intercourse, women may be subject to verbal pressure and threats from their partner that he intends to make them pregnant. In this same time frame, partners may prevent women’s access to and use of effective contraception. During sexual intercourse, which can be forced, men can manipulate contraception to render it ineffective which includes not withdrawing when that was the agreed-upon method of contraception or removing condoms. Post-conception, partners can attempt to influence the outcome of the pregnancy for it to end either in an abortion or a birth. More examples of each type of reproductive control as experienced by our sample are provided in Table 1.

Section snippets

Methods

The study, conducted in 2007, collected the reproductive experiences of women who have ever experienced IPV. We employed a purposive sampling strategy, recruiting 75 women with a history of IPV from three sites: a domestic violence shelter, a freestanding abortion clinic, and a family planning clinic providing a full range of reproductive health services including abortion. All sites were located in large metropolitan areas, one in the Midwest and two on the East Coast approximately 150 miles

Sample characteristics

Sample characteristics are presented in Table 2. Fifty-three respondents (74%) reported ever experiencing some type of reproductive control. The demographic characteristics of the respondents who reported experiencing at least one type of reproductive control did not differ from the rest of the sample. Most respondents were between 20 and 29 years of age, African-American, and had completed at least high school.

Pregnancy promoting behavior (prior to sexual intercourse)

Women who had experienced reproductive control often began their narrative

Discussion & implications

These narratives capture the range and intensity of partners’ attempts to control women’s reproductive lives. Just as other types of abuse are emotional as well as physical, reproductive control was also emotional (through pregnancy promotion, accusing a woman of infidelity if she suggests contraceptive use) as well as physical (through forced sex or physically interfering with a woman’s use of contraception). The behaviors presented here do not represent an escalating sequence of events (from

Acknowledgements

The authors would like to acknowledge the women we interviewed for this project who shared the most intimate and painful details of their lives in order to help others. We thank you. We also thank Rebecca Levenson and Lisa James for their expertise in the field of family violence and their contribution to the conceptualization, design, implementation and analysis of this project. We would also like to thank Nakeisha Blades, Gabrielle Oestreicher and Ragnar Anderson of the Guttmacher Institute

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