A conceptual re-evaluation of reproductive coercion: centring intent, fear and control

(2021) 18:87 Tarzia and Hegarty Reprod Health https://doi.org/10.1186/s12978-021-01143-6 Open Access COMMENTARY A conceptual re‑evaluation of reproductive coercion: centring intent, fear and control Laura Tarzia1,2* and Kelsey Hegarty1,2 Abstract Background: Reproductive coercion and abuse (RCA) is a hidden form of violence against women. It includes behaviours intended to control or dictate a woman’s reproductive autonomy, for the purpose of either preventing or promoting pregnancy. Main text: In this commentary, we argue that there is a lack of conceptual clarity around RCA that is a barrier to developing a robust evidence base. Furthermore, we suggest that there is a poor understanding of the way that RCA intersects with other types of violence (intimate partner violence; sexual violence) and—as a result—inconsistent definition and measurement in research and healthcare practice. To address this, we propose a new way of understanding RCA that centres perpetrator intent and the presence of fear and/or control. Recommendations for future research are also discussed. Conclusion: We suggest that IPV and SV are the mechanisms through which RCA is perpetrated. In other words, RCA cannot exist without some other form of co-occurring violence in a relationship. This has important implications for research, policy and healthcare practice including for screening and identification of women in reproductive healthcare settings. Keywords: Reproductive coercion, Intimate partner violence, Sexual violence, Reproductive autonomy, Women, Family violence Background Reproductive coercion and abuse (RCA), first defined as simply “reproductive coercion” by Elizabeth Miller and colleagues in 2010, refers to any deliberate attempt to influence or control a person’s reproductive choices [1] or interfere with their reproductive autonomy. It is typically perpetrated against women by a male intimate partner [2], although other family members can also be participants or instigators [3]. RCA is commonly understood to take three main forms: pregnancy coercion (where a woman is pressured or forced to become pregnant against her will); contraceptive sabotage (deliberately *Correspondence: 1 Department of General Practice, The University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, VIC 3010, Australia Full list of author information is available at the end of the article damaging, hiding, or otherwise interfering with birth control); and controlling the outcome of a pregnancy (forcing a woman to terminate or continue a pregnancy against her will) [2]. Extant literature suggests associations between RCA and intimate partner violence (IPV) [3–6], unwanted pregnancies [2, 7], poor mental health [8], decreased contraceptive self-efficacy [9, 10], and increased risk of sexually transmitted infections [11]. These negative health outcomes have led to a recent rise in media interest in the issue. We argue in this commentary, however, that we have seen a lack of definitional and conceptual clarity around RCA, leading to inconsistency across prevalence data, a poor understanding of the risk factors, and difficulties in demonstrating the effectiveness of interventions in health settings. RCA research remains in its infancy; it is therefore an opportune time to pause © The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. 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Our perspective in writing this commentary is as health and violence researchers working in a university setting in a high-income country. One of us (KH) has a clinical background as a general practitioner and LT is an applied sociologist. Our arguments and their implications for research and practice are thus shaped by the assumptions that: (1) violence against women is a major public health issue; (2) health systems are well-placed to identify and respond to violence against women and (3) a solid theoretical and empirical evidence base is critical for informing the development and implementation of interventions in health settings. We recognise and welcome discussion of conceptual issues relating to RCA within other disciplines such as philosophy and gender studies; however, our purpose is to define and discuss RCA insofar as it affects healthcare practice and outcomes for women. What do we know about RCA? It is not our intention here to review the growing body of literature on RCA. This has been covered by several comprehensive systematic reviews [2, 7, 12, 13] which address the prevalence and types of reproductive coercion and its associations with IPV, unintended pregnancy, contraceptive non-adherence, and poor sexual and reproductive health. In brief, the evidence suggests that: • RCA is common and comprises a spectrum of behaviours such as pressure, manipulation, emotional blackmail, trickery, threats, and the use of physical violence [2, 7]; • The lifetime prevalence of RCA ranges between 8 and 30% depending on the sample and setting [7]. More recent studies also sit within this range (e.g. Swan and colleagues [14]; Grace and colleagues [15]); • RCA is associated consistently with IPV, unintended pregnancy, and contraceptive non-adherence [7]. More recent work using multi-dimensional tools to measure IPV suggests that RCA is associated with more severe forms of violence [15]; • Risk factors reported for RCA include being of nonWhite background [15], being young [7], and being single/non-partnered or experiencing relationship issues [7, 15]. Issues with the existing evidence base We outline below a number of key issues which—in our view—hamper the field of RCA research and call into question some of the findings reported in the extant literature. Some of these are based on our own qualitative Page 2 of 10 work in the field [16–21], whilst others are our reflections on the lack of empirical ev (...truncated)