Men’s reproductive coercion of women: prevalence, experiences, and coping strategies—a mixed method study in urban health facilities in León, Nicaragua

(2021) 21:310 Brenner et al. BMC Women’s Health https://doi.org/10.1186/s12905-021-01441-y RESEARCH ARTICLE Open Access Men’s reproductive coercion of women: prevalence, experiences, and coping strategies—a mixed method study in urban health facilities in León, Nicaragua Cecilia Brenner1, William J. Ugarte2, Ida Carlsson3 and Mariano Salazar4* Abstract Background: Reproductive coercion (RC) is a common form of violence against women. It can take several expressions aiming at limiting women’s reproductive autonomy. Thus, the frequency and how reproductive coercion can be resisted must be investigated. There is limited research regarding RC in Latin America. Therefore, this study aimed to measure RC prevalence and associated factors and to explore the women experiences and coping strategies for RC. Methods: A convergent mixed-methods study with parallel sampling was conducted in Nicaragua. A quantitative phase was applied with 390 women 18–35 years old attending three main urban primary health care facilities. Lifetime and 12 months of exposure to RC behaviors including pregnancy promotion (PP) and contraceptive sabotage (CS) were assessed. Poisson regression with a robust variance estimator was used to obtain adjusted prevalence rate ratios and 95% Confidence Intervals (CIs). In addition, seven in-depth interviews were collected and analyzed using qualitative content analysis. Results: Ever RC prevalence was 17.4% (95% CI, 13.8–21.6) with similar proportions reporting ever experiencing PP (12.6%, 95% CI 9.4–16.3) or ever experiencing CS (11.8%, 95% CI 8.7–15.4). The prevalence of last twelve months RC was slightly lower (12.3%, 95% CI, 9.2–16.0) than above. Twelve months PP (7.4%, 95% CI 5.0–10.5) and CS (8.7%, 95% CI 6.1–12.0) were also similar. Women’s higher education was a protective factor against ever and 12 months of exposure to any RC behaviors by a current or former partner. Informants described a broad spectrum of coping strategies during and after exposure to RC. However, these rarely succeeded in preventing unintended pregnancies or regaining women’s long-term fertility autonomy. Conclusions: Our facility-based study showed that men’s RC is a continuous phenomenon that can be enacted through explicit or subtle behaviors. Women in our study used different strategies to cope with RC but rarely succeeded in preventing unintended pregnancies or regaining their long-term fertility autonomy. Population-based studies are needed assess this phenomenon in a larger sample. The Nicaraguan health system should screen for RC and develop policies to protect women’s reproductive autonomy. *Correspondence: 4 Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Tomtebodavägen 18a, Widerströmska Huset, 171 77 Stockholm, Sweden Full list of author information is available at the end of the article © 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. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Brenner et al. BMC Women’s Health (2021) 21:310 Page 2 of 12 Keywords: Reproductive coercion, Contraceptive sabotage, Pregnancy promotion, Coping strategies, Mixedmethods Background Reproductive Coercion (RC) is one of the many forms of violence against women (VAW) and constitutes a set of behaviors aiming at limiting a woman’s reproductive autonomy [1]. These controlling behaviors can range from forcing a woman to become pregnant (either verbally, physically, or by sabotaging her contraceptives) to limit her access to elective abortion services where those services are legal. In addition, it can include forcing a woman to terminate a pregnancy that she wants to continue [1]. Reproductive coercion of women is quite common [1–3] and can be exerted by current or previous partners and/or other family members. The prevalence varies between settings [2–4], ranging from 20% to 19% among women attending health facilities in Jordan [5] and in the USA [2], 18.5% in rural Cote d’Ivoire [6] to 12% among currently married women in Uttar Pradesh, India [7]. Reproductive coercion can take several expressions such as disapproval of the woman’s contraceptive usage, interfering with the woman’s usage of contraceptives and male partner refusing to use contraceptives during sexual intercourse [2, 5, 6, 8, 9]. Like other expressions of violence, RC does not occur in a vacuum as it is influenced by social and individual factors in a given setting. Demographic factors such as women’s age, women’s low socioeconomic status, and parity have been reported as RC risk factors [10]. However, other studies have found that age was the only factor increasing RC exposure [11]. Women’s education has also been reported as a risk or protective factors across settings [12]. Women’s exposure to emotional, physical, and sexual intimate partner violence (IPV), has also been consistently shown to be a key risk factor for RC exposure [1–3, 13–15]. Although RC is an expression of IPV in itself, several studies show a higher risk of exposure to RC among women who experience other forms of IPV. Nevertheless, since RC also has been found to exist in relations with no other expressions of IPV [3], we believe that it needs to be studied as a separate phenomenon. Endorsement of unequal societal gender norms such as male dominance and control over women has also been associated with a higher risk of RC [2, 3, 14, 16, 17]. Men’s reproductive coercion of women has been associated with several negative health outcomes such as unintended pregnancies, sexually transmitted infections (STI), miscarriages and pregnancy complications [10, 15, 18]. Reproductive coercion can also have a lasting socioeconomic impact on women’s lives, since a lack of access to contraception and not being able to freely decide over ones’ reproduction can curtail women’s access to education and the benefits that it brings [10, 11, 19]. Exposure to men’s RC might be one of the factors contributing to the high unintended pregnancy rates in La (...truncated)