Women’s perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis

PLOS ONE RESEARCH ARTICLE Women’s perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis Jessica E. Moulton ID*, Martha Isela Vazquez Corona ID, Cathy Vaughan, Meghan A. Bohren Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 * Abstract Background OPEN ACCESS Citation: Moulton JE, Corona MIV, Vaughan C, Bohren MA (2021) Women’s perceptions and experiences of reproductive coercion and abuse: a qualitative evidence synthesis. PLoS ONE 16(12): e0261551. https://doi.org/10.1371/journal. pone.0261551 Editor: Alison Gemmill, Johns Hopkins University Bloomberg School of Public Health, UNITED STATES Received: August 4, 2021 Accepted: December 3, 2021 Published: December 21, 2021 Peer Review History: PLOS recognizes the benefits of transparency in the peer review process; therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. The editorial history of this article is available here: https://doi.org/10.1371/journal.pone.0261551 Copyright: © 2021 Moulton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its S1 File, S1 Checklist, S1– S5 Tables files. Reproductive coercion and abuse is a major public health issue, with significant effects on the health and well-being of women. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person’s reproductive choices. The aim of this qualitative evidence synthesis is to explore women’s experiences of reproductive coercion and abuse globally, to broaden understanding of the different ways reproductive coercion and abuse is perpetrated, perceived and experienced across settings and socio-cultural contexts. Method We searched Medline, CINAHL and Embase for eligible studies from inception to 25th February 2021. Primary studies with a qualitative study design that focused on the experiences and perceptions of women who have encountered reproductive coercion and abuse were eligible for inclusion. Titles and abstracts, and full texts were screened by independent reviewers. We extracted data from included studies using a form designed for this synthesis and assessed methodological limitations using CASP. We used Thomas and Harden’s thematic analysis approach to analyse and synthesise the evidence, and the GRADE-CERQual approach to assess confidence in review findings. Results We included 33 studies from twelve countries in South Asia, the Asia Pacific, North America, South America, Africa and Europe. Most studies used in-depth interviews and focus group discussions to discuss women’s experiences of reproductive coercion and abuse. Reproductive coercion and abuse manifested in a range of behaviours including control of pregnancy outcome, pregnancy pressure or contraceptive sabotage. There were a range of reasons cited for reproductive coercion and abuse, including control of women, rigid gender roles, social inequalities and family pressure. Women’s different responses to reproductive PLOS ONE | https://doi.org/10.1371/journal.pone.0261551 December 21, 2021 1 / 21 PLOS ONE Funding: The author(s) received no specific funding for this work, which was completed as part of JEM’s MPH at University of Melbourne School of Population and Global Health. MAB’s time is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200100264) and a Dame Kate Campbell Fellowship (University of Melbourne Faculty of Medicine, Dentistry, and Health Sciences). Competing interests: The authors declare that they have no competing interests. Women’s perceptions and experiences of reproductive coercion and abuse coercion and abuse included using covert contraception and feelings of distress, anger and trauma. Across contexts, perpetration and experiences of reproductive coercion and abuse were influenced by different factors including son preferences and social exclusion. Conclusions We reflect on the importance of socio-cultural factors in understanding the phenomenon of reproductive coercion and abuse and how it affects women, as well as how the mechanisms of power and control at both individual and societal levels work to perpetuate the incidence of reproductive coercion and abuse against women. Abbreviations: IPV, Intimate Partner Violence; USA, United States of America. 1 | Background Reproductive coercion and abuse is a major public health issue, with significant effects on the mental, sexual, reproductive and maternal health of women who have experienced it. Reproductive coercion and abuse includes any form of behaviour that intentionally controls another person’s reproductive choices [1]. These behaviours include forcing a person to continue or terminate a pregnancy, or sabotaging contraception, for example, by removing or damaging a condom, or throwing away oral contraceptives [2]. Reproductive coercion and abuse is often a manifestation of a partner’s demand to enforce their own reproductive intentions [3], using physical, psychological, sexual, financial and other strategies with the purpose of maintaining power and control within the relationship [4]. These threats and acts of violence often overrule a woman’s ability to exercise their reproductive rights and autonomy [5]. Reproductive coercion and abuse is a relatively recent term used to denote a pattern of behaviours described in the gender-based violence literature. The term ‘reproductive coercion and abuse’ was first mentioned in academic literature in 2010 [6]. However, well before this, pregnancy-controlling behaviours by male partners have been described in the gender-based violence literature without being labelled as reproductive coercion and abuse [7]. Prevalence rates of reproductive coercion and abuse have ranged from 8.6% of all women in The National Intimate Partner and Sexual Violence Survey in the United States of America (USA) to as high as 37.8% among young, self-identified Black or African American women in Baltimore, Maryland [8]. However, a lack of consistent measurement and conceptual clarity around reproductive coercion and abuse mean that true prevalence rates are inconclusive [9]. A systematic review by Grace and Anderson [7] found that in the USA, reproductive coercion and abuse disproportionately affects women experiencing other forms of intimate partner violence, women of low socioeconomic status and women who are Latina, African American, or multiracial. Similarly, in an Australian study of prevalence among women using a pregnancy counselling service, Indigen (...truncated)