Re-defining reproductive coercion using a socio-ecological lens: a scoping review

BMC Public Health Graham et al. BMC Public Health (2023) 23:1371 https://doi.org/10.1186/s12889-023-16281-8 Open Access RESEARCH Re-defining reproductive coercion using a socio-ecological lens: a scoping review Melissa Graham1*, Greer Lamaro Haintz2, Megan Bugden1, Caroline de Moel-Mandel1, Arielle Donnelly1 and Hayley McKenzie3 Abstract Background Reproductive coercion is a significant public health issue in Australia which has mainly been conceptualised as a form of violence at the interpersonal level. This limited scope ignores the role of the gendered drivers of violence and fails to encompass a socio-ecological lens which is necessary to consider the multiple interacting layers that create the context in which reproductive coercion occurs. The aim of the scoping review was to explore how the reproductive coercion is defined by international research. Specifically, how is reproductive coercion defined at the social-cultural-systems-structural levels, and are the definitions of reproductive coercion inclusive of the conditions and contexts in which reproductive coercion occurs? Methods A scoping review was undertaken to explore existing definitions of reproductive coercion. Searches were conducted on Embase, Cochrane Library, Informit Health Collection, and the EBSCOHost platform. Google was also searched for relevant grey literature. Articles were included if they were: theoretical research, reviews, empirical primary research, grey literature or books; published between January 2018 and May 2022; written in English; and focused on females aged 18–50 years. Data from eligible articles were deductively extracted and inductively thematically analysed to identify themes describing how reproductive coercion is defined. Results A total of 24 articles were included in the scoping review. Most research defined reproductive coercion at the interpersonal level with only eight articles partially considering and four articles fully considering the sociocultural-systems-structural level. Thematic analysis identified four main themes in reproductive coercion definitions: Individual external exertion of control over a woman’s reproductive autonomy; Systems and structures; Social and cultural determinants; and Freedom from external forces to achieve reproductive autonomy. Conclusions We argue for and propose a more inclusive definition of reproductive coercion that considers the gendered nature of reproductive coercion, and is linked to power, oppression and inequality, which is and can be perpetrated and/or facilitated at the interpersonal, community, organisational, institutional, systems, and societal levels as well as by the state. Keywords Reproductive coercion, Scoping review, Reproductive autonomy, Definitions *Correspondence: Melissa Graham 1 Department of Public Health, School of Psychology and Public Health, La Trobe University, 3086 Bundoora, VIC, Australia 2 School of Health and Social Development, Deakin University, Locked Bag 20, Geelong 000, 3220, Australia 3 School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood 3125, VIC, Australia © The Author(s) 2023. 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://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Graham et al. BMC Public Health (2023) 23:1371 Introduction Reproductive coercion is a significant public health issue globally, driven by gender inequality and imbalances in power, with negative consequences for a wide range of sexual, reproductive, and mental health issues [1–2]. It is important to acknowledge the historical context of women’s reproduction whereby extended family members, health professionals, and the state have all limited women’s reproductive rights and autonomy [3]. In several countries, including Australia, colonisation has also had a role in compounding forms of reproductive coercion occurring at a structural level, facilitated by the state [4, 5]. For example in Australia, Aboriginal and Torres Strait Islander women and girls were subjected to assimilationist legislation and policies by the State which resulted in the Stolen Generation, wherein infants and children were forcibly removed from their families and their communities [3, 4, 6]. Forced marriage and forced sterilisation were also common practices [3]. Reproductive coercion has been experienced by multiple diverse groups including, but not limited to, single/unwed mothers, women and girls with disabilities [7], intersex people, and women from newly arrived, refugee and migrant backgrounds [3, 6]. Further, both historically and currently, women in rural and remote areas or women with low socioeconomic status are disproportionately impacted by state policies which create limited access to affordable contraception and abortion, constraining women’s autonomy to enact their fertility desires [3]. This failure to focus on how structural factors within society institute reproductive coercion renders diverse groups of Australian women’s experiences invisible. Given the historically hidden nature of reproductive coercion, limited Australian research exists to demonstrate its full extent. The data that does exist relates to women’s experiences of gender-based violence, which commonly includes reproductive coercion. Research exploring the prevalence of violence against women in Australia demonstrates that one in five women over the age of 15 will experience violence in their lifetime [8]. Further, a recent study found 15% of women attending two family planning clinics had experienced reproductive control and abuse, which included pregnancy prevention and abortion [9]. Public health practice widely accepts that gender inequality is the underlying cause of all forms of violence against women [10–14]. Research exploring the determinants of violence against women in Australia is ongoing, but at present suggests gender norms and structural gender inequality interact in complex ways, across social ecology, to influence the prevalence of violence against women (...truncated)