Research

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GENERAL GYNECOLOGY

Reproductive coercion and co-occurring intimate partner

violence in obstetrics and gynecology patients
Lindsay E. Clark, MD; Rebecca H. Allen, MD, MPH; Vinita Goyal, MD, MPH; Christina Raker, ScD; Amy S. Gottlieb, MD
OBJECTIVE: Reproductive coercion is male behavior to control con-

traception and pregnancy outcomes of female partners. We examined

the prevalence of reproductive coercion and co-occurring intimate
partner violence among women presenting for routine care at a large,
urban obstetrics and gynecology clinic.
STUDY DESIGN: Women aged 18-44 years completed a self-

administered, anonymous survey. Reproductive coercion was defined

as a positive response to at least 1 of 14 questions derived from previously published studies. Women who experienced reproductive coercion
were also assessed for intimate partner violence in the relationship where
reproductive coercion occurred.
RESULTS: Of 641 women who completed the survey, 16% reported

reproductive coercion currently or in the past. Among women who

experienced reproductive coercion, 32% reported that intimate partner

violence occurred in the same relationship. Single women were more
likely to experience reproductive coercion as well as co-occurring
intimate partner violence.
CONCLUSION: Reproductive coercion with co-occurring intimate
partner violence is prevalent among women seeking general obstetrics
and gynecology care. Health care providers should routinely assess
reproductive-age women for reproductive coercion and intimate
partner violence and tailor their family planning discussions and recommendations accordingly.

Key words: birth control sabotage, family planning counseling, intimate partner violence, reproductive coercion, screening for intimate
partner violence

Cite this article as: Clark LE, Allen RH, Goyal V, et al. Reproductive coercion and co-occurring intimate partner violence in obstetrics and gynecology patients.
Am J Obstet Gynecol 2014;210:42.e1-8.

eproductive coercion is male behavior to control contraception and

pregnancy outcomes of female partners.
Reproductive coercion includes: (1) pregnancy coercion, such as threatening to
harm a woman physically or psychologically (eg, with indelity or abandonment)
if she does not become pregnant; and (2)
birth control sabotage, such as ushing
oral contraceptive pills down the toilet,

From the Division of Research (Dr Raker),

Department of Obstetrics and Gynecology (all
authors), Warren Alpert Medical School, Brown
University, and Women and Infants Hospital,
Providence, RI.
Received June 9, 2013; revised Aug. 23, 2013;
accepted Sept. 13, 2013.
The authors report no conict of interest.
Presented at the 61st Annual Clinical Meeting
of the American Congress of Obstetricians
and Gynecologists, New Orleans, LA, May
4-8, 2013.
Reprints: Lindsay E. Clark, MD, Bridgeport
Hospital, Yale New Haven Health, 267 Grant St.,
Bridgeport, CT 06110. lilly1401@gmail.com.
0002-9378/$36.00
2014 Mosby, Inc. All rights reserved.
http://dx.doi.org/10.1016/j.ajog.2013.09.019

intentionally breaking or removing condoms, or inhibiting a womans ability to

obtain contraception.1 Based on the National Center for Injury Prevention and
Centers for Disease Control and Prevention survey of 9000 women, at least 9% of
adult females in the United States have
experienced reproductive coercion.2 In the
landmark study of Miller et al3 of 1300
young women seeking care in family
planning clinics, 19% of all respondents
reported pregnancy coercion and 15%
of all respondents reported birth control
sabotage.
Reproductive coercion may lead to
unprotected intercourse and thus could
have signicant implications for health
care providers efforts to promote reproductive health and family planning.4 In
the context of reproductive coercion,
women may not be able to negotiate
contraception, including condom use,
and may face unwanted impregnation.5,6
Indeed, in the Miller et al3 study, women
who experienced reproductive coercion
were at signicantly increased risk of
unintended pregnancy.
In addition to impacting a womans
ability to control her own fertility,

42.e1 American Journal of Obstetrics & Gynecology JANUARY 2014

reproductive coercion has been associated with intimate partner violence.3,7

Intimate partner violence may include
physical injury, psychological abuse, sexual assault, progressive isolation, stalking,
deprivation, intimidation, and threats
inicted by someone who is or was in an
intimate relationship with the victim.1 In
the United States, 1 in 3 women experience intimate partner violence.2 In the
Miller et al3 study, approximately 75% of
women reporting reproductive coercion
also reported a lifetime history of intimate partner violence. Additionally, in
the survey by Gee et al7 of 1500 patients
seeking care at Planned Parenthood
clinics in Philadelphia, PA, women who
revealed a lifetime history of intimate
partner violence were also more likely to
report reproductive coercion by their
partners. However, whether these experiences of reproductive coercion and intimate partner violence co-occurred within
the same relationship was not assessed in
either study.
Prior research on reproductive coercion has been performed mostly in
specialized clinical settings like family
planning clinics or among potentially

General Gynecology

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TABLE 1

Demographic and reproductive characteristics of study population

Demographic

Value

Age, y (n 600)
Mean, SD (range)

26.1, 6.3 (18.0e44.0)

Race/ethnicity (n 622)
Latina

260 (41.8)

Black

102 (16.4)

White

168 (27.0)

Other

54 (8.7)

>1 race

38 (6.1)

Single/dating

174 (27.9)

Committed/not married

322 (51.6)

Married

112 (17.9)

Other/do not know

16 (2.6)

Gravidity (n 463)
Median (range)

2.0 (1.0e11.0)

No. of children (n 378)

Median (range)

2.0 (1.0e9.0)

Ever pregnant (n 625)

Yes
No/do not know

587 (93.9)
38 (6.1)

Any children (n 624)

Yes

418 (67.0)

No/do not know

206 (33.0)

Currently pregnant (n 609)

Yes

354 (58.1)

No/do not know

255 (41.9)

Education (n 612)
<High school

66 (10.8)

High school graduate or equivalent

266 (43.5)

Associates degree/some college

213 (34.8)

College graduate

67 (10.9)

Insurance (n 607)
Private
Medicaid

91 (15.0)
448 (73.8)

Hospital free care

32 (5.3)

Other/do not know/none

36 (5.9)

Born in United States (n 622)

Yes

487 (78.3)

No

135 (21.7)

Data are n (%) unless stated otherwise.

Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

high-risk groups such as women residing

in domestic violence shelters.3,5-7 The
current study aimed to estimate the
prevalence of reproductive coercion in
a large obstetrics and gynecology clinic
located within a urban, university-based
medical center. Additionally, we assessed
the prevalence of intimate partner violence specically in relationships where
reproductive coercion occurred to further our understanding of the relationship between these 2 phenomena.

M ATERIALS

Relationship status (n 624)

Research

AND

M ETHODS

From January through May 2012 we

administered a cross-sectional, anonymous survey approved by the institutional
review board of Women and Infants
Hospital of Rhode Island. We offered a
28-item, self-administered questionnaire
to English-speaking women presenting
for routine obstetrics and gynecology care
at a large obstetrics and gynecology clinic.
Women were excluded from the study
if they were age <18 or >44 years, were
non-English speaking, or presented for
a surgical or subspecialty appointment.
Women who self-identied as being unable to read English were also excluded
from the study. A medical assistant escorted eligible women into an examination room alone, per usual clinic policy,
and then gave them the paper-based
questionnaire with written instructions
for completion. A cover sheet attached to
each survey clearly explained the voluntary nature of the study and emphasized
that the decision to participate would
not affect health care. Additionally, the
cover sheet stated that the clinic providers
would not be aware of who participated in
the study. Each participant was given a
resource card with contact information
for local organizations serving abused
women and for the study team. Each
woman was asked to place her questionnaire in a sealed envelope in the examination room prior to her providers
arrival regardless of whether or not she
had chosen to complete the survey. After
the visit, the medical assistant placed the
sealed envelope in a locked collection box.
Per institutional review board approval,
informed consent was implied when patients voluntarily completed the survey.

JANUARY 2014 American Journal of Obstetrics & Gynecology

42.e2

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To our knowledge, no validated questionnaires currently exist to assess reproductive coercion. Therefore, prior to
beginning the main study, we conducted
a pretest in which 14 women meeting the
inclusion criteria described above were
asked to complete a survey with questions assessing for reproductive coercion
derived from the previously published
study by Miller et al.3 Two study investigators (L.E.C. and V.G.) then queried
these women in private about clarity and
readability of all survey questions and
solicited suggestions to improve understanding of the instrument.8
We incorporated feedback from the
pretest to create the nal 28-question
survey. The nal survey included 10
demographic questions on age, relationship status, race and ethnicity, type
of insurance, education level, pregnancy
status, parity, and immigration status; 14
questions assessing reproductive coercion; 3 questions addressing intimate
partner violence in relationships where
reproductive coercion occurred, and 1
question asking respondents who had
experienced reproductive coercion how
their health care providers could have
helped them navigate their situations.3,9
We further divided the questions assessing for reproductive coercion into
questions addressing pregnancy coercion and birth control sabotage. The
pregnancy coercion section employed
the following 7 questions (questions 1-6
were derived from Miller et al3). Study
participants were asked, Has a husband,
boyfriend, sexual partner, or someone
you were dating ever: 1) told you not to
use any birth control (like the pill, shot,
ring, patch etc.); 2) said he would leave
you if you did not get pregnant; 3) told
you he would have a baby with someone
else if you didnt get pregnant; 4) hurt
you physically because you did not agree
to get pregnant; 5) tried to physically
force you to become pregnant; 6) tried to
pressure you with words, promises, or
mean comments to become pregnant?
and 7) Have you ever hidden birth
control from a husband, boyfriend, sexual partner, or someone you were dating
because you were afraid he would get
upset with you for using it? For each
of these questions participants could

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TABLE 2

Demographic and reproductive characteristics of study population by

RC status
Demographic

RCD

RCe

Total, n (%)

103 (16.1)

538 (83.9)

Mean (SD)

26.9 (6.7)

26.0 (6.2)

Range

18.0e43.0

18.0e44.0

P value

Age, y
.2

Race/ethnicity, n (%)
Latina

37 (37.4)

223 (42.6)

Black

21 (21.2)

81 (15.5)

White

19 (19.2)

149 (28.5)

Other

11 (11.1)

43 (8.2)

>1 race

11 (11.1)

27 (5.2)

Single/dating

39 (39.0)

135 (25.8)

Committed/not married

36 (36.0)

286 (54.6)

Married

18 (18.0)

94 (17.9)

7 (7.0)

9 (1.7)

Median

2.5

2.0

Range

1.0e9.0

1.0e11.0

Median

2.0

2.0

Range

1.0e6.0

1.0e9.0

95 (96.0)

492 (93.5)

4 (4.0)

34 (6.5)

Yes

69 (69.0)

349 (66.6)

No/do not know

31 (31.0)

175 (33.4)

.03

Relationship status, n (%)

Other/no not know

.0003

Gravidity
.1

No. of children
.3

Ever pregnant, n (%)

Yes
No/do not know

.5

Any children, n (%)

.7

Currently pregnant, n (%)

Yes

46 (46.5)

308 (60.4)

No/do not know

53 (53.5)

202 (39.6)

<High school

14 (14.3)

52 (10.1)

High school graduate/equivalent

34 (34.7)

232 (45.1)

Associates degree/some college

38 (38.8)

175 (34.0)

College graduate

12 (12.2)

55 (10.7)

Private

15 (15.6)

76 (14.9)

Medicaid

63 (65.6)

385 (75.3)

.01

Education, n (%)
.2

Insurance, n (%)

Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

42.e3 American Journal of Obstetrics & Gynecology JANUARY 2014

.05
(continued)

General Gynecology

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TABLE 2

Demographic and reproductive characteristics of study population by

RC status (continued)
Demographic

RCD

P value

RCe

10 (10.4)

22 (4.3)

8 (8.3)

28 (5.5)

Yes

76 (76.8)

411 (78.6)

No

23 (23.2)

112 (21.4)

Hospital free care

Other/do not know/none
Born in United States, n (%)

.7

Data are column % unless stated otherwise.

RC, reproductive coercion.
Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

check yes, no, do not know, or

decline to answer. Pregnancy coercion
was dened as a positive answer to any of
the above items.
We assessed birth control sabotage
was with 7 additional questions

(questions 1-6 were derived from Miller

et al3). Study participants were asked,
Has a husband, boyfriend, sexual partner, or someone you were dating ever: 1)
taken off a condom while you were
having sex so that you would get

TABLE 3

Demographic and reproductive characteristics associated with RC

Unadjusted
b

Adjusteda

Variable

OR (95% CI)

ORb (95% CI)

Currently pregnant

0.55 (0.35e0.86)

0.60 (0.37e0.97)

Latina

1.00

1.00

Black

1.58 (0.86e2.91)

1.37 (0.72e2.59)

White

0.66 (0.35e1.23)

0.67 (0.35e1.28)

Other

1.48 (0.68e3.23)

1.50 (0.67e3.34)

>1 race

2.81 (1.21e6.49)

2.50 (1.04e5.99)

Committed/not married

1.00

1.00

Race/ethnicity

Relationship
Single/dating

2.67 (1.58e4.50)

2.16 (1.26e3.70)

Married

1.54 (0.80e2.94)

1.46 (0.75e2.85)

Other/do not know

6.34 (2.21e18.20)

5.57 (1.86e16.67)

Medicaid

1.00

1.00

Private

1.03 (0.54e1.98)

1.01 (0.50e2.01)

Hospital free care

3.01 (1.34e6.79)

2.27 (0.96e5.38)

Other/none/do not know

1.82 (0.75e4.45)

1.66 (0.65e4.19)

Insurance

Limited to 560 participants (92 positive and 468 negative for RC) with complete data on all variables in adjusted model.
CI, confidence interval; OR, odds ratio; RC, reproductive coercion.
a

Adjusted model included all 4 variables listed in table; b Screening positive vs negative for RC.

Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

Research

pregnant; 2) put holes in the condom so

you would get pregnant; 3) broken a
condom on purpose while you were
having sex so you would get pregnant; 4)
made you have sex without a condom so
you would get pregnant; 5) taken off a
condom after you agreed to use one; 6)
taken your birth control (like pills) away
from you so you would get pregnant; 7)
kept you from going to the clinic to get
birth control so you would get pregnant? For each of these questions patients could check yes, no, do not
know, or decline to answer. Birth
control sabotage was dened as a positive answer to any of these questions.
Reproductive coercion was dened as a
positive answer to any of the 14 questions assessing pregnancy coercion and
birth control sabotage. To obtain the
most conservative estimate of reproductive coercion prevalence, we designated women who declined to answer
or reported that they did not know if
any of the above actions had occurred
as not having experienced reproductive
coercion.
If a woman answered in the afrmative to any of the 14 reproductive coercion questions listed above, she was
directed within the survey to complete 3
additional questions assessing for intimate partner violence specically in that
relationship where reproductive coercion had occurred. The respondent was
asked, In that relationship, did your
husband, boyfriend, sexual partner, or
someone you were dating ever: 1)
threaten or hurt you; 2) hit, kick, choke,
or hurt you physically; 3) force you to do
something sexually that you did not
want to do? These 3 questions are part of
the intimate partner violence screening
standard at our hospital (Women and
Infants Hospital of Rhode Island) and are
based on the Abuse Assessment Screen, a
validated screening instrument.9 Intimate partner violence was dened as a
positive answer to any of these questions.
Additionally, respondents who answered
afrmative to any of the 14 reproductive
coercion questions were asked, In that
relationship, which of the following
would have been helpful to you (check all
that apply): 1) your doctor or health care
provider asking you if your partner

JANUARY 2014 American Journal of Obstetrics & Gynecology

42.e4

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General Gynecology

messed with your birth control; 2) your

doctor or health care provider asking you
if you partner pressured you to become
pregnant; 3) your doctor or health care
provider talking with you about hidden
types of birth control like the Depo shot
or IUD?
To be included in the nal analysis,
women had to answer at least 1 of the
14 reproductive coercion questions.
Prior to beginning our study, we performed a sample size calculation that
assumed a 19% prevalence of reproductive coercion based on the ndings of
Miller et al.3 We calculated needing 946
respondents to produce a 95% condence interval (CI) for our estimated
prevalence with a precision of 2.5%.
However, due to nancial and time
limitations, we ended recruitment after
641 respondents, which gave us a precision of 3% for the 95% CI of our
estimated prevalence. We calculated
differences in demographic and reproductive characteristics between women
identied as positive vs negative for
reproductive coercion, pregnancy coercion, and birth control sabotage by employing Fisher exact test for categorical
variables and t tests or Wilcoxon rank
sum test for continuous variables. We
used multiple logistic regression to estimate adjusted odds ratios and 95% CI
for participant characteristics and reproductive coercion. Variables associated
initially with reproductive coercion at
P < .1 were included in the adjusted
model. Similarly, we calculated differences in characteristics between women
who screened positive for reproductive
coercion and intimate partner violence vs
positive for reproductive coercion only.
All calculated P values were 2-sided and
P < .05 was considered statistically signicant. Analyses were performed using
software (SAS, version 9.2; SAS Institute,
Cary, NC).

R ESULTS
A total of 737 women were approached
to participate in the study. Of these,
641 (87%) women completed at least 1
of the reproductive coercion questions.
The average age of participants was
26 years (Table 1). The study sample was
diverse with 42% self-identied as being

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TABLE 4

Prevalence of IPV among women reporting RC, PC, or BCS

Variable

IPVD, n (%)

95% CI

Among RC (n 103)

33 (32.0)

23.0e41.1

Among BCS (n 58)

27 (46.6)

33.7e59.4

Among PC (n 74)

25 (33.8)

23.0e44.6

BCS, birth control sabotage; CI, confidence interval; IPV, intimate partner violence; PC, pregnancy coercion; RC, reproductive
coercion.
Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

Latina, 16% as black, 27% as white, and

15% as another or mixed race. Twentyeight percent reported being single or
in a dating relationship, and 70% were
married or in a committed relationship.
Almost everyone reported ever being
pregnant (94%) and over half (58%)
were currently pregnant. Almost half of
the sample (46%) had obtained an associates degree, attended some college,
or received a 4-year college degree. The
majority of women (74%) were covered
under the Medicaid program. Because
the survey was self-administered, missing
data were present and ranged from 25%
for gravidity and parity to 3% for relationship status.
As seen in Table 2, 16% (95% CI,
13.2e18.9%) of women reported some
form of reproductive coercionepregnancy coercion, birth control sabotage,
or bothewithin their lifetime. On univariable analysis, women who reported
reproductive coercion compared with
those who did not were more likely to
be single or in a dating relationship
(P < .01); more likely to be black,
multiracial, or other race (P .03);
and more likely to be receiving free care
from the hospital, have no insurance at
all, or be unaware of their insurance
status (P .05). Additionally, women
who experienced reproductive coercion
were less likely to report currently being
pregnant (P .01). Findings were
similar among the 11% of women
who reported pregnancy coercion only
(95% CI, 9.1e14.0%) and the 9% who
reported birth control sabotage only
(95% CI, 6.8e11.3%) (data not shown).
In multiple logistic regression, after
adjusting for relationship status, current
pregnancy status, race and ethnicity, and

42.e5 American Journal of Obstetrics & Gynecology JANUARY 2014

insurance type, women who were single

or in a dating relationship were 2 times
more likely to report reproductive coercion than women in a committed relationship (P < .01), and respondents
uncertain of their relationship status
were almost 6 times more likely to report reproductive coercion (P < .01)
(Table 3). Additionally, those who were
currently pregnant were less likely to
report reproductive coercion (P .04).
Among the 103 women who reported
any type of reproductive coercion, 32%
(95% CI, 23e41%) also screened positive for intimate partner violence within
the same relationship (Table 4). Nearly
half of the women who experienced
birth control sabotage also reported
intimate partner violence in that
same relationship (46.6%; 95% CI,
33.7e59.4%), and over one-third (34%;
95% CI, 23e44.6%) of those who
experienced pregnancy coercion reported co-occurring intimate partner
violence. Of note, women reporting
birth control sabotage and pregnancy
coercion were included in both analyses. Only 2 women who experienced
reproductive coercion did not complete
the intimate partner violence questions,
and we considered their responses
as negative to obtain the most conservative estimate. In univariable analysis,
women who reported relationships
characterized by both reproductive
coercion and intimate partner violence
were more likely to be in a single,
dating, or undened relationship (P <
.01) and were more likely to be white,
Latina, or of >1 race (P .04) than
women who experienced reproductive
coercion without intimate partner
violence (Table 5).

General Gynecology

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TABLE 5

Demographic and reproductive characteristics of women reporting RC

and IPV
Demographic

IPVD

IPVe

Total, n (%)

33 (32.0)

70 (68.0)

Mean (SD)

26.4 (5.8)

27.2 (7.2)

Range

18.0e43.0

18.0e43.0

Latina

13 (39.4)

24 (36.4)

Black

6 (18.2)

15 (22.7)

White

10 (30.3)

9 (13.6)

Other

0 (0.0)

11 (16.7)

>1 race

4 (12.1)

7 (10.6)

15 (45.5)

24 (35.8)

Committed/not married

8 (24.2)

28 (41.8)

Married

3 (9.1)

15 (22.4)

Other/do not know

7 (21.2)

0 (0.0)

P value

Age, y
.6

Race/ethnicity, n (%)
.04

Relationship status, n (%)

Single/dating

.0003

Gravidity
Median

2.5

2.5

Range

1.0e9.0

1.0e8.0

Median

2.0

2.0

Range

1.0e6.0

1.0e6.0

31 (93.9)

64 (97.0)

2 (6.1)

2 (3.0)

Yes

23 (69.7)

46 (68.7)

No/do not know

10 (30.3)

21 (31.3)

Yes

14 (43.8)

32 (47.8)

No/do not know

18 (56.3)

35 (52.2)

.8

No. of children
.8

Ever pregnant, n (%)

Yes
No/do not know

.6

Any children, n (%)

1.0

Currently pregnant, n (%)

.8

Education (n 98), n (%)

<High school

4 (12.1)

10 (15.4)

High school graduate/equivalent

15 (45.5)

19 (29.2)

Associates degree/some college

12 (36.4)

26 (40.0)

2 (6.1)

10 (15.4)

2 (6.1)

13 (20.6)

26 (78.8)

37 (58.7)

College graduate

.4

Insurance, n (%)
Private
Medicaid

Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

.2
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Research

Finally, of the 103 women who reported some form of reproductive coercion, 20% stated it would have been
helpful if their doctors or health care
providers had discussed hidden forms
of birth control with them. Additionally,
14% responded that it would have been
helpful if these providers had asked
about feeling pressured to become pregnant. Three percent reported it would
have been helpful if their doctor had
asked if their partners messed with their
birth control.

C OMMENT

In this study of >600 women presenting

for general obstetrics and gynecology
care at a large, urban clinic, 16% reported
having experienced reproductive coercion (pregnancy coercion, birth control
sabotage, or both). Additionally, 32% of
these women experienced reproductive
coercion in the setting of intimate partner violence. After adjustment for possible confounders, being single or in
a dating or undened relationship was
signicantly associated with reproductive
coercion, suggesting that uncommitted
or unmarried women may be more
vulnerable to this phenomenon or, alternatively, that women who have experienced past reproductive coercion are less
likely to engage in committed relationships. Single women were also more likely
to report intimate partner violence in
the same relationship where reproductive
coercion occurred. Twenty percent of
women who had experienced reproductive coercion stated they could have
beneted from a discussion with their
health care providers about hidden forms
of birth control.
This study afrms ndings of previous
investigations that reproductive coercion
is common among reproductive-age
women and is associated with a history
of intimate partner violence.3,5-7 It also
advances current knowledge by assessing
the prevalence of reproductive coercion
among a broader female patient population and addressing the prevalence
of intimate partner violence specically
in relationships where reproductive
coercion has occurred. As such, its results should be more applicable to the
general obstetrician-gynecologist and

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TABLE 5

Demographic and reproductive characteristics of women reporting RC

and IPV (continued)
Demographic

IPVD

IPVe

Hospital free care

3 (9.1)

7 (11.1)

Other/do not know/none

2 (6.1)

6 (9.5)

Yes

29 (87.9)

47 (71.2)

No

4 (12.1)

19 (28.8)

P value

coercion and effective interventions when

it occurs. With improved understanding,
obstetrician-gynecologists will be better
equipped to identify affected female patients and offer them options to help
interrupt the cycle of birth control sabotage, male power over pregnancy decision
making, and unwanted pregnancies. -

Born in United States, n (%)

ACKNOWLEDGMENTS

.08

Data are column % unless stated otherwise.

IPV, intimate partner violence; RC, reproductive coercion.

The authors would like to thank Day One Sexual

Assault and Trauma Resource Center for
donating the intimate partner violence resource
cards provided to each study participant.

Clark. Reproductive coercion in ob-gyn patients. Am J Obstet Gynecol 2014.

may inform routine clinical practice,

especially around contraceptive counseling and family planning. The studys
major strengths are its large sample size,
high response rate, and setting within
a general ambulatory obstetrics and gynecology clinic.
The results are limited by the crosssectional study design so that identied
associations between demographic characteristics and reproductive coercion as
well as between intimate partner violence
and reproductive coercion do not imply
causality. We also did not assess past
compared to current reproductive coercion. In addition, because they are
derived from a self-administered, anonymous survey, study results may be subject to missing data and responses that
cannot be conrmed with medical records. However, we believed that an
anonymous survey would allow us to
obtain a higher response rate for sensitive
questions.10 Furthermore, while there
was up to 35% missing data for certain
variables, for all variables included in
the logistic regression model there was
only 13% missing data. Another limitation is that the population assessed
was primarily comprised of underserved,
English-speaking, urban women. However, participants from all racial/ethnic
categories, educational levels, and insurance statuses reported reproductive
coercion. Additionally, we did not ask
women without a history of reproductive
coercion to comment on their experience
of intimate partner violence. Thus, we
are unable to remark on intimate

partner violence prevalence among

women experiencing reproductive coercion compared with those who did not
experience it. Moreover, while our institutions standard intimate partner
violence screening tool does include a
question about threatening behavior, the
full range of emotional abuse is not
queried. Consequently, we may have
underestimated the prevalence of intimate partner violence in women who
screened positive for reproductive coercion. Lastly, women may not accurately
recall reproductive coercion or intimate
partner violence that took place in the
past. Nonetheless, the prevalence rates we
observed for both reproductive coercion
and intimate partner violence are
consistent with those identied in previously published studies.2,3
Based on a growing body of research, it
is clear that a striking number of sexually
active women experience reproductive
coercion by their male partners and are
thus potentially compromised in their
ability to use contraception and plan
pregnancies. Obstetrician-gynecologists
are well placed to identify this phenomenon and lessen its impact on the health
and well-being of patients and their
families. Currently, many major medical
organizations and the US Preventative
Services Task Force recommend screening for intimate partner violence.11-15
Additionally, the American Congress of
Obstetricians and Gynecologists recommends routine screening for reproductive
coercion.16 Further research is needed on
the health implications of reproductive

42.e7 American Journal of Obstetrics & Gynecology JANUARY 2014

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