How to address reproductive coercion in practice

October 07, 2022

2 minutes read


Source/Disclosures

Source:

Healio Interviews


Disclosure: Rowlands does not report relevant financial information.

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A new article appeared in The BMJ provides physicians with guidance on how to identify patients who are victims of reproductive coercion and how best to help them.

According to a press release, reproductive coercion is a form of abuse used by partners or family members to manipulate women’s reproductive decisions. It is often about psychological and emotional pressure, but also about physical abuse and sexual violence.

“Although this has long been known, the extent of reproductive coercion has only been studied in the last decade.” Sam Rowlands, LLM, MD, FRCGP, FFSRH, a visiting professor in the Department of Medical Sciences and Public Health at the University of Bournemouth, UK, said in the press release.

In this interview, Rowlands discusses the key indicators of reproductive compulsion and how clinicians should ensure the well-being of patients affected by it.

Healio: What prompted this article?

Rowlands: This article was commissioned by The BMJ. Since 2018 I have been very interested in reproductive coercion and abuse. I have co-authored a review article for sexual and reproductive health specialists, been interviewed for a national radio program and co-authored a book chapter on the subject. A need for an educational article for general practitioners was identified.

Healio: What are the top signs of reproductive coercion that clinicians should look for?

Rowlands: Reproductive coercion is widespread but often hidden. It is most commonly, but not exclusively, inflicted on straight cis women. It consists of interfering with a woman’s reproductive decision making. It can either be a compulsion to have a pregnancy or not to have a pregnancy – the former is more common. Survivors may be reluctant to disclose what is happening to them. Increased awareness and the ability to ask specific questions are required. Situations that may raise suspicions include repeated requests for pregnancy testing, emergency contraception, or testing for sexually transmitted infections. Women who have had more than one abortion can also raise suspicions.

Healio: What should clinicians do when a patient confides in them about reproductive coercion?

Rowlands: This is not easy, especially when it involves domestic violence and children in the family. Also, it may take some time before a patient is ready to make a disclosure. It is all about giving the patient information, showing understanding and gaining trust. Some cases may require a protection assessment and referral to a specialist.

Healio: How can clinicians ensure victims of reproductive assault remain safe after leaving the office?

Rowlands: In many cases of reproductive coercion, the main feature is coercive control rather than violence. In a significant fraction of cases, the patient may have little insight into the partner’s abnormal behavior and it becomes a way of life. Clinicians can help gain insight into their relationship and think about ways they can resist control, such as: B. the covert use of contraceptives. Care must be taken to ensure that any interventions do not trigger any retaliatory measures from the partner.

Healio: Is there anything else you would like to add?

Rowlands: This is not a new phenomenon, but it is increasingly recognized. Sex and relationship education must include information about healthy relationships. Relationships seem to go well at first, but control begins to kick in. It’s easier to break out of an unhealthy relationship early, especially before children are born.

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