Domestic violence can take many forms. It impacts all genders and the results of this abuse can be visible; or they can be invisible, more insidious. During this year’s Domestic Violence Awareness Month (DVAM) we want to take this opportunity to talk about one form of domestic violence that intersects with and influences our work at Upstream: reproductive abuse and coercion.
Before we delve deeper, it is important to define this often hidden form of domestic violence. Reproductive Coercion (RC) occurs when an abuser uses intimidation, threats, and/or physical violence to control their partner’s reproductive choices. This can include prohibiting someone from controlling their own birth control methods, forcing someone to either end or continue a pregnancy, pressuring a partner to get pregnant, or sabotaging birth control.
The 2010 National Intimate Partner and Sexual Violence Survey revealed that 8.5% of women (about 10.1 million women) and 9.7% of men (an estimated 11.1 million men) experienced RC by an intimate partner in their lifetime. This includes men and women who report having a partner who tried to get (them) pregnant without their consent, as well as men and women who report having a partner who refused to wear a condom. In addition, the National Network to End Domestic Violence (NNDEV) found women experiencing abusive RC tactics and domestic violence are less likely to use birth control and are at greater risk for reproductive health issues.
We believe all patients need to choose the form of birth control that works best for them and this remains at the center of our work. Every patient has different goals and desires related to contraception and pregnancy, which means that there is no “one size fits all” method – for some, the pill is the perfect method, for others, the IUD may be best if they feel safer since it is invisible. What is most important is that people who want to prevent pregnancy are able to do so, and are able to choose the method that is best for them and their unique circumstances. We call this patient-centered care and this is the approach we bring to our agency partners who want to deliver best-in-class contraceptive care.
One way we prepare our partners to support patients who may be experiencing reproductive abuse and coercion, is through our patient education materials. These materials include information on hidden birth control methods and can serve as a prompt for domestic violence counseling. Upstream’s training is also trauma-informed and aims to equip our healthcare partners with the tools they need to meet patients where they are, and connect them with same-day contraceptive care.
At an Upstream-trained FQHC, a mother of six mentioned to her child’s pediatrician that she did not want to have any more children. She then described her husband as “controlling” and explained that he would not allow her to have a tubal ligation at her last delivery. She was offered contraceptive counseling, chose, and received, a Paragard IUD on the same day. She was also offered, and received, counseling on domestic violence.
As we recognize DVAM this October, we want to remind our staff and agency partners to look beyond the visible forms of domestic violence and consider how our shared commitment to patient-centered care can meaningfully support survivors of domestic violence.
If you or someone you know is a victim of domestic violence, call the U.S. National Domestic Violence Hotline at 1-800-799-7233 and TTY 1-800-787-3224, or 911 if it is safe to do so. For more information about DVAM and how to support domestic violence victims and survivors, visit the NNDEV and National Coalition Against Domestic Violence campaign web pages.
