Birth control pills should be available without a prescription, the American College of Obstetricians and Gynecologists says.(Photo: Photo Disc)
(USA TODAY) -- When a husband hides a wife's birth control pills or a boyfriend takes off a
condom in the middle of sex in hopes of getting an unwilling girlfriend
pregnant, that's a form of abuse called reproductive coercion.
While researchers don't know exactly how common such coercion is, it's common
enough - especially among women who are abused by their partners in other ways -
that health care providers should screen women for signs at regular check-ups
and pregnancy visits, says the nation's leading group of obstetricians and
gynecologists.
"We want to make sure that health care providers are aware that this is
something that does go on and that it's a form of abuse," says Veronica
Gillispie, an obstetrician and gynecologist at Ochsner Health System, New
Orleans, and a member of the committee that wrote the opinion for the American
College of Obstetricians and Gynecologists. It's published in the February issue
of Obstetrics & Gynecology, out today.
Reproductive coercion occurs whenever a partner tries to prevent a woman from
making her own choices about pregnancy, Gillispie says. That includes trying to
get a woman pregnant against her will, through forced sex or other means; it
also includes using pressure or threats to get a woman to continue an unwanted
pregnancy or end a wanted one.
In studies cited by the committee, "birth control sabotage" was reported by
25% of teen girls with abusive partners and by 15% of women who were physically
abused. Some men go as far as to pull out a woman's intrauterine device (IUD) or
vaginal contraceptive ring, the committee says.
"Often, it's about taking away choices, taking away freedom, control and
self-esteem," says Rebekah Gee, an obstetrician and gynecologist in New Orleans
and assistant professor at Louisiana State University. She did not work on the
opinion, but has studied the problem.
While it may be rare for men to dislodge an IUD, she says, it's not uncommon
for men to refuse to wear condoms, putting women at risk for both pregnancy and
sexually transmitted diseases. An abusive man may believe that getting a woman
pregnant binds her closer to him, Gee says.
The opinion says obstetricians and gynecologists can help women in these
relationships by directing them to agencies and hotlines that help abused women,
including the National Domestic Violence Hotline at
1-800-799-SAFE (7233). But it also says doctors can take direct action, by
providing women with hard-to-detect birth control methods (including IUDs with
the removal strings cut, if necessary) or a stash of emergency contraceptive
pills (in a plain envelope).
In clinics where doctors already have started such efforts, results have been
encouraging, says Rebecca Levenson, senior policy analyst at Futures Without
Violence, a non-profit advocacy group based in San Francisco. In one small
study, reports of reproductive coercion dropped 71% among women who got
information and questionnaires about such abuse. Some of the information was on
a card that "can fit inside a shoe," she says.
Anne Teitelman, an associate professor of nursing at the University of
Pennsylvania, says she often hears about sexual and reproductive coercion from
the girls and women she treats as a nurse practitioner at a family planning
clinic.
But "if we don't ask the questions, often patients don't realize that there's
something they can do to change the situation," she says. Getting more health
providers to ask about such abuse and help stop it is important, she says. But
the next step is prevention -- programs that help "both young girls and young
boys" avoid abusive relationships in their futures, she says.
Kim Painter, Special for USA TODAY