Calls for screenings in UK as quarter of US women subject to control or coercion over pregnancy

Figure includes instances of 'contraceptive sabotage' where partners remove condoms during sex or lie about vasectomy

Maya Oppenheim
Women's Correspondent
Tuesday 08 January 2019 00:30
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The report defines the phenomenon of coercion over reproduction as 'actions that interfere with a woman's reproductive intentions and any actions that pressurise or coerce a woman into initiating or terminating a pregnancy'
The report defines the phenomenon of coercion over reproduction as 'actions that interfere with a woman's reproductive intentions and any actions that pressurise or coerce a woman into initiating or terminating a pregnancy'

Experts have called for health professionals to screen for coercive control in the UK after a study suggested a quarter of US women were subject to control or coercion over their reproductive lives.

New research found control over women's reproductive choices was "common", with one in four women in a series of American studies over seven years saying they had experienced it.

The scale of the problem is thought to be similar in Britain but there is no research on UK women published yet.

The report, published in the British Medical Journal, defines the phenomenon of coercion over reproduction as "actions that interfere with a woman's reproductive intentions and any actions that pressurise or coerce a woman into initiating or terminating a pregnancy".

While it is chiefly carried out by intimate partners, it can also be perpetrated by the wider family and in organised crime, with young people and ethnic minorities particularly vulnerable.

Actions include emotional blackmail, threats of violence, pressure to continue or end a pregnancy or to not use certain types of contraception.

It also includes "contraceptive sabotage", such as a male partner falsely saying they have had a vasectomy, piercing condoms before use, or "stealthing", where a condom is covertly removed during sex.

The report called for screening to take place in maternity, sexual and reproductive health and abortion services and GP surgeries. A set of questions has already been formulated.

Professionals should be alert to its possibility when they see women who persistently fail to use contraception, make frequent requests for emergency contraception, and pregnancy or STI testing.

Where women say they are being controlled, professionals may advise them on "concealable" methods of contraception.

It also recommends that women who attend services with an escort are seen alone "so that these sensitive issues can be raised".

Professor Sam Rowlands, one of the report's authors, said professionals were missing chances to help women who are facing pressure over getting or staying pregnant.

"I think we do need to replicate some of these studies,” he said. “Just to be sure that it's happening, but most of us who have worked in women's health, we know from talking to women that this definitely happens, so I think it's not whether it happens, but it's whether it happens to the same extent as some countries.

"And then also people need to be thinking about training, and getting people to raise this a bit more proactively in consultations, and then how to handle it when you find it."

Some women may not have insight into their relationship, especially if there is no physical or sexual violence, as they may become inured to the control being exercised on them, the report says.

Describing how it could manifest, the professor said: "I think it is like a spectrum, at the worst extreme end there probably is violence and extreme things going on like food deprivation, on the other end it's really just a kind of psychologically controlling atmosphere - keeping tabs on everything the woman is doing, maybe being restrictive over when she goes out."

He said the issue was not being raised during consultations for many women, adding that there were no UK guidelines or advice for health professionals, the majority of whom "were not terribly aware and would not be thinking about raising this".

The academic argued that health professionals who were conscious of it were responding on an individual basis to individual patients.

Clare Murphy, of the British Pregnancy Advisory Service (BPAS), the UK’s largest abortion provider, said discussion about reproductive coercion often hinges on suggestions women are forced into abortions they do not want, but the greater issue may in fact lie with forced pregnancies.

She noted that some women request contraceptives that their partner will not be able to find evidence of, such as the injection, because they are being pressurised to conceive.

She said: “We also know that the requirement to attend a clinic - sometimes for multiple appointments - for abortion advice and care can raise serious concerns for a small number of women in coercive relationships who need to keep their decision to end a pregnancy completely hidden from their partner.

“All women attending our services are seen alone by fully trained members of staff to allow for a safe and confidential discussion about their circumstances, and assessment of risk of abuse is routine for all women.

“Termination of pregnancy – and indeed any medical treatment – can only be provided after the woman has given her informed consent. For consent to be valid and legal, it must be voluntary and not influenced by coercion from family or friends.”

Nicola Moore, of UK abortion provider Marie Stopes, said they train nurses to spot signs of abuse and also provide unlimited, free counselling.

She said: “We are very aware of this issue and the crucial role we play in protecting and empowering women and girls. For those who are more vulnerable we are a vital support, all too frequently identifying protection issues such as physically and emotionally abusive relationships, FGM and rape.”

Additional reporting by PA

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