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Ob-gyns sound alarm on "contraceptive sabotage"

By Genevra Pittman

NEW YORK (Reuters Health) - Doctors should ask teen girls and women whether their partners are trying to force them to get pregnant or otherwise "reproductively coercing" them, according to a group of ob-gyns.

That could include pressuring women to have sex - possibly without a condom or other birth control, forcing them to continue (or end) a pregnancy or intentionally exposing them to sexually transmitted infections, according to The American College of Obstetricians and Gynecologists (ACOG).

"What we're talking about is specific to women and girls' ability to contracept, to control their reproductive health," said Jay Silverman, who studies violence against women at the University of California, San Diego School of Medicine.

"What we've found is that many male partners are more actively involved than we would have thought in really blocking women and girls' ability to do that, as a form of control that's part of a larger picture of violence against women and girls," added Silverman, who wasn't part of the ACOG committee.

One study of the National Domestic Violence Hotline found a fourth of callers had experienced reproductive coercion.

"All the different forms of violence and coercion of women and girls from male partners are based in the entitlement to control their lives, physically and otherwise," Silverman said. "They also feel entitled to decide whether she's going to get pregnant or not."

The Centers for Disease Control and Prevention reports close to three in 10 U.S. women have experienced rape, stalking or physical violence by a partner. Other studies suggest as many as half of women will experience psychological aggression from an intimate partner at some point in their lives.

OFFERING ‘SAFE SPACE'

Earlier this month, the government-backed U.S. Preventive Services Task Force called on doctors to screen women of childbearing age for domestic violence and refer those who need it to intervention services.

"I think this is a very common problem - it's extremely underreported," said Dr. Eduardo Lara-Torre, a member of the ACOG committee from the Virginia Tech Carilion School of Medicine, of reproductive coercion.

In cases of reproductive coercion or "contraceptive sabotage," the ob-gyn group said doctors can help women obtain safe and concealable birth control, such as emergency contraceptive pills packaged in plain envelopes or intrauterine devices with trimmed strings.

Doctors can also give women safety cards, hotline numbers and referrals to domestic violence services, according to the committee opinion published in Obstetrics & Gynecology.

"For this particular scenario, (doctors need to) be able to offer them a safe space to discuss it, number one… as well as offer them alternatives and strategies so they don't get sabotaged," Lara-Torre told Reuters Health

In addition, he said, doctors should "offer them help and assistance, including shelters, for whatever else they might need."

Silverman agreed that doctors and other clinic staff should ask women and girls about reproductive coercion, especially when they come to the office for contraception.

"It is incredibly important that these are issues that are asked about, because if we don't understand the context in which a woman is attempting to contracept, then we are not often giving her the tools to be effective to do that," he told Reuters Health.

"It may be that she needs a long-acting control method that her partner has no control over and may not be able to detect."

SOURCE: http://bit.ly/s3TyE Obstetrics & Gynecology, online January 23, 2013.

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