Study finds asking about pregnancy coercion and IPV can reduce their incidence

[MAITRI]

Study finds asking about pregnancy coercion and intimate-partner
violence can reduce their incidence


(SACRAMENTO, Calif.) — Specifically asking young women during visits
to family planning clinics whether their partners had attempted to
force them to become pregnant — a type of intimate-partner violence
called reproductive coercion — dramatically reduced the likelihood
that the women would continue to experience such pressures, according
to a new pilot study led by researchers at the UC Davis School of
Medicine.

Young women who recently experienced partner violence had a 70 percent
reduction in the odds that they would continue to experience pregnancy
coercion following the questioning, which is called a brief
intervention, the study found. The study participants also were 60
percent more likely to report ending a relationship with a partner
because they felt unsafe or the relationship felt unhealthy.

"This pilot study was focused on how we might better identify intimate-
partner violence and reproductive coercion in clinical settings and
offer women specific strategies to reduce their risk of an unwanted
pregnancy and increase their safety," said Elizabeth Miller, associate
professor of pediatrics at the UC Davis School of Medicine and the
study's lead author. "These findings are extremely encouraging, and
suggest that such clinical interventions may be useful in reducing
both partner violence and unintended pregnancy."

Published online in the journal Contraception the study, "A Family
Planning Clinic Partner Violence Intervention to Reduce Risk
Associated with Reproductive Coercion," assessed the effectiveness of
what the authors said is the first step toward a harm-reduction health-
care protocol for reducing women's risk of becoming pregnant by
abusive partners, a widespread public-health problem.

Reproductive coercion involves both pregnancy coercion, in which
partners verbally pressure women to become pregnant, and birth-control
sabotage. Birth-control sabotage involves partners' interference with
contraception, including secretly or overtly damaging condoms to force
a woman to become pregnant or throwing away or preventing her from
using birth control pills.

The study was conducted in four Northern California family-planning
clinics between May 2008 and October 2009. The intervention was
designed collaboratively with the Family Violence Prevention Fund and
reproductive health experts. Family planning counselors and clinicians
were trained to implement the intervention at two of the four sites.
Two control sites provided standard domestic violence and sexual
assault screening. Participants included approximately 900 English-
and Spanish-speaking women between 16 and 29 years old, with the vast
majority of the women, 76 percent, aged 24 or younger.

The intervention involved assessing for partner violence and
reproductive coercion during a reproductive health visit, discussing
harm-reduction strategies to reduce risk for unintended pregnancy and
connecting women to violence-related resources. In the context of
inquiries about the reason for the clinic visit, the participants who
received the intervention were asked straight-forward questions about
pregnancy coercion and birth-control sabotage integrated into their
reproductive health visit. A positive response to any of these
inquiries was considered reproductive coercion. The inquiries
included:

* "Have you hidden birth control from your partner so he wouldn't
get you pregnant?"
* "Has your partner tried to force you to become pregnant when you
didn't want to be?"
* "Does your partner mess with your birth control?"
* "Does your partner refuse to use condoms when you ask?"
* "Has your partner ever hurt you physically because you didn't
agree to become pregnant?"

Study participants at control clinics who did not receive the
intervention received standard-of-care questionnaires that asked:
"Have you ever been hit, kicked, slapped or choked by your current or
former partner?" and "Have you ever been forced to have sex against
your will?" Follow-up surveys with all participants were conducted
between 12 and 24 weeks from the date of the initial interviews.

While the odds of pregnancy coercion dropped by 70 percent for women
who received the intervention, there was no significant change in the
odds of pregnancy coercion for women who had not reported experiencing
intimate-partner violence within the past three months, or for women
who did not receive the intervention. However, awareness of intimate-
partner violence-related resources increased in both the intervention
group and the control group, the authors said.

"Given recent reports that question the usefulness of screening for
intimate-partner violence in clinical settings and the current
critical need for effective low-cost unintended- and teen-pregnancy
prevention, it is extremely encouraging that this combination of
screening for reproductive coercion and abuse and providing simple
educational information significantly reduced women's pregnancy
coercion," said Jay Silverman, senior author of the study and
associate professor of society, human development and health at the
Harvard School of Public Health.

"There is a strong, indisputable link between domestic and dating
violence and unintended pregnancy. This study is extremely important
because it identifies an effective solution that can be implemented
relatively easily," said study author Rebecca Levenson, of the Family
Violence Prevention Fund. "We need to build on these results by making
this intervention the norm in health-care settings throughout the
nation as quickly as possible."


Other study authors include Michele R. Decker of the Johns Hopkins
Bloomberg School of Public Health, Heather McCauley of the Harvard
School of Public Health and Daniel Tancredi of UC Davis.

The study was funded by a grant from the National Institute of Health
to Miller and Silverman and the National Institutes of Health-
affiliated UC Davis Health System Building Interdisciplinary Research
Careers in Women's Health and UC Davis Health System Research awards
to Miller.

The UC Davis School of Medicine is among the nation's leading medical
schools, recognized for its research and primary-care programs. The
school offers fully accredited master's degree programs in public
health and in informatics, and its combined M.D.-Ph.D. program is
training the next generation of physician-scientists to conduct high-
impact research and translate discoveries into better clinical care.
Along with being a recognized leader in medical research, the school
is committed to serving underserved communities and advancing rural
health. For more information, visit UC Davis School of Medicine at
www.ucdmc.ucdavis.edu/medschool/.

http://www.eurekalert.org/pub_releases/2010-08/uoc--sfa082810.php