A Systematic Review of Reproductive Coercion in International Settings

• Published date: 01 December 2016
• Date: 01 December 2016
• DOI: http://doi.org/10.1002/wmh3.209

A Systematic Review of Reproductive Coercion in

International Settings

Karen Trister Grace and Christina Fleming

Reproductive coercion is behavior that interferes with a woman’s autonomous reproductive decision

making. It may take the form of birth control sabotage, pregnancy coercion, or controlling the

outcome of a pregnancy. Perpetrators may be partners, a partner’s family, or the woman’s family.

This article reviews the literature on reproductive coercion in international settings. In this review

of 10 research studies, f‌indings are presented on prevalence and type of reproductive coercion,

associated factors, specif‌ic tactics, relationship with intimate partner violence (IPV) and domestic

violence (in-laws particularly), and implications for women’s reproductive health. Findings

highlight reproductive coercion as a subset of IPV that is poorly understood, especially in

international settings. More research is needed on protective factors, how interventions can

capitalize on protective factors, and the strategies women use to resist reproductive coercion. Policy

implications and recommendations are discussed with particular attention to issues related to

diverse social and cultural environments.

KEY WORDS: reproductive coercion, unintended pregnancy, intimate partner violence

Introduction

Reproductive coercion is behavior that interferes with a woman’s autonomy

in reproductive decisions (Miller et al., 2010; Moore, Frohwirth, & Miller, 2010).

This may take the form of birth control sabotage (such as removing a condom,

damaging a condom, removing a contraceptive patch, or throwing away oral

contraceptives), pregnancy coercion, or controlling the outcome of a pregnancy

(such as pressure to continue a pregnancy or pressure to terminate a pregnancy)

(Miller et al., 2010; Moore et al., 2010). When reproductive coercion has been

studied in the United States, perpetrators are almost exclusively intimate partners

(Borrero et al., 2015; Clark, Allen, Goyal, Raker, & Gottlieb, 2014; Hathaway,

Willis, Zimmer, & Silverman, 2005; McCauley et al., 2015; McCauley, Dick, et al.,

2014; Miller et al., 2007, 2010, 2014; Moore et al., 2010; Nikolajski et al., 2015;

Sutherland, Fantasia, & Fontenot, 2015). In international settings and studies of

immigrant women, perpetrators have been found to also include family members

of the woman or of her partner (Char, Saavala, & Kulmala, 2010; Clark et al.,

World Medical & Health Policy, Vol. 8, No. 4, 2016

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2008; Gupta, Falb, Kpebo, & Annan, 2012; McCauley, Falb, Streich-Tilles, Kpebo,

& Gupta, 2014; Puri, Adams, Ivey, & Nachtigall, 2011; Raj et al., 2011). Women in

different countries, due to different social and cultural norms and legal rights,

may experience reproductive coercion in disparate ways from women in the

United States and from each other. These differences may have different

implications for clinicians, researchers, and policymakers. Hence, this article

focuses exclusively on literature on reproductive coercion in international

settings.

Reproductive coercion was f‌irst def‌ined in the literature in 2010 (Miller et al.,

2010; Moore et al., 2010). This review examines literature from f‌ive years prior to

this def‌inition until f‌ive years hence (2005–15), and highlights themes such as the

impact of social and cultural norms surrounding involvement of in-laws and

male partners in family planning decisions, a preference for male children, and

attempts by women to resist coercion. The objectives of this article are to review

the current state of knowledge about reproductive coercion and about the specif‌ic

behaviors of reproductive coercion, when examined separately, in international

settings, to address the questions:

1. What is known about reproductive coercion?

2. What strategies do women use to preserve their reproductive autonomy when

experiencing reproductive coercion?

3. What interventions are effective to decrease reproductive coercion?

Methods

A research librarian assisted with literature searches, which were preformed

in July 2015. The databases PubMed, CINAHL, PsycINFO, and Embase were

searched, including search terms “reproductive,” “coercion,” “sexual partners,”

“pregnancy,” “contraception,” “birth control,” “reproductive behavior,” and

“sexual behavior.” Inclusion criteria were research studies of humans, English

language, and the ten-year period surrounding the f‌irst mention of reproductive

coercion in the literature (2005–15) that covered reproductive coercion or any of

its specif‌ic behaviors, and were set in locations outside the United States.

Abstracts and titles were reviewed by both authors for this inclusion criteria, as

well as exclusion criteria: only examining sexual coercion, IPV, or coercion by the

government (e.g., forced sterilization). Articles that were potentially relevant were

reviewed in full text for inclusion and exclusion criteria by both authors.

Following database searches, a hand search was conducted on the reference lists

of all relevant articles.

The meta-analysis of observational studies in epidemiology (MOOSE) (Stroup

et al., 2000) and preferred reporting items for systematic reviews and meta-

analyses (PRISMA) (Liberati et al., 2009) protocols guided the review. The authors

extracted data from each included article on the topics of reproductive coercion

(including birth control sabotage, pregnancy coercion, and abortion coercion), the

intersection with IPV, the intersection with unintended pregnancy, resistance

Grace/Fleming: International Reproductive Coercion 383