Homicide is a leading cause of death for pregnant women in the United States, according to new guidelines issued by the American College of Obstetricians and Gynecologists.
In addition to lethal violence, many abused girls and women have male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections or force them into having unwanted pregnancies or abortions.
In the new guidelines, the College describes reproductive and sexual coercion as a pattern of physical violence and/or psychologically coercive behaviors intended to control a womans sexual decision-making, contraceptive use and/or pregnancy. Sabotaging a womans contraceptive method, pressuring her to become pregnant unwillingly or forcing her to end or continue a pregnancy against her will all are examples of reproductive coercion.
Some male partners go as far as to forcefully remove intrauterine devices and vaginal rings, poke holes in condoms or destroy birth control pills. Repeated pressure to have sex, forcing sex without a condom and intentionally exposing a partner to an STI are examples of sexual coercion.
The College calls for ob-gyns to routinely screen teens and women for sexual and reproductive coercion at annual exams, new patients visits, prenatal visits and postpartum. Both unintended pregnancies and STI and HIV infections in women may be red flags because both are highly related to abusive relationships. Intervention strategies can help women to leave unhealthy relationships and reduce unwanted pregnancies.
Ob-gyns can employ a number of strategies to help women experiencing reproductive and sexual coercion. They can recommend long-acting contraceptives such as IUDs, the implant and the injection, which are more difficult than other contraceptives for partners to detect. As an additional safety measure, IUD strings can be trimmed short to avoid detection and forced removal. Providing emergency contraceptive pills and advising women to store them in a plain envelope to disguise them is another harm-reduction strategy.
The guidelines appear as a “committee opinion” in the February issue of the journal Obstetrics & Gynecology, and are available at http://bit.ly/WQ0RQf.