You might never even have heard of it, but experts are trying to pull the issue of reproductive coercion out of the shadows and into the forefront of health professionals’ minds.
The most obvious examples might be a boyfriend forcing his partner to have an abortion or to keep a pregnancy, but a woman is also experiencing reproductive coercion if her partner stealthily removes the condom during sex, or emotionally blackmails her into taking, or not taking, emergency contraception.
Alarmingly, a US report found one in four women visiting a sexual health clinic were experiencing reproductive coercion, and Aussie experts say we are little different.
“We think it would be similar here,” Sophie Keramidopoulos, the counselling manager at family planning association Marie Stopes, said.
There is no clear Australian data – in fact, the term was only used for the first time in 2010 – but the counselling service, Children By Choice, report that one in seven of their clients were experiencing reproductive coercion.
Marie Stopes has advice for identifying this problem for GPs.
Some subtle red flags include pregnant women saying, “I don’t want to disappoint anyone” or “I don’t think I have a choice”, Ms Keramidopoulos said.
Something about their behaviour around an ultrasound might also prompt further investigation, she continued.
“If they are asking to see the ultrasound and they are having a termination, it could be that they’re being coerced into a termination and they’re wanting to continue with the pregnancy,” she said. “If they’re asking not to see the ultrasound it might be the flip of that.”
She would also be alert if a woman was asking about discreet contraception, or was quiet and uncommunicative around their partner or failed to return for follow-up blood tests or ultrasounds.
Other warning signs included: if they had a history of family violence, repeated terminations, or repeatedly seeking help for STIs and gynaecological issues.
Ms Keramidopoulos said that after the publication of the association’s white paper on this late last year, they received calls from women who only then realised that they had been experiencing reproductive coercion.
While any of those warning signs were not sure-fire signals that someone was in a coercive situation, Ms Keramidopoulos said those signs would trigger her to probe a little deeper.
One way of doing this was to get the patient on their own, which could be done by telling the support person it was standard procedure at the clinic.
“[Then] asking questions around the pregnancy: so how they became pregnant, whether it was a planned pregnancy or an unplanned pregnancy, if they consented, whether contraception was discussed and if the plan was followed, [and] if they are talking about contraception, if there any barriers to using or continuing contraception,” Ms Keramidopoulos explained.
The first thing many women want to know is what to do or where to go, “and a GP is a really good point of reference,” she said.
Ways to facilitate this are to direct them to non-judgemental counselling in the local area or over the phone, preferably in a trauma-informed practice, and knowing what reproductive and sexual health services are available.
GPs can also offer discreet contraception, such as the three-month injection.
Another important role for GPs is in assisting with booking appointments and helping patients follow-up with appointments.
There is overlap with domestic violence and reproductive coercion, which means that many women may be able to visit their GP but not other health services, especially reproductive ones. A place where patients could get their results sent back to would be a big asset, Ms Keramidopoulos said.
At risk groups include women from culturally and linguistically diverse and Aboriginal and Torres Strait Islander backgrounds.
Because reproductive coercion can be a part of family violence, women with dependent children can be at heightened risk.
Men can also be victim of reproductive coercion, with an at-risk time being around vasectomy.
It also manifests in structural issues, such as government regulations around access to contraception or abortion, and policies encouraging childbirth such as the “baby bonus”, the white paper said.