Reproductive coercion: connecting the dots between partner violence and unintended pregnancy.

Reproductive health professionals are in a critical position to reach women victimized by abusive relationships. In the general population, physical and sexual violence victimization by an intimate partner affects an estimated one in four women across the life span, with one in five adolescent girls reporting such abuse [1–3]. The prevalence of intimate partner violence reported among women utilizing sexual health services and seeking care in gynecologic and adolescent clinics is generally double these populationbased estimates [4–7]. This is not surprising, as such victimization is consistently associated with increased pregnancy and sexually transmitted infection (STI), with abused women demonstrating disproportionately higher rates of seeking care at family planning and other health services related to sexual health, such as HIV and STI testing [8–16]. Moreover, mounting evidence that unintended pregnancy occurs more commonly in abusive relationships highlights that victimized women face compromised decision making regarding contraceptive use and family planning, including condom use [17–22]. Forced sex, fear of violence if she refuses sex and difficulties negotiating contraception and condom use in the context of an abusive relationship all contribute to increased risk for unintended pregnancy and STIs. Thus, in settings where women seek care for sexual and reproductive health services, providers are well situated to build a bridge to further services for a significant number of women affected by partner violence. We suggest that providers can actually do more than simply offering a woman victim advocacy hotline numbers, based on new research findings. In the April issue of Contraception, we highlighted a phenomenon we labeled “reproductive coercion”: explicit male behaviors to promote pregnancy (unwanted by the woman). Reproductive coercion can include “birth control sabotage” (interference with contraception) and/or “preg-