Contraceptive Sabotage Not Uncommon

Ob-Gyns: Screen Patients for Reproductive and Sexual Coercion

January 23, 2013

Washington, DC -- Homicide is one of the leading causes of death for pregnant women in the US, according to new recommendations issued today by The American College of Obstetricians and Gynecologists (The College). In addition to lethal violence, many abused adolescent girls and women have male partners who intentionally sabotage their contraception, deliberately give them sexually transmitted infections (STIs), 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 woman’s sexual decision-making, contraceptive use, and/or pregnancy. Sabotaging a woman’s contraceptive method, pressuring her to become pregnant unwillingly, or forcing her to end or continue a pregnancy against her will are all examples of reproductive coercion. Some male partners go so far as to forcefully remove intrauterine devices (IUDs) 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, during 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 to detect by partners than other contraceptives. As an additional safety measure, IUDs strings can be trimmed short to avoid detection and forced removal. Providing emergency contraceptive pills and advising women to remove the pills and put them into a plain envelope to disguise them is another harm-reduction strategy.

Committee Opinion #554, “Reproductive and Sexual Coercion,” is published in the February 2013 issue of Obstetrics & Gynecology.

Free wallet-sized cards that educate women about reproductive and sexual coercion are available at Futures Without Violence.

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Other recommendations issued in this month’s Obstetrics & Gynecology:

Committee Opinion #553 “Multifetal Pregnancy Reduction” (Revised)
ABSTRACT: Fertility treatments have contributed significantly to the increase in multifetal pregnancies. The first approach to the problem of multifetal pregnancies should be prevention, and strategies to limit multifetal pregnancies, especially high-order multifetal pregnancies, should be practiced by all physicians who treat women for infertility. Incorporating the ethical frameworks presented in this Committee Opinion will help physicians counsel and guide patients when making decisions regarding multifetal pregnancy reduction. In cases of high-order multifetal pregnancies, counseling should include the availability of multifetal pregnancy reduction. Fellows should be knowledgeable about the medical risks of multifetal pregnancy, the possible medical benefits of multifetal pregnancy reduction, and the complex ethical issues inherent in decisions regarding the use of multifetal pregnancy reduction. Physicians should not be required to act in ways that conflict with their value systems but should be prepared to react in a professional and ethical manner to patient requests for both information and intervention.

Practice Bulletin #133 “Benefits and Risks of Sterilization” (Revised)
ABSTRACT: Female and male sterilization are both safe and effective methods of permanent contraception used by more than 220 million couples worldwide (1). Approximately 600,000 tubal occlusions and 200,000 vasectomies are performed in the United States annually (2–4). For women seeking permanent contraception, sterilization obviates the need for user-dependent contraception throughout their reproductive years and provides an excellent alternative for those with medical contraindications to reversible methods. The purpose of this document is to review the evidence for the safety and effectiveness of female sterilization in comparison with male sterilization and other forms of contraception.

The American College of Obstetricians and Gynecologists (The College), a 501(c)(3) organization, is the nation’s leading group of physicians providing health care for women. As a private, voluntary, nonprofit membership organization of approximately 56,000 members, The College strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care. The American Congress of Obstetricians and Gynecologists (ACOG), a 501(c)(6) organization, is its companion organization.


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