Heather L. McCauley

Pregnancy coercion, intimate partner violence and unintended pregnancy ☆

BACKGROUND Reproductive control including pregnancy coercion (coercion by male partners to become pregnant) and birth control sabotage (partner interference with contraception) may be associated with partner violence and risk for unintended pregnancy among young adult females utilizing family planning clinic services. STUDY DESIGN A cross-sectional survey was administered to females ages 16-29 years seeking care in five family planning clinics in Northern California (N=1278). RESULTS Fifty-three percent of respondents reported physical or sexual partner violence, 19% reported experiencing pregnancy coercion and 15% reported birth control sabotage. One third of respondents reporting partner violence (35%) also reported reproductive control. Both pregnancy coercion and birth control sabotage were associated with unintended pregnancy (AOR 1.83, 95% CI 1.36-2.46, and AOR 1.58, 95% CI 1.14-2.20, respectively). In analyses stratified by partner violence exposure, associations of reproductive control with unintended pregnancy persisted only among women with a history of partner violence. CONCLUSIONS Pregnancy coercion and birth control sabotage are common among young women utilizing family planning clinics, and in the context of partner violence, are associated with increased risk for unintended pregnancy.

A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion

BACKGROUND This study examined the efficacy of a family-planning-clinic-based intervention to address intimate partner violence (IPV) and reproductive coercion. STUDY DESIGN Four free-standing urban family planning clinics in Northern California were randomized to intervention (trained family planning counselors) or standard of care. English-speaking and Spanish-speaking females ages 16-29 years (N = 906) completed audio computer-assisted surveys prior to a clinic visit and 12-24 weeks later (75% retention rate). Analyses included assessment of intervention effects on recent IPV, awareness of IPV services and reproductive coercion. RESULTS Among women reporting past-3-months IPV at baseline, there was a 71% reduction in the odds of pregnancy coercion among participants in intervention clinics compared to participants in the control clinics that provided standard of care. Women in the intervention arm were more likely to report ending a relationship because the relationship was unhealthy or because they felt unsafe regardless of IPV status (adjusted odds ratio = 1.63; 95% confidence interval=1.01-2.63). CONCLUSIONS Results of this pilot study suggest that this intervention may reduce the risk for reproductive coercion from abusive male partners among family planning clients and support such women to leave unsafe relationships.

Sex trafficking, sexual risk, sexually transmitted infection and reproductive health among female sex workers in Thailand

Background The trafficking of women and girls for sexual exploitation is an internationally recognised form of gender-based violence, and is thought to confer unique sexual and reproductive health vulnerabilities. To date, little research has compared sexual risk or health outcomes among female sex workers (FSWs) on the basis of experiences of sex trafficking. Aim To compare experiences of sexual risk and sexual and reproductive health outcomes among FSWs on the basis of experiences of trafficking as an entry mechanism to sex work. Methods Data from a national sample of FSWs in Thailand (n=815) was used to assess (a) the prevalence of sex trafficking as an entry mechanism into sex work and (b) associations of sex trafficking with sexual risk and health outcomes. Results Approximately 10% of FSWs met criteria for trafficking as an entry mechanism to sex work. Compared with their non-trafficked counterparts, sex-trafficked FSWs were more likely to have experienced sexual violence at initiation to sex work (adjusted risk ratio (ARR) 2.29, 95% CI 1.11 to 4.72), recent workplace violence or mistreatment (ARR 1.38, 95% CI 1.13 to 1.67), recent condom failure (ARR 1.80, 95% CI 1.15 to 2.80), condom non-use (ARR 3.35, 95% CI 1.49 to 7.52) and abortion (ARR 2.83, 95% CI 1.48 to 5.39). Discussion Both the prevalence of sex trafficking as an entry mechanism to sex work and the threats to sexual and reproductive health observed on the basis of trafficking status show the need for comprehensive efforts to identify and support this vulnerable population. Moreover, existing STI/HIV-prevention programming may be stymied by the limited condom-use capacity and high levels of violence observed among those trafficked into sex work.

Coercive Forms of Sexual Risk and Associated Violence Perpetrated by Male Partners of Female Adolescents

CONTEXT Partner violence is associated with STDs among female adolescents, but the mechanisms underlying this association remain unclear. Sexually coercive and deceptive behaviors of male partners that increase female STD risk may be factors in this relationship. METHODS A sample of 356 females aged 14-20 who attended adolescent health clinics in Greater Boston between April and December 2006 were assessed for physical and sexual violence perpetrated by male partners and for exposure to sexual risk factors. Adjusted logistic regression models were used to examine the associations between intimate partner violence and standard sexual risk behaviors (e.g., multiple partnerships) and coercive or deceptive sexual risk factors (e.g., coerced condom nonuse). RESULTS More than two-fifths of the sample had experienced intimate partner violence. In adjusted analyses, adolescents reporting intimate partner violence were more likely than others to report standard sexual risk behaviors--multiple partners, anal sex and unprotected anal sex (odds ratios, 1.7-2.2). They also were more likely to report coercive or deceptive sexual risk factors--partner sexual infidelity, fear of requesting condom use, negative consequences of condom request, and coerced condom nonuse (2.9-5.3). CONCLUSION The high prevalence of intimate partner violence against young women attending adolescent clinics strongly indicates the need to target this population for abuse-related interventions. This need is underlined by the observed association between partner violence and sexual risk involving coercion or deception by male partners. Clinic-based STD and pregnancy prevention efforts should include assessment of sexual risk factors that are beyond the control of young women, particularly for those experiencing abuse.

Recent reproductive coercion and unintended pregnancy among female family planning clients.

OBJECTIVE Reproductive coercion (RC)--birth control sabotage and coercion by male partners to become pregnant and to control the outcome of a pregnancy--has been associated with a history of both intimate partner physical and sexual violence (IPV) and unintended pregnancy among females utilizing reproductive health services. The temporal nature of associations of RC and unintended pregnancy (distinct from the impact of IPV), however, has remained less clear. STUDY DESIGN A survey was administered to females aged 16-29 years seeking care in 24 rural and urban family planning clinics in Pennsylvania (n=3539). RESULTS Five percent of respondents reported RC in the past 3 months, and 12% reported an unintended pregnancy in the past year. Among those who reported recent RC, 21% reported past-year unintended pregnancy. Compared to women exposed to neither condition, exposure to recent RC increased the odds of past-year unintended pregnancy, both in the absence of a history of IPV [adjusted odds ratio (AOR) 1.79, 1.06-2.03] and in combination with a history of IPV (AOR 2.00, 1.15-3.48); history of IPV without recent RC was also associated with unintended pregnancy (AOR 1.80, 1.42-2.26). CONCLUSIONS Findings indicate the temporal proximity of the association of RC and unintended pregnancy, with recent RC related to past-year unintended pregnancy, both independently and in combination with a history of IPV. Recent RC is relatively prevalent among young women using family planning clinics and is associated with increased risk for past-year unintended pregnancy even in the absence of IPV. IMPLICATIONS Recent RC and a history of IPV are prevalent among female family planning clients, particularly younger women, and these experiences are each associated with unintended pregnancy. Pregnancy prevention counseling should include not only assessment for physical and sexual partner violence but also specific inquiry about RC.

Male Perpetration of Intimate Partner Violence and Involvement in Abortions and Abortion-Related Conflict

Men aged 18 to 35 years (n = 1318) completed assessments of perpetration of intimate partner violence (IPV), abortion involvement, and conflict regarding decisions to seek abortion. IPV was associated with greater involvement by men in pregnancies ending in abortion and greater conflict regarding decisions to seek abortion. IPV should be considered within family planning and abortion services; policies requiring women to notify or obtain consent of partners before seeking an abortion should be reconsidered; they may facilitate endangerment and coercion regarding such decisions.

Gender-equitable attitudes, bystander behavior, and recent abuse perpetration against heterosexual dating partners of male high school athletes

OBJECTIVES We assessed the relationship between gender attitudes, identified as a critical component of violence prevention, and abuse toward dating partners among adolescent male athletes. METHODS Our sample comprised 1699 athletes from 16 high schools in northern California who were surveyed between December 2009 and October 2010 in the larger Coaching Boys Into Men trial. We used logistic regression to assess the association between gender-equitable attitudes, bystander behavior, and recent abuse incidents. RESULTS Athletes with more gender-equitable attitudes and greater intention to intervene were less likely (adjusted odds ratio [AOR] = 0.36; 95% confidence interval [CI] = 0.28, 0.46; and AOR = 0.60; 95% CI = 0.48, 0.75, respectively) and athletes who engaged in negative bystander behavior were more likely (AOR = 1.22, 95% CI = 1.10, 1.35) to perpetrate abuse against their female dating partners. CONCLUSIONS Despite the shift among bystander intervention programs toward gender neutrality, our findings suggest a strong association between gender attitudes and dating violence. Programs designed for adolescents should include discussion of gender attitudes and target bystander behavior, because these components may operate on related but distinct pathways to reduce abuse.

Mexico's northern border conflict: collateral damage to health and human rights of vulnerable groups

OBJECTIVE To compare distributions of human rights violations and disease risk; to juxtapose these patterns against demographic and structural environmental variables, and to formulate implications for structural interventions. METHODS Female sex workers who inject drugs were surveyed in Tijuana and Ciudad Juarez, Mexico. Structured interviews and testing for sexually transmitted infections (STIs) were conducted (October 2008 to October 2009). Frequencies of individual and environmental factors, including police abuse, risk of HIV infection, and protective behaviors, were compared between sites using univariate logistic regression. RESULTS Of 624 women, almost half reported police syringe confiscation despite syringes being legal; 55.6% reported extortion (past 6 months), with significantly higher proportions in Ciudad Juarez (P < 0.001). Reports of recent solicitation of sexual favors (28.5% in Tijuana, 36.5% in Ciudad Juarez, P = 0.04) and sexual abuse (15.7% in Tijuana, 18.3% in Ciudad Juarez) by police were commonplace. Prevalence of STIs was significantly lower in Tijuana than in Ciudad Juarez (64.2% and 83.4%, P < 0.001), paralleling the lower prevalence of sexual risk behaviors there. Ciudad Juarez respondents reported significantly higher median number of monthly clients (6.8 versus 1.5, P < 0.001) and lower median pay per sex act (US

Recent partner violence and sexual and drug-related STI/HIV risk among adolescent and young adult women attending family planning clinics

10 versus US

Gender-based disparities in infant and child mortality based on maternal exposure to spousal violence: The heavy burden borne by Indian girls

20, P < 0.001) (in the past month). Relative to Tijuana, security deployment, especially the armys presence, was perceived to have increased more in Ciudad Juarez in the past year (72.1% versus 59.2%, P = 0.001). CONCLUSIONS Collateral damage from police practices in the context of Mexicos drug conflict may affect public health in the Northern Border Region. Itinerant officers may facilitate disease spread beyond the region. The urgency for mounting structural interventions is discussed.