A new study has found that women in abusive relationships are less likely to use birth control. When they do use contraception, abused women choose more discreet methods — IUDs, injections, or even sterilization — that they don’t have to disclose, and that their partners are unable to refuse, deny to them or sabotage.
The study, authored by four professors at McGill University and published in a journal put out by the Public Library of Science, shows that abuse often has a direct effect on women’s contraception choices. It suggests that medical providers looking to reduce the incidence of STIs and HIV have to ask women about violence in their relationships, and work with them to find a birth control option that’s not subject to interference from their partners.
“When talking to abused women, I had often heard them mention they were opting for contraception methods their male partner could not refuse,” Lauren Maxwell, a PhD student at McGill University, told the research news website Futurity. “I wanted to know whether, across countries, women who experience intimate partner violence are less able to use contraception, which might explain why rates of abortion and HIV transmission are higher among women abused by their partners.” (The World Health Organization says abused women are more likely to contract HIV, for a variety of reasons: rape can increase vaginal trauma and tearing, for one, which opens the door to future HIV infections. Also, as the WHO notes, “violence and fear of violence” can make it hard for women to “negotiate safe sex.”)
The McGill authors looked at studies of abused women in the United States, India, South Africa, Zimbabwe, and Nicaragua. They found, not surprisingly, that women in abusive relationships were much less likely to report having partners who used condoms:
This review indicates that women who experience IPV [intimate partner violence] are less likely to report that their male partners use condoms than women who do not. Future research might examine the impact of harm reduction strategies on the ability of women who experience IPV to use condoms with their male partners. Condom use requires a complex set of negotiations between a woman and her male partner.
The study suggests that medical providers ask about intimate partner violence when discussing birth control options with their patients, something doctors in the United States are already supposed to do:
The American College of Obstetricians and Gynecologists offers specific guidance for providers to ask women about their experience of reproductive coercion. Recent clinical guidelines suggest that health care providers caring for women who experience reproductive coercion should offer contraceptive methods that are less susceptible to partner sabotage (e.g., IUD and implant) while counseling women about IPV and safety planning strategies. Ensuring that women can access long-acting and permanent contraceptive methods could help women who experience IPV plan their families.
As Futurity points out, the United Nations said in 2000 that they wanted to achieve “universal access to reproductive health” by 2015. That clearly hasn’t happened. Domestic violence, Maxwell told the publication, could be part of the problem. Lack of contraception, she said, “is detrimental to maternal and child health and to women’s education. To improve both, we should consider partner violence when creating programs designed to improve women’s access to contraception.”
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