Center for Health Equity Research and Promotion, VA Pittsburgh Health Care System.
Division of Adolescent Medicine, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh.
Am J Obstet Gynecol. 2018 Feb;218(2):239.e1-239.e8. doi: 10.1016/j.ajog.2017.10.015. Epub 2017 Oct 19.
Male partner reproductive coercion is defined as male partners' attempts to promote pregnancy through interference with women's contraceptive behaviors and reproductive decision-making. Male partners may try to promote pregnancy through birth control sabotage such as taking away or destroying their partners' contraceptives, refusing to wear condoms, and/or verbally pressuring their partners to abstain from contraceptive use. Reproductive coercion is associated with an elevated risk for unintended pregnancy. Women who experience intimate partner violence, who are in racial/ethnic minorities, and who are of lower socioeconomic status are more likely to experience reproductive coercion. Women veterans who use Veterans Affairs for health care may be particularly vulnerable to reproductive coercion because they are disproportionally from racial/ethnic minority groups and experience high rates of intimate partner violence.
We sought to examine the prevalence, correlates, and impact of reproductive coercion among women veterans who are served by the Veterans Affairs healthcare system.
We analyzed data from a national telephone survey of women veterans aged 18-44 years, with no history of sterilization or hysterectomy, who had received care within the Veterans Affairs system in the previous 12 months. Participants who had sex with men in the last year were asked if they experienced male partner reproductive coercion. Adjusted logistic regression was used to examine the relationship between participant characteristics and male partner reproductive coercion and the relationship between reproductive coercion and the outcomes of contraceptive method used at last sex and pregnancy and unintended pregnancy in the last year.
Among the 1241 women veterans in our study cohort, 11% reported experiencing male partner reproductive coercion in the past year. Black women, younger women, and single women were more likely to report reproductive coercion than their white, older, and married counterparts. Women who experienced military sexual trauma were also more likely to report reproductive coercion compared with women who did not report military sexual trauma. In adjusted analyses, compared with women who did not experience reproductive coercion, those who did were less likely at last sex to have used any method of contraception (76% vs 80%; adjusted odds ratio, 0.61; 95% confidence interval, 0.38-0.96), prescription contraception (43% vs 55%; adjusted odds ratio, 0.62; 95% confidence interval, 0.43-0.91), and their ideal method of contraception (35% vs 45%; adjusted odds ratio, 0.63; 95% confidence interval, 0.43-0.93). Those who reported coercion were more likely to have had a pregnancy in the last year (14% vs 10%; adjusted odds ratio, 2.07; 95% confidence interval, 1.17-3.64); there were no significant differences in unintended pregnancy by coercion status (6% vs 4%; adjusted odds ratio, 1.63; 95% confidence interval, 0.71-3.76).
Eleven percent of women veterans in our sample experienced male partner reproductive coercion, which may impact their use of contraception and ability to prevent pregnancy.
男性伴侣生殖胁迫是指男性伴侣通过干扰女性的避孕行为和生殖决策来促进怀孕的企图。男性伴侣可能会通过破坏或拿走伴侣的避孕药具、拒绝使用安全套和/或口头施压伴侣停止使用避孕药具等方式来尝试促进怀孕。生殖胁迫与意外怀孕的风险增加有关。经历过亲密伴侣暴力、属于少数族裔和社会经济地位较低的女性更有可能经历生殖胁迫。在退伍军人事务部接受医疗保健的女性退伍军人可能特别容易受到生殖胁迫的影响，因为她们不成比例地来自少数族裔群体，并经历高比例的亲密伴侣暴力。
我们试图研究在接受退伍军人事务医疗保健系统服务的女性退伍军人中，生殖胁迫的流行率、相关性和影响。
我们分析了一项针对年龄在 18-44 岁、过去 12 个月内曾在退伍军人事务系统接受过护理、无绝育或子宫切除术史的女性退伍军人的全国性电话调查数据。在过去一年中与男性发生过性行为的参与者被问及他们是否经历过男性伴侣生殖胁迫。采用调整后的逻辑回归来研究参与者特征与男性伴侣生殖胁迫之间的关系，以及生殖胁迫与最后一次性行为中使用的避孕方法以及过去一年中怀孕和意外怀孕之间的关系。
在我们的研究队列中，1241 名女性退伍军人中有 11%报告在过去一年中经历过男性伴侣生殖胁迫。黑人女性、年轻女性和单身女性比白人、年长和已婚女性更有可能报告生殖胁迫。经历过军事性创伤的女性比没有经历过军事性创伤的女性更有可能报告生殖胁迫。在调整后的分析中，与没有经历生殖胁迫的女性相比，经历过生殖胁迫的女性在最后一次性行为中使用任何避孕方法的可能性较低（76%比 80%；调整后的优势比，0.61；95%置信区间，0.38-0.96）、使用处方避孕药的可能性较低（43%比 55%；调整后的优势比，0.62；95%置信区间，0.43-0.91）和她们理想的避孕方法的可能性较低（35%比 45%；调整后的优势比，0.63；95%置信区间，0.43-0.93）。报告遭受胁迫的女性更有可能在过去一年中怀孕（14%比 10%；调整后的优势比，2.07；95%置信区间，1.17-3.64）；胁迫状态与意外怀孕之间没有显著差异（6%比 4%；调整后的优势比，1.63；95%置信区间，0.71-3.76）。
我们样本中的 11%的女性退伍军人经历过男性伴侣生殖胁迫，这可能会影响她们使用避孕措施和预防怀孕的能力。
