Two recent “meta” studies (1, 2) paint a grim picture of the impact of domestic violence, i.e., intimate partner violence, on women’s use, or more accurately, non-use of contraception, and on having abortions. The studies are not limited to the United States and don’t necessarily involve unwed parents.
You can read the studies for yourself, but if you’re not versed in statistics lingo, it’s a slow go. And, as all good researchers do, the studies’ authors qualify their findings with caveats about results changing if new facts are discovered. But the findings are clear enough for me to present them in bullet point quotes. Note that the authors refer to domestic violence as IPV, intimate partner violence.
Study on Domestic Violence and Use of Contraception
- “Women’s experience of IPV was associated with a significant reduction in the odds of using contraception.” Explanation: domestic violence victims are significantly less likely to use contraception than women who are not victims.
- When women relied on their partners to use condoms, “experience of IPV was associated with a significant decrease in condom use.” The focus of that finding should be on the man, not the woman. What it really means is that batterers are less likely to use condoms than men who are not batterers.
- “[S]tudies from a number of countries indicate that IPV is associated with a constellation of women’s reproductive health outcomes related to contraception use including rapid repeat pregnancy (pregnancy within 24 months of a previous pregnancy); unintended pregnancy; pregnancy termination [abortion]; and … HIV infection.”
- “Reproductive coercion, taking control of women’s reproductive health, is one form of IPV. Women may be forced to have sex or to practice unprotected sex by their male partners and male partners may sabotage women’s use of family planning to increase their female partner’s dependency or to otherwise express their control over their partner’s decision making.”
- “[B]irth control sabotage is a type of reproductive coercion and … women may adopt contraceptive methods they can hide from their partners or that do not require negotiation with their male partners …”
- “Women’s ability to control the timing, spacing, and number of pregnancies is a critical health and human rights issue.”
- When the authors limited their focus to the seven most reliable previous studies, they found that “the odds of women who had experienced IPV reporting contraceptive use were 53% lower than the odds for women who had not experienced IPV.” Appalling explanation: domestic violence victims are 53% less likely to use contraception than non-victims. Said another way, DV victims are only half as likely to use birth control as women who are not victims.
- “[W]omen who experience IPV may be more likely to adopt contraceptive methods that they can hide from their partners. Further research is needed to understand whether women who experience IPV prefer to adopt long-acting reversible [LARC – IUDs and subcutaneous implants] and permanent contraceptive methods that are less likely to require their partner’s involvement.”
- “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.”
Study on Domestic Violence and Abortion
The language of this study is especially dense, and the results are spread across tables throughout the article. In the quotations, I have replaced the authors’ term, termination of pregnancy and its acronym TOP, with a word that more clearly reflects what it is, abortion. Though reading the article is a chore, the results are clear enough and, as with the other study, appalling:
- “High rates of physical, sexual, and emotional IPV were found across six continents among women seeking an abortion.” Explanation: women who sought abortions all over the world were highly likely to be victims of domestic violence, including physical, sexual, and emotional abuse.
- ‘[W]omen in abusive relationships were more likely to report inability to make autonomous contraceptive choices, partner contraceptive sabotage, and sexual violence, and they were less likely to have informed their partner about the pregnancy or involved him in decision-making about it.”
- “[W]omen who reported IPV were more likely … to have a history of multiple abortions. … The highest quality study found that women presenting for a third abortion were over two and a half times more likely to have a history of physical or sexual violence than women presenting for their first [abortion].” Let’s be clear on this. All of the women they’re talking about sought abortions. Among those women, the ones who had multiple abortions were two and a half times more likely to be domestic violence victims than women who were going for the first time to have an abortion.
- “Women reporting IPV were more likely to report an unwanted pregnancy.”
- “Women in violent relationships were more likely to have concealed the abortion from their partner than those who were not.”
- Five out of six studies of high to medium quality “found that compared to married women, those who were single, separated, divorced, or widowed were more likely to have a history of IPV and abortion.”
- One study specifically found that “Boyfriends were more likely to carry out physical violence than husbands, although the two groups were equally likely to perpetrate sexual violence.”
In the articles, the abortion connection is worded so innocuously sometimes that the point is lost to us readers unschooled in the technical terminology of the researchers. What these studies show, nevertheless, is that intimate partner violence is one of the main causes for women to need and obtain abortions. Even worse, women who have three abortions are two and a half times more likely to be victims of domestic violence. In other words, DV victims are more likely to have multiple abortions than women who are not victims of intimate partner violence.
How do I hurt thee? Let me count the ways.
The following is my unpoetic, plain language list of the reproductive effects of battering gleaned from these two articles; it flips Elizabeth Barrett Browning’s loving sonnet How Do I Love Thee? on its head:
- DV victims are significantly less likely than non-victims to use birth control. In fact, the best studies indicate that domestic violence victims are only half as likely as non-victims to use contraception.
- In couples who rely primarily on condoms for birth control, batterers are less likely to use condoms than non-batterers, and, therefore, the woman runs a higher risk of pregnancy and STDs.
- DV victims are more likely than non-victims to get pregnant too soon after a previous pregnancy.
- Batterers may force their partners to have unwanted or unprotected sex.
- Batterers may sabotage, i.e., interfere with, a woman’s use of contraception to maintain control over her or increase her dependence on him.
- DV victims are more likely to have unplanned pregnancies.
- DV victims are more likely to have unwanted pregnancies.
- Women all over the world who get abortions are likely to be victims of domestic violence.
- Women who have a second or third abortion are more likely to be victims of domestic violence than women seeking a first abortion. Women seeking a third abortion are two and a half times more likely to be DV victims than women seeking their first abortion.
The Baby Mama/Baby Daddy/ Boyfriend Connection
Unwed relationships are less stable and more prone to domestic violence. But because of the ever-changing live-in arrangements and greater likelihood of domestic violence in baby mama/baby daddy/boyfriend relationships, the impact of domestic violence is greater for unmarried mothers than for married moms. Although there is not a lot of scholarly research on this issue, these two studies support my thesis. I also have no doubt that intimate partner violence in unmarried relationships contributes to the fact that most unwed pregnancies are unplanned.
LARC: Long Acting Reversible Contraception
These studies indicate that some women, when their partner sabotages their birth control efforts, resort to contraceptive methods they can hide from their partners. The experts in these articles suggest that long acting reversible contraception (LARC), or even permanent methods, may be one way for victims to deal with intimate partner contraceptive sabotage.
The authors say more study is needed on the issue, but they point out that the American College of Obstetricians and Gynecologists’ clinical guidelines suggest that health care providers should offer victims of reproductive coercion methods of contraception that are less susceptible to sabotage. Specifically, they recommend IUDs and implants.
IUDs and subcutaneous implants are the two varieties of long acting reversible contraception. I have been a vocal advocate of free LARC to any woman who wants it. The Contraceptive CHOICE Project at Washington University in St. Louis established beyond question that free LARC can result in a tremendous drop in unplanned pregnancies and abortions. LARC won’t stop intimate partner violence, including coerced unprotected sex, but it can give DV victims an option for birth control that the man can’t sabotage.
(In case the links to the studies don’t work, these are their formal names:
Estimating the Effect of Intimate Partner Violence on Women’s Use of Contraception: A Systematic Review and Meta-Analysis by Lauren Maxwell et al (February 18, 2015).
Associations between Intimate Partner Violence and Termination of Pregnancy: A Systematic Review and Meta- Analysis by Megan Hall et al (January 2014).
I found both on PLOS online.)
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