New advice to doctors on how to identify and

A new paper has been published in BMJAdvise health workers on identifying signs of forced childbearing – when a woman becomes pregnant, or when a pregnancy is prevented or forcibly terminated, against her will.

Reproductive coercion can include a range of behaviours, all of which are forms of abuse. A partner or family member can include psychological pressure and emotional blackmail, as well as physical and sexual violence, to dictate a woman’s reproductive choices. As with all forms of abuse, many authorities, including social workers and the police, can be involved. Health care workers are often in a good position to detect the signs first.

“Although this has been known for a long time, the extent of reproductive coercion has only been studied in the past decade,” said Professor Sam Rowlands of Bournemouth University who led the group that produced the new educational paper. He was also one of the first health professionals to write on the subject.

“More information and guidance is still needed to help clinicians identify and support affected women,” he added.

During his study, Professor Rowlands found that women can be reluctant to reveal whether their pregnancy, or termination of pregnancy, has been imposed on them. This could be because children may be involved or because they feel dependent on their controlling partner.

Prof Rowlands explained: “It’s easy to miss the marks completely because they can be invisible from the outside, so this is often hiding in plain sight.”

In this new paper, Professor Rowlands and his team advise that repeated requests for emergency contraception, a pregnancy test, a sexually transmitted infection test, or a pregnancy termination may be signs of a compulsion. Women who experience forced childbearing are also more likely to request highly effective contraceptive methods such as implants, intrauterine contraceptives, or sterilization.

They also put together a series of questions that doctors could ask the women to gather more information if they suspected coercion. This includes how to ask the woman’s partner to leave the room so they can talk to her on her own.

“It is important that doctors’ questions are specific and that it is clear to affected women that they understand this,” Prof Rowlands explained. Vague questions like “How are things going at home?” And questions that appear as a routine square tick are unlikely to lead to someone asserting that they have been abused.”

The study team advises that a professional doctor-patient relationship, based on trust and confidentiality, is critical. Women who experience this type of abuse will know the implications of disclosure, for example doctors may have a duty to involve the police and other authorities. This can be another barrier to openness. In these cases, doctors advise giving women cards showing how they can get advice and support. Posters on clinic walls can also help raise awareness among people who are being abused, or for people who suspect that a friend or family member may be affected.

The paper concludes with practical steps doctors can take if a woman who has experienced such abuse feels unable to separate from her partner.

“As professionals, we can help women by providing concealable contraceptives, so they can offer some kind of resistance to coercion,” said Professor Rowlands. “It is good for patients to have a doctor who understands what is going on but who are confident enough to know that they will not routinely share other parties against their wishes.

“Combining providing them with contraceptives that their partners are unlikely to find out with information about how to get support is a positive way to empower women to decide on next steps when they feel the time is right,” he concluded.

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