In January 2013, the American College of Obstetricians and Gynecologists (ACOG) reported homicide as the number one killer of pregnant women, but physical violence is not the only kind of violence women face in dangerous relationships. Contraceptive sabotage is more common than many women may recognize, leading ACOG to establish guidelines and support materials for obstetricians to educate patients who may be experiencing violence at home. The program is called Futures Without Violence.
At the heart of contraceptive sabotage is intimate partner violence (IPV). IPV can be used to change a woman’s mind about sex, contraception and pregnancy. In some cases women are forced into leaving contraception behind in hopes of pregnancy. ACOG describes destructive behavior known as reproductive coercion. Reproductive coercion can include destroying birth control, damaging condoms or forcing a woman to remove an internal birth control device like an IUD. There are also reported cases of men forcibly removing IUDs without permission from the woman.
In an attempt to gain a better hold on reproductive coercion and contraceptive sabotage, ACOG suggests obstetricians screen teens and young women for IPV and reproductive coercion at yearly exams. Screening can also take place during prenatal or postpartum visits. Women reporting unintended pregnancy are at higher risk of IPV as are women who contract HIV or other STDs.
ACOG also suggests recommended contraceptive methods less likely to be detected – injected contraception or IUD with trimmed string to prevent removal. The focus of ACOG recommendations is to help obstetricians recognize patients at increased risk for IPV and reproductive coercion and help protect patients against unintended pregnancy or STD contraction without increasing personal risk to the patient.
Source: Reproductive and sexual coercion. Committee Opinion No. 554. American College of Obstetricians and Gynecologists. Obstet Gynecol 2013;121:411–5.