Associations Between Reproductive Coercion and Abuse by a Partner and Physical, Mental, Sexual and Reproductive Health Outcomes

Purpose: Reproductive coercion and abuse (RCA) is defined as deliberate interference in a person’s reproductive choices. It is overwhelmingly perpetrated against women by male intimate partners. Whilst it is generally agreed that RCA is harmful to health and wellbeing, reliable evidence for its specific associations has been lacking. In this study, our aim was to identify the physical, mental, sexual and reproductive health outcomes associated with RCA, using conceptually robust, comprehensive questions that encompass both pregnancy preventing and promoting behaviors and specify perceived perpetrator intent. Methods: In this study, we drew on data from two waves of the Australian Longitudinal Study on Women’s Health (n=6322 women aged 43-48 and n=5711 women aged 28-35). We reported the percentage of women with each health outcome, grouped by whether they had ever experienced RCA. We then estimated risk ratios for the association between RCA and each health outcome, controlling for sociodemographics and other intimate partner violence (IPV). Results: We found that lifetime partner-perpetrated RCA was associated with a range of adverse health outcomes for women aged 43-48 and 28-35 including elevated risk of unintended pregnancies (adjRR=2.42, 95% CI=2.16, 2.72 among women aged 28-35), miscarriages (adjRR=1.22, 95% CI=1.05, 1.41, and adjRR=2.08, 95% CI=1.74, 2.49, respectively), terminations (adjRR=2.39, 95% CI=2.11, 2.71, and adjRR=2.97, 95% CI=2.52, 3.50, respectively), premature birth (adjRR=1.72, 95% CI=1.01, 2.93 among women aged 28-35), and perinatal mental health disorders (adjRR=1.45, 95% CI=1.21, 1.74, and adjRR=1.68, 95% CI=1.42, 1.98, respectively), even after adjusting for sociodemographic variables and other IPV. RCA was also associated with poorer physical health (adjRR=1.33, 95% CI=1.05, 1.70, and adjRR=1.30, 95% CI=1.07, 1.57, respectively) and very high psychological distress (adjRR=1.24, 95% CI=1.03, 1.48 among women aged 28-35), including anxiety and depression (adjRR=1.24, 95% CI=1.07, 1.44, and adjRR=1.13, 95% CI=1.02, 1.24, respectively) and self-harm (adjRR=2.04, 95% CI=1.17, 3.56, and adjRR=1.49, 95% CI=1.11, 1.99, respectively). Conclusions: Our findings have important implications at the policy level and for the healthcare sector, highlighting the potential harms of RCA and the need for tailored screening, early intervention and response, particularly in abortion and antenatal settings.