Birth Control As A Universal Right

When we think of domestic violence, we usually form a picture of a man who is physically abusive towards his partner, frequently covering her in bruises and leaving her with little control over her own life.

Domestic violence, unfortunately, occurs in a large variety of ways — it is worth mentioning that women are certainly not the only victims, though abusive partners are often men. Physical abuse frequently forms a big part of domestic violence, but emotional and psychological abusive and manipulation are other pieces of the puzzle. One other piece that society tends to neglect is reproductive coercion.

Control over one's reproductive choices is a fundamental part of western civilization, and it can be hard to imagine that women in developed countries are being forced to get pregnant and stay pregnant. Intentional exposure to sexually transmitted diseases, partner sabotage of birth control, and pressure to undergo abortion are other elements of a living hell many more women than we'd ever like to admit call reality.

Reproductive coercion is not limited to rural communities in developing countries; women right within our communities could be facing this horror, and most likely are. SteadyHealth joins women's rights campaigners from around the world in marking International Day Of Action For Women's Health today. We recognize that reproductive coercion, and domestic violence in general, is far from straight forward, and think that ensuring abused women maintain control over if and how they get pregnant is essential.

One Woman's Reproductive Coercion Story

What kind of woman ends up in an abusive relationship, facing reproductive coercion among other forms of abuse? It is impossible to fit domestic abuse into a neat box, as much as we'd like to. Abuse happens to all kinds of women, and all kinds of women find it terribly hard to get out. I'm sharing one woman's story here, to give reproductive coercion a face. 

Violet is an articulate, highly educated and well-read woman who has no trouble taking a stand on many political issues. We met through friends, and started hanging out at local parks a few years back after we found out our two kids really hit it off. Having someone who was into many of the same things I cared about to talk to was marvelous — park days were much less boring for me now I had someone to talk to.

We both feel passionate about homebirth, breastfeeding, the environment and classical literature. Violet turned out to be a great friend, but I soon discovered she was also carrying around a dark secret, and a heavy burden. Her handsome husband was eight years her junior. He worked abroad for months at a time, and when he returned he initially worked hard to make me and the other park moms like him.

It was clear something wasn't quite right rather soon, though. Violet's husband was a controlling jerk. He would either show up at the park to monitor her activities (then, he'd tell all the other moms she was cheating on him), or else would call her on her cellphone every 30 minutes or so. When he went off to work again, he'd paradoxically completely vanish, leaving Violet to struggle with finances — he “wouldn't let her get a job”, so she was dependent on him. 

Since I've known her, Violet's husband has done some pretty shocking things. He beat her up, kicked her in the abdomen while pregnant, and left them without money for basic needs like food. But the way in which he has been manipulating her reproductive life is perhaps the most surprising side of this woman's life.

One time, she asked me to babysit her son so she could get an abortion. The back story? Her husband was convinced that she had cheated on him, and didn't want the baby. She felt she had no choice. Another time, she asked to borrow a book I have about herbs, including herbal birth control, because her husband didn't want her to go on the pill. She eventually got pregnant again, and again her husband was sure she cheated. He vanished for nine months, telling everyone around her that she had been unfaithful and he wasn't the baby's father. Once the baby was born, he came back and played the cheerful, responsible daddy.

After Violet had her second child, she asked friends to get her the morning-after pill many times, because he was hell-bent on getting her pregnant again. His constant presence meant she could not just go to the doctor, and the park was her only refuge. 

Partner violence is a complex issue. Most people, including me, would ask why Violet and women like her don't simply leave their abusive partners. Many try, only to come back again — Violet too. This is where reproductive coercion proves to be such a powerful form of abuse. Denying a woman access to birth control, and forcing her to get pregnant and have children gives abusive men a real edge:

• The children become a pawn, and the fear that the man would get custody over the kids if the abused woman were to leave is very real for many.

• Taking care of young children places the woman at a distinct economic disadvantage, which keeps them dependent on their abusive partners.

• Being violated in this frighteningly intimate way strips the woman of her basic dignity. When an abused woman is robbed of her confidence, she is less likely to leave.

• Single parenthood still presents a stigma in many communities, and women with children may feel they are stuck in the abusive relationship.

Violet continues to be in an on-off relationship with her abusive husband, though she can see the situation clearly and has tried to leave several times. When her husband kicked her in the abdomen during her last pregnancy in front of a police officer (she'd called the police when he beat her up), she managed to get a restraining order against him. He was deemed unsafe and wasn't allowed to see his children. Despite that, she allowed him into her life again — and had another abortion.

Why? “I'm not ready, I'm not strong enough to be without him,” is the most truthful answer she can come up with. Yet, she is quite aware she and her children are victims, and allowed me to share her story anonymously. She says she will leave, one day. These women often meet with judgement from society, including from healthcare providers. Whether you want to judge these women or feel compassionate, one thing is clear: many abused women do not leave their relationships, and these women have a very real need for reproductive care and birth control.

Helping Abused Women Access Birth Control And Reproductive Care

Reproductive coercion has many faces:

• Denying the victim access to birth control outright.

• Preventing her from seeing healthcare providers, including for prenatal care and regular gynecological check-ups.

• Hiding contraceptives such as birth control pills.

• Tampering with contraceptives, like replacing pills with placebos or making holes in condoms.

• Forcing the victim to undergo an abortion.

• Coercing the victim to get pregnant and have children.

Clearly, primary healthcare providers have a huge role to play in helping these women. One part of that role is screening every women seeking some form of reproductive care for domestic violence.

All abortion care providers should ask themselves if the woman in front of them is being coerced into terminating her pregnancy by her partner. Speaking to the women without the presence of her partner is essential in this.

Pregnant women benefit from the same type of screening. Prenatal care providers can help women by attempting to find out more about their personal situation, and by making it clear that they can be part of the solution if domestic violence is an issue.

Any healthcare provider who deals with reproductive care could make all the difference in a woman's life by providing information on where abused women can get help, and reminding her that what she is facing is abuse. This information can be provided in the form of posters, or cards and leaflets handed out directly to women deemed to be at risk.

In cases where it is clear that a woman is in an abusive relationship where reproductive coercion is a problem, covert contraception is one concrete way in which healthcare providers can help. Intrauterine devices with the strings cut off can't be detected by abusive partners, and Implanon birth control implants may be another option. Offering contraceptive pills disguised as multivitamins or other medications is something I haven't seen suggested anywhere, but that I think can help too.

Women in abusive relationships would ideally come to the decision to leave their partner to start a life fresh from violence, together with any children they have. There is no need to say that doctors, nurses, midwives and psychologists make the biggest difference if they can support a domestic violence victim in such a way that she feels able to leave. Reality tells us that this is not always possible, and that meeting victims where they are can still give them much greater control over their life. Helping a woman regain control over her own uterus is a huge start.

All the rest of us, people who aren't healthcare providers, can also play a role in helping abused women. A few will end up in the position to offer a helping hand or lend a listening ear to abused women, like Violet, while others will volunteer at charities that help women and children escape violence, or make donations.

But you don't need to commit your time or money to use International Day Of Action For Women's Health as an opportunity to help advance women's rights. Simply thinking about the predicament in which abused women find themselves is a large step. Understand that domestic violence and reproductive coercion are real, that they are complex issues, and that victims need and deserve practical support, instead of judgement. That alone is huge.