Abstract
Men aged 18 to 35 years (n = 1318) completed assessments of perpetration of intimate partner violence (IPV), abortion involvement, and conflict regarding decisions to seek abortion. IPV was associated with greater involvement by men in pregnancies ending in abortion and greater conflict regarding decisions to seek abortion. IPV should be considered within family planning and abortion services; policies requiring women to notify or obtain consent of partners before seeking an abortion should be reconsidered; they may facilitate endangerment and coercion regarding such decisions.
Intimate partner violence (IPV) is a major public health issue that affects the lives and health of approximately 20% to 25% of adolescent and adult US women,1,2 with women of reproductive age at greatest risk.3,4 Major reproductive health concerns associated with experiences of IPV include unintended5 and rapid repeat pregnancies.6–8 Given that unintended and unwanted pregnancies are the primary reason for seeking abortion,7,9 abused women are thought to be more likely to experience abortion than are their nonabused counterparts.10–12 Recent qualitative research suggests there is a broad role played by abusive male partners in controlling women's reproductive health,13–15 including attempts to control abortion-related decisions.13,15 However, quantitative data on this issue have primarily been collected from women attending abortion services, which therefore precludes comparisons to women with no abortion history.10–12 Given the increasing recognition of the role of male partners in controlling a woman's reproductive health and decision-making, coupled with the continuing public debate concerning both women's access to abortion and the role of family members in decisions regarding abortion (e.g., spousal consent),16 it is critical to understand to what extent abuse from male partners may relate to both women's seeking abortion and coercion regarding abortion-related decisions. We examined the association of young adult men's reports of perpetration of IPV and their participation in pregnancies ending in abortion as well as conflict surrounding abortion-related decisions.
METHODS
English-, Spanish-, or Portuguese-speaking men between the ages of 18 and 35 years were recruited from 3 large community health centers located in lower-income, urban, Boston-area neighborhoods. The participants completed a computer-based anonymous survey and received a $20 gift card and a list of local resources upon completion. The participation rate of men approached for inclusion was 65%; our sample was limited to participating men who reported ever having had sex (n = 1318).
Lifetime history of perpetration of physical and sexual IPV was assessed by use of modified versions of the Conflict Tactics Scale 217 and the Sexual Experiences Survey.18 Abortion involvement was assessed by a single item, “How many pregnancies that you have been involved in have resulted in abortion?”; responses were coded to reflect involvement in no abortions, 1 or 2 abortions, or 3 or more abortions. Conflict over abortion was assessed via a single item on the basis of our previous qualitative study: “Sometimes couples fight over what to do about a pregnancy. Have you and your girlfriends/sex partners/wife ever fought about a pregnancy?” Positive responses included “Yes, we fought because I wanted her to have the baby and she wanted an abortion” and “Yes, we fought because I wanted an abortion and she wanted to have the baby.” Prevalence estimates were calculated for lifetime history of IPV perpetration, abortion involvement, and abortion conflict; differences in abortion outcomes on the basis of the perpetration of IPV were assessed by χ2 analyses. Log-binomial regression models estimating adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) for the associations of IPV perpetration and abortion outcomes were constructed with adjustment for age, race/ethnicity, and recruitment site.
RESULTS
Approximately 1 in 3 participants reported having perpetrated physical or sexual violence against a female partner (31.9%; Table 1) or having been involved in a pregnancy that ended in abortion (33.2%; Table 2). Experiences of abortion involvement were more common among men reporting IPV perpetration (48.9% versus 25.9%; ARR = 1.79; 95% CI = 1.54, 2.06). The risk of being involved in 3 or more abortions was also greater for abusive men (8.8% versus 3.1%; ARR = 3.39; 95% CI = 2.06, 5.56). Similarly, partner conflict regarding abortion was more likely among abusive men (19.8% versus 7.0%; ARR = 2.80; 95% CI = 2.06, 3.82), with the perpetration of IPV associated with men's attempts to both promote and restrict the seeking of abortion services by female partners (ARRs = 2.41–2.60).
TABLE 1.
Perpetration of IPV |
Involved in at Least 1 Abortion |
||||
Sample Demographic, %a | %b | P | %b | P | |
Age, y | .002 | <.001 | |||
18–21 | 31.1 | 25.8 | 19.7 | ||
22–25 | 21.3 | 38.4 | 37.3 | ||
26–30 | 21.0 | 29.5 | 41.8 | ||
31–35 | 26.6 | 35.2 | 38.7 | ||
Race/ethnicity | .136 | <.001 | |||
White | 8.1 | 34.6 | 33.6 | ||
Black | 48.5 | 34.0 | 39.7 | ||
Hispanic | 31.5 | 30.7 | 27.1 | ||
Otherc | 11.9 | 24.8 | 22.9 | ||
Total | 31.9 | 33.2 |
Note. IPV = intimate partner violence. P values were determined with the χ2 test.
Column %.
Row %.
Asian/Pacific Islander/Native American.
TABLE 2.
Perpetration of IPV |
||||
Sample Percentage, % | Yes, % | No, % | ARR (95% CI) | |
Abortion involvement | ||||
None (Ref) | 66.8 | 51.1 | 74.1 | 1.00 |
Any | 33.2 | 48.9 | 25.9 | 1.79 (1.54, 2.06) |
1–2 | 28.3 | 40.1 | 22.7 | 1.79 (1.52, 2.11) |
≥ 3 | 4.9 | 8.8 | 3.1 | 3.39 (2.06, 5.56) |
Disagreement about abortion | ||||
None (Ref) | 89.9 | 80.2 | 93.0 | 1.00 |
Any | 11.1 | 19.8 | 7.0 | 2.80 (2.06, 3.82) |
Male partner sought to prevent seeking abortiona | 8.0 | 14.0 | 5.1 | 2.60 (1.76, 3.87) |
Male partner sought to compel to seek abortiona | 4.1 | 7.3 | 2.6 | 2.41 (1.38, 4.20) |
Note. ARR = adjusted risk ratio; CI = confidence interval; IPV = intimate partner violence. ARRs were adjusted for age, race/ethnicity, and recruitment site.
Responses not mutually exclusive.
DISCUSSION
Our findings clearly indicate that abusive men are more likely than their nonabusive peers to report being involved in pregnancies ending in abortion, with this effect amplified for the association of IPV and involvement in 3 or more abortions. Although these cross-sectional analyses did not allow us to reach definitive conclusions regarding causal relationships, the findings from previous research suggest that these results likely reflected abusive men's greater involvement in unintended pregnancy8,9 stemming from a range of behaviors that include forced or coerced sex, condom refusal, and control over contraception.13,19 Female partners of abusive men may also seek abortions more frequently on the basis of their fear of a shared child limiting their ability to leave the perpetrator or a fear of the abuse and neglect of such a child from this same man.20,21 These data describe the significant threat to women's reproductive control related to violence from male partners, a threat that should be considered in the design of all services and policies related to family planning and abortion. An important example of such consideration are policies supporting screening clients regarding their ability to control contraception and ensuring women's access to methods of contraception that are beyond the control of male partners (e.g., injectable contraception).
Importantly, men who perpetrated IPV were also more likely to report conflicts with pregnant female partners regarding decisions related to seeking abortion. This finding is consistent with studies demonstrating that women who experience IPV are less likely to discuss abortion decisions with a partner, often because of fear.22,23 Thus, clinical services requiring that women have the opportunity to meet privately with providers (i.e., without partners) should be mandated to ensure safety and autonomy regarding women's decisions. These data in no way indicate that women's access to abortion services should be impeded, rather that reductions in abusive men's coercive control over women's reproductive choices may well reduce many women's need for such services. Policies aimed at requiring women to notify partners or to obtain partner consent before undergoing an abortion should be reconsidered because of the likelihood of both endangering women and placing them at risk for coercion regarding this critical decision. Efforts to prevent the violent and coercive behavior of men and boys should be incorporated within any comprehensive program to reduce unintended pregnancy and the subsequent need for abortion services.
Acknowledgments
Support for the current study was provided to J. G. Silverman from the National Center for Injury Prevention and Control of the Centers for Disease Prevention and Control (R49CE000447).
Human Participant Protection
All methods were approved by the Human Subjects Committee at the Harvard School of Public Health.
References
- 1.Silverman JG, Raj A, Mucci LA, Hathaway JE. Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA 2001;286(5):572–579 [DOI] [PubMed] [Google Scholar]
- 2.Tjaden P, Thoennes N. Prevalence, Incidence and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey Washington, DC: Department of Justice, National Institute of Justice; 1998 [Google Scholar]
- 3.Hamberger LK, Ambuel B. Dating violence. Pediatr Clin North Am 1998;45(2):381–390 [DOI] [PubMed] [Google Scholar]
- 4.Bureau of Justice Statistics. Intimate Partner Violence Washington, DC: US Department of Justice; 2000 [Google Scholar]
- 5.Campbell JC, Soeken KL. Forced sex and intimate partner violence: effects on women's risk and women's health. Violence Against Women 1999;5(9):1017–1035 [Google Scholar]
- 6.Jacoby M, Gorenflo D, Black E, Wunderlich C, Eyler AE. Rapid repeat pregnancy and experiences of interpersonal violence among low-income adolescents. Am J Prev Med 1999;16(4):318–321 [DOI] [PubMed] [Google Scholar]
- 7.Kaye DK, Mirembe FM, Bantebya G, Johansson A, Ekstrom AM. Domestic violence as risk factor for unwanted pregnancy and induced abortion in Mulago Hospital, Kampala, Uganda. Trop Med Int Health 2006;11(1):90–101 [DOI] [PubMed] [Google Scholar]
- 8.Cripe SM, Sanchez SE, Perales MT, Lam N, Garcia P, Williams MA. Association of intimate partner physical and sexual violence with unintended pregnancy among pregnant women in Peru. Int J Gynaecol Obstet 2008;100(2):104–108 [DOI] [PubMed] [Google Scholar]
- 9.Silverman JG, Gupta J, Decker MR, Raj A. Intimate partner violence and unwanted pregnancy, miscarriage, induced abortion, and stillbirth among a national sample of Bangladeshi women. BJOG 2007;114(10):1246–1252 [DOI] [PubMed] [Google Scholar]
- 10.Wu J, Guo S, Qu C. Domestic violence against women seeking induced abortion in China. Contraception 2005;72(2):117–121 [DOI] [PubMed] [Google Scholar]
- 11.Hedin LW, Janson PO. Domestic violence during pregnancy. Acta Obstet Gynecol Scand 2000;79(8):625–630 [DOI] [PubMed] [Google Scholar]
- 12.Fisher WA, Singh SS, Shuper PA, et al. Characteristics of women undergoing repeat induced abortion. CMAJ 2005;172(5):637–641 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Miller E, Decker MR, Reed E, Raj A, Hathaway JE, Silverman JG. Male partner pregnancy-promoting behaviors and adolescent partner violence: findings from a qualitative study with adolescent females. Ambul Pediatr 2007;7(5):360–366 [DOI] [PubMed] [Google Scholar]
- 14.Silverman JG, Decker MR, McCauley HL, Reed E, Raj A, Miller E. Partner violence and coercive and deceptive forms of sexual risk among female adolescent clinic attendees. Perspect Sex Reprod Health In press [DOI] [PubMed] [Google Scholar]
- 15.Hathaway JE, Willis G, Zimmer B, Silverman JG. Impact of partner abuse on women's reproductive lives. J Am Med Womens Assoc 2005;60(1):42–45 [PubMed] [Google Scholar]
- 16.Annas GJ. The Supreme Court and abortion rights. N Engl J Med 2007;356(21):2201–2207 [DOI] [PubMed] [Google Scholar]
- 17.Straus MA, Hamby SL, Boney-McCoy S, Sugarman DB. The Revised Conflict Tactics Scales (CTS2). J Fam Issues 1996;17(3):283–316 [Google Scholar]
- 18.Koss MP, Gidycz C, Wisniewski N. The scope of rape: incidence and prevalence of sexual aggression and victimization in a national sample of higher education students. J Consult Clin Psychol 1987;55(2):162–170 [DOI] [PubMed] [Google Scholar]
- 19.Raj A, Santana C, La Marche A, Amaro H, Cranston K, Silverman JG. Perpetration of intimate partner violence associated with sexual risk behaviors among young adult men. Am J Public Health 2006;96(10):1873–1878 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Finer LB, Frohwirth LF, Dauphinee LA, Singh S, Moore AM. Reasons why U.S. women have abortions: quantitative and qualitative perspectives. Perspect Sex Reprod Health 2005;37(3):110–118 [DOI] [PubMed] [Google Scholar]
- 21.Bankole A. Reasons why women have induced abortions: evidence from 27 countries. Int Fam Plan Perspect 1998;24(3):117–152 [Google Scholar]
- 22.Woo J, Fine P, Goetzl L. Abortion disclosure and the association with domestic violence. Obstet Gynecol 2005;105(6):1329–1334 [DOI] [PubMed] [Google Scholar]
- 23.Glander SS, Moore ML, Michielutte R, Parsons LH. The prevalence of domestic violence among women seeking abortion. Obstet Gynecol 1998;91(6):1002–1006 [DOI] [PubMed] [Google Scholar]