Experiences of reproductive coercion among Latina women and strategies for minimizing harm: “The path makes us strong”

Abstract

Introduction

Latina women disproportionately report experiencing reproductive coercion (RC), a set of behaviors that interfere with autonomous reproductive decision-making. Given RC’s associations with intimate partner violence (IPV) and unintended pregnancy, it is critical to identify and address RC to assist women to achieve safety, autonomy, and reproductive life plans. The purpose of this study was to describe and understand the context of RC and the use of RC safety strategies among Latina women receiving services at an urban clinic, through listening to the experiences of the women in their own words.

Methods

Qualitative descriptive methodology was used. Semi-structured interviews were conducted with a purposive sample of 13 Latina women recruited from a Federally Qualified Health Center in the Washington, DC area.

Results

Data were organized into three a priori categories: (1) RC Behaviors, (2) Co-occurrence of RC and IPV, and (3) RC Harm Reduction Strategies. New RC behaviors emerged, and immigration status was used as a method of coercive control. From these a priori categories emerged four themes: Impact of Immigrant and Citizenship Status, Machismo, Strength and Bravery, and Importance of Family. Harm reduction strategies included less detectable contraception; some sought community services but others resorted to deception and stalling as the only tools available to them.

Discussion

Less detectable methods of contraception remained useful harm reduction strategies for women experiencing RC. Midwives should inquire about method fit and be mindful of honoring the request when patients ask to change methods. Women’s strength and resilience emerged as a vital source of power and endurance. This diverse sample and the powerful voices of the women who participated make a significant contribution to the understanding of RC experienced by Latina women in the United States.

Précis:

Reproductive coercion (behaviors that threaten women’s autonomous reproductive health decision-making) is studied in a sample of Latina women, with implications for clinicians and researchers.

INTRODUCTION

While an estimated 45 percent of pregnancies in the United States are unintended, there is significant racial and ethnic disparity in this health concern.¹ Latina women have a 71% higher odds of unintended pregnancy compared to white women,² and have the second highest rate of unintended births.¹ Many factors underlie this disparity, from individual and interpersonal to systemic and societal.^{2,3,12,4–11} Reproductive coercion (RC), behavior that interferes with women’s autonomous reproductive decision-making, is strongly correlated with unintended pregnancy.^13–15 RC disproportionately affects Latina women (when compared to white women)^13–17 and may contribute to unintended pregnancy disparities.

Partners may exert coercive reproductive control over women by sabotaging contraceptive methods, verbally pressuring them to get pregnant or to end a pregnancy, threatening violence if the woman does not get pregnant or end a pregnancy, or blocking access to reproductive health services.¹⁸ Aspects of RC overlap with intimate partner violence (IPV); power and coercive control are often motivating factors for both, and RC is one type of coercive behavior used by some abusers.^19,20

Existing literature points to population differences in the experience of RC. Some racial, ethnic and socioeconomic groups have a higher prevalence of RC^13,15,16,21 and qualitative research suggests etiologies and interpretation of RC behaviors may vary among populations as well.^22–25 Prevalence of RC in samples of Latina women is 14%¹⁶–17%^13,15. In studies of Latino men, unique factors have been identified as associated with IPV perpetration, including patriarchal gender role attitudes.²⁶ These factors may also impact RC among Latina women, but have not been studied. Some studies note that Latina women with immigration concerns may be less likely to seek help or report IPV to police,^27,28 a concern which may also impact help seeking related to RC.

Current recommendations for healthcare providers who work with women who experience RC are limited to providing trauma-informed care^29,30 and promoting harm reduction strategies including social services referral and less detectable methods of abortion and contraception.³¹ To minimize harm, some women experiencing RC use surgical sterilization,^32,33 hide or surreptitiously use contraception,^34–37 use less detectable methods of contraception such as intrauterine devices (IUDs) and injectables,^15,22 check condom placement during sex³⁸ and use deception or stalling with male partners.³⁶

While the prevalence of RC among Latina women is well-documented, qualitative data on specific experiences of RC, safety and harm reduction strategies, and care-seeking patterns is needed to provide practitioners with concrete guidance on how best to support women’s reproductive life plans³⁹ and to address RC. This qualitative exploratory study focuses on listening to the experiences of Latina women seeking services at an urban clinic to offer women’s insights on improving recognition of and support for women experiencing RC. We aimed to position this analysis within the Latina cultural context to ensure current definitions of RC are inclusive of the cultural and social contexts described by Latina women.

METHODS

This research is part of a larger mixed-methods study about RC and pregnancy intention among Latina women. The component described in this paper utilizes qualitative descriptive methodology to comprehensively describe RC as a phenomenon from the voices of Latina women.^40,41

Recruitment

A purposive sample of participants were recruited from a federally qualified health center (FQHC) in the Washington, DC metropolitan area. Associations between RC and IPV are well-documented.^13,42 Thus, women receiving IPV services were referred by social services providers if they expressed interest in the study. Other clinic patients were also asked by healthcare providers and staff if they were interested in talking to a researcher about a study when they presented for appointments. Eligible women were between the ages of 18 and 45, self-identified as Latina, Hispanic or Spanish, and answered “yes” to any of the lifetime RC screening questions (Table 1).¹³ Researchers screened women for study eligibility by phone or in person. Recruitment continued until thematic saturation was reached.⁴³

Table 1.

Reproductive Coercion Eligibility Screening Questions

In your lifetime, has someone you were dating or going out with…

tried to force or pressure you to become pregnant, or to end a pregnancy? told you not to use any birth control (such as pills, shot, ring, etc.)? said he would leave you if you did not get pregnant or did not end a pregnancy? told you he would have a baby with someone else if you did not get pregnant? taken off the condom while you were having sex so that you would get pregnant? put holes in the condom so you would get pregnant? broken a condom on purpose while you were having sex so you would get pregnant? taken your birth control (such as pills) away from you or kept you from going to the clinic to get birth control? made you have sex without a condom so you would get pregnant? hurt you physically because you did not agree to get pregnant or would not end a pregnancy?

Source: Miller et al¹³

Data Collection

Interviews were conducted in English or Spanish by the primary researcher and bilingual research assistants. Interviews were conducted between May 2017 and May 2018 at health clinics, participants’ homes, community locations, and by telephone, based on participant preference, and lasted approximately one hour. Interviews were audio recorded with participant consent, and recordings were transcribed by either the primary researcher or by a professional Spanish translator, who also translated the transcripts into English. Interviews were semi-structured and followed a suggested guide that covered experiences with RC (eg, Can you tell me about a time when someone you were dating or going out with or married to told you not to use birth control?) and IPV (eg, Has the partner we have been discussing ever been violent with you?).

Data Analysis

The iterative process of qualitative analysis was ongoing during the data collection phase. Transcripts were entered into a web-based qualitative analysis program. Using qualitative descriptive methodology,^40,41,44 the first author read each transcript multiple times to verify accuracy and gain an understanding of the overall responses to the interview, ensuring confirmability. In a process of deductive analysis, RC behaviors and harm reduction strategies from existing scientific literature served as an a priori framework for developing a codebook which was organized into categories and applied to the data. Several codes emerged during this process, expanding the codebook. Analytic memos to record thoughts and ideas as they developed were kept to ensure reflexivity during the research process. After preliminary readings, two authors completed detailed readings and independently applied codes to all transcripts. They compared coding to resolve any discrepancies and discussed emerging themes throughout the coding process. In an inductive analysis process of pattern coding, codes were examined and grouped into emerging themes.^41,44,45 A third author with expertise in qualitative analysis was available to resolve any persisting discrepancies and to assist in the development of themes. Negative or disconfirming cases that did not fit with the emerging themes were analyzed in depth to consider alternative explanations and to broaden understanding of the theme. Careful analytic documentation was maintained during analysis regarding procedural steps, decision rules, and conclusions drawn, to create an audit trail.⁴⁶ Saturation of themes was reached after 13 interviews; no new codes or themes emerged and themes were fully developed at this point.

Ethical Review and Informed Consent

The study was approved by the Johns Hopkins Medicine Institutional Review Board. Participants provided demographic information and oral informed consent prior to the interview and were given a $20 gift card to thank them for their time at the completion of the interview. Participants were assigned pseudonyms to protect anonymity.

RESULTS

The sample consisted of 13 Latina women (Table 2), ranging in age from 20 to 40 (mean 30.7 years), who were either born in the United States (n=2) or emigrated from Mexico (n=2), El Salvador (n=6), Guatemala (n=2), or Honduras (n=1). Among those who immigrated, their time living in the United States ranged from 11 months to 28 years (mean 12.3 years, median 12 years). Four interviews were conducted in English (corresponding to the four who lived in the United States the longest) and nine in Spanish.

Table 2.

Participant Characteristics

Participant #	Age	Country of birth	Time in the US	Children	Education	Employment status
1	20	United States	Life	0	High School	Part-time
2	30	El Salvador	28 years	3	Some college	Unemployed
3	36	Mexico	21 years	0	9th Grade	Part-time
4	40	El Salvador	4 years	2	High School	Unemployed
5	26	United States	Life	0	Associates Degree	Unemployed
6	35	Mexico	18 years	3	11th grade	Full-time
7	24	Guatemala	3 years	2		Unemployed
8	37	Guatemala	19 years	3	Primary	Part-time
9	31	El Salvador	1 year	1	10th grade	Unemployed
10	29	El Salvador	13 years	3	GED	Unemployed
11	30	El Salvador	14 years	3	3rd grade	Full-time
12	29	Honduras	11 months	2	10th grade	Part-time
13	32	El Salvador	13 years	2	9th Grade	Part-time

We used the a priori coding structure to organize data into code categories. We named these categories: a) Types of RC Behaviors; b) Co-occurrence of RC and IPV; and c) RC Safety and Harm Reduction Strategies. From these code categories, four themes emerged: a) Impact of Immigrant Status, b) Machismo, c) Strength and Bravery, and d) Importance of Family.

Types of Reproductive Coercion Behaviors

The first step of this descriptive qualitative analysis was to organize data into a priori code categories consistent with established definitions of RC.

Pregnancy Pressure and Manipulation

Women in this study described a variety of means by which partners pressured them to get pregnant. These included lying about infertility and threatening to leave or to have a baby with another woman if they did not get pregnant.

He told me… that he couldn’t have children. And when I got pregnant, I was scared because he had told me that if I got pregnant that it wasn’t his… But when I told him that I was pregnant he got really happy and jumped around and we were excited and that’s when he told me that it was a lie that he couldn’t, no, that he wanted me to get pregnant.

Birth Control Sabotage

Existing literature describes a spectrum of birth control sabotage behaviors as part of RC, ranging from physical tampering with a method to preventing access to it, either physically or financially. The women’s narratives described numerous episodes consistent with this, including hiding or throwing away oral contraceptive pills, refusing to pay for birth control, preventing attendance at contraceptive appointments either by verbal pressure, diversions or physical restraint, not withdrawing when withdrawal had been the agreed-upon contraceptive method, and refusal to use condoms. One woman described a partner threatening to tamper with implant contraception:

He had seen the bruise I had here. And he said to me, “what’s happening, what’s that, what’s that in your arm?” And I said “they put in an implant, it’s something new, I want to try it…” He touched it or sometimes… he would grab it like this and he said to me that he was going to break it. I didn’t know what it was, until they took it out… I thought it was something metal, I was really afraid.

Controlling Pregnancy Outcome

RC behaviors may include controlling the outcome of a pregnancy, whether by pressure to have or not have an abortion. In this study, women reported these experiences as well as pressure not to place a baby for adoption. Some also reported experiencing violence from their partners that was intended to cause a miscarriage.

He made me abort by kicking me. After he hit me, the very next minute I started to have contractions in my spine. And then I started to bleed…blood gushed out of me. And then he took me to the doctor, and they did the curettage… He got me pregnant himself, that was his baby, and he hit me himself. And I said, “You killed that baby yourself.”

Narratives from these women demonstrate common RC experiences across the domains of RC behaviors. Reproductive autonomy was usurped through actions from their partners and had detrimental consequences on their health.

Co-occurrence of RC and IPV

Most participants described episodes of physical or sexual violence, controlling behavior and emotional abuse with their partners. Examples given by women included trying to attend contraceptive appointments in the face of escalating violent attacks aimed at preventing her from leaving the house, a partner’s use of violence to interfere with a contraceptive method, and sexual assault that resulted in pregnancy. A connection was explicitly made between violence and RC behaviors by one woman: “When I was already pregnant he would still hit me, abuse me. After he was the one who wanted a baby.”

The intersection of RC and IPV was apparent in descriptions of violent attacks related to controlling reproductive decision-making. Partners who attempted to infringe on reproductive autonomy were also physically and emotionally abusive.

RC Safety and Harm Reduction Strategies

To protect themselves from threats to their reproductive autonomy, women used a variety of strategies to stay safe or reduce the harm of coercive behaviors.

Less detectable contraception

Several women reported using a less detectable method of contraception to conceal its use or surreptitiously sought emergency contraception to avoid pregnancy. Less detectable methods included IUD, implant and injectables. Despite attempts, however, to use contraception that could be concealed from partners, these methods did not always prove to be sound harm reduction strategies. One woman reported that even an IUD would be detectable by her partner. Another woman described her experience of side effects with an IUD and then getting coerced into pregnancy by her husband, who later used violence to cause a miscarriage, ultimately leading her to choose an implant method. She described this experience and her unsuccessful attempts to conceal the implant from her partner:

The IUD hurt me, so the last option for me was the one in the arm, the implant. I was taking care of myself with methods that weren’t… the pill so that he couldn’t destroy it because I really didn’t feel good about wanting more children… I made the appointment at a health center near my house where I was living, and when the appointment came… I walked to the center, and they gave it to me… They told me to rest, but I couldn’t hide it. I had to cook, clean. I wore clothes so that he wouldn’t notice it for a few days.

Deception and stalling

With limited resources in many cases, women utilized the tools that were available to them to resist RC behaviors, and in some cases, this included deception and stalling. One woman pretended that her 3-month injectable method was supposed to be used every month, so that her partner would think she was not complying with appropriate use. When her partner sabotaged her birth control method, another woman allowed him to think he had been successful, then surreptitiously took emergency contraception. And one woman used her knowledge of reproductive physiology to lie to her husband about not being able to have sex.

The woman, there are certain days when she’s fertile… He wanted to have relations every day… Sometimes I would say that I had my period, sometimes I even put on a pad and I would say “look… I can’t right now.” So, I had to feed him little lies like that.

Help seeking

Women actively sought help from family members or from community services to resist or stay safe in the face of coercive or violent behaviors. These included services available at the clinic they were recruited from as well as through their children’s schools. One woman had a cousin in her home country send her emergency contraception when she could not afford American prices. One woman especially appreciated universal provision of social services to all patients at her health clinic, without having to ask for it.

[When I came to the clinic] I wanted to talk to somebody about this. And the fact that… [seeing a social worker is] the first thing that you have to do is good because I didn’t even have to seek for it, it was just there.

Abortion

None of the women in the study reported aborting a pregnancy that was the result of RC, but several strongly considered abortion as they planned to separate from their coercive partners, fearing that having a child would increase ties to the partner and prevent them from seeking safety.

I didn’t want to have the baby… My fear was the father of my children… I don’t want another baby with him, I don’t want to be like this, still tied to him by another child. I don’t want him bothering me, coming around saying, “Where’s my daughter, I want to see her.” Or, “I want to call you to see her.” I don’t want any more of that.

The women in this study described strategies to minimize the harm of RC experiences by using contraception without their partner knowing, avoiding coercive behaviors through deception, actively or passively utilizing social and community networks to stay safe, and considering abortion in order to separate from an abusive partner.

Emerging Themes

Four themes emerged to describe data from participants in the study. The first theme, Impact of Immigrant or Citizenship Status, describes the compounding effect that immigration and citizenship status had on the experience of RC and IPV, as well as the use of citizenship status as a coercive tactic. The second theme, Machismo, describes a Latino cultural norm of hyper-masculinity named by many participants as influencing their coercive and abusive partners. The third theme, Strength and Bravery, describes characteristics reported by many women that enabled them to endure coercive and abusive relationships. And the fourth theme, Importance of Family, describes the extreme importance of having children ascribed to many male partners by the women in this study.

Impact of Immigrant or Citizenship Status

Not all women in the sample were immigrants to the United States, but many women described male partners using immigration or citizenship status as a tactic to pressure them to get pregnant or as compounding the effect of IPV. Partners and sometimes family members used a woman’s immigration or citizenship status as a threat or means of control. Recent immigration also influenced women’s vulnerability to violence and RC by virtue of being geographically far from sources of support. Concerns around immigration status and threats of deportation negatively affected women’s use of harm reduction and safety strategies; some women reported their status made them afraid or unable to seek help.

It was my fear that I’m not from this country… I’m scared that, after everything I’ve put up with… I’m saying the problems we’re having and maybe they’re going to put him in jail, or put me in jail, or both, and they’re going to take my children away… In the clinic they would ask if you’ve been abused at home or verbally… or at work. I would say “No, everything’s fine.” But it was because I was afraid to talk.

Machismo

The Latino cultural norm of machismo was explicitly named by many women in this study as a direct cause of their partner’s pregnancy coercive, contraceptive sabotaging, or violent behaviors.

He lied so that I would get pregnant… Planning for children is something to plan between both of you, and not just one person… So for me, that’s machismo. Not letting a woman decide whether she wants more children or not.

For me, machismo is my husband. It’s my husband because he is the person that doesn’t let you use birth control… He’s the person that says you’re going to dress like this, eat like this…we’re going to use this. He’s the person who doesn’t let you go out. Or doesn’t want to share you with your family.

Machismo was named by numerous women in this study and universally described with negative connotations. Women directly connected it to coercive and abusive accompanying behaviors that put them at risk for escalating violence.

Strength and bravery

Many women in the study described qualities of strength and bravery as enabling them to endure coercive, often violent relationships and to keep their children safe. This strength was described as emerging from the experience of hardship.

Not all people are very strong. The path makes us strong. But we’re made stronger by our children… You say to yourself, if I die, or if he ends up killing me, if I end up being a victim of my own husband, who’s going to stay with my children? He’s going to be in prison and I’m going to be dead. So, for them you make yourself brave.

Strength and bravery also enabled some women to find a way to leave coercive and dangerous relationships.

I feel that I was very brave to make the decision well, in the case of leaving him, and saying it doesn’t matter what happens, but my daughter is not going to be in any danger… So, I feel that, not that I think I’m such a big thing, but I’m here, a woman, I feel that I’m strong, in fighting for my daughter.

The women’s narratives describe qualities of strength and bravery that were innate and also that resulted from experiencing difficult and abusive situations. These qualities gave them the power to be able to endure or escape hardship.

Importance of Family

The importance of family and children was suggested as a motivator for male pregnancy promoting behaviors experienced by women in this study. Women suggested their partners pressured them to get pregnant or prevented them from accessing contraception because being a father was so important to them. Importance of family was also described as motivating some women to stay with an abusive and coercive partner, as their primary goal was protecting and providing for their children.

And the mother is afraid, she says I don’t want my children to suffer, there’s too many, it’s better if we stay here. Even if he does what he wants with me, but that doesn’t matter because my children are here and they’re going to be safe here.

Arguably, the importance of family could also be described as a source of strength for women, as the narratives often included the desire to protect and care for their children as figuring prominently in what enabled women to endure hardship. But overall this theme describes a source of vulnerability for women. Partner RC behaviors were attributed to the emphasis men put on the role of fatherhood, and the women themselves described a lack of alternatives to their abusive relationships due to the importance they placed on remaining together as a family.

DISCUSSION

The purpose of this qualitative analysis was to examine RC and the use of safety and harm reduction strategies in a sample of Latina women. Identifying specific experiences and strategies in the own words of participants is needed to provide practitioners with concrete and culturally relevant guidance. Though RC affects women of all nationalities, races and ethnicities,^47,48 this qualitative descriptive study focuses on listening to the experiences of Latina women to offer women’s insights on improving recognition of women experiencing RC.

Descriptions of RC behaviors emerged that were similar to existing literature focused on other racial and ethnic groups, but some new behaviors emerged, including threats to break an implant contraceptive device, physically restraining a woman to prevent attendance at contraceptive appointments, and pressuring a woman not to place a baby for adoption. These behaviors are not necessarily specific to Latino populations or motivated by Latino cultural norms, but these new behaviors add to a broader and more inclusive description of RC. Pressure to have or not have an abortion was perpetrated by partners, and abortion was cited by some women as a strategy for separating from a coercive partner. Immigration status was used against some women as a method of coercive control. The cultural norm of machismo, named by many participants, emerged as a source of increased vulnerability for some Latina women.

Quantitative literature describes a strong statistical association between RC and IPV,^13,42 and this was supported conceptually by our qualitative findings. Many coercive partners were also violent, supporting the suggestion that RC is one tactic used by violent men to exert power and control over women. IPV and RC were often compounded by machismo and vulnerable citizenship status in the lives of these women, and the importance of family was cited as a motivation for staying with abusive and coercive partners.

Some women used strategies to resist RC that are also recommended by professional guidelines.^31,49 Women in this study used less detectable methods of contraception, but it is important to note the caveats these women provide, that IUDs and implants can sometimes be detected, and a determined partner can prevent a woman from accessing other methods such as injectables. Some women sought assistance from community services, as is also recommended by experts, but others had to resort to deception and stalling as the only tools available to them. The strength and bravery of women emerged as powerful sources of resilience and endurance that many women called upon to survive their difficult or dangerous situations, inspiring them to leave or to employ the use of a safety strategy.

This qualitative descriptive study does not assert to represent all Latina women, a heterogenous ethnic group originating from many countries and influenced by varying cultural norms. Cultural norms are generally accepted values stemming from culture that may be ascribed to a particular population. They are by no means universal to a population, but exploration of them may help to illuminate health behaviors and outcomes. The gender role norm of machismo (strongly masculine, emphasizing bravery and virility) has been suggested as a possible influence on IPV vulnerability,²⁶ but also as a source of strength and resilience for Latino communities, as it also connotes courage, respect, and protection of family.⁵⁰ In this study (of women recruited specifically for their experience of RC), machismo was only cited as a source of violent and coercive behavior by partners. It is likely that positive dimensions of machismo would emerge if women in healthy or non-coercive relationships were included in the sample.

Findings from this study should be viewed within a broader context of reproductive justice. RC is one cause of unintended pregnancy and restricted reproductive autonomy and may be linked to outcomes such as these in populations of Latina women, but other factors impact reproductive health outcomes as well. Political, economic, environmental, and sociological factors intersect to affect the ability of women to decide when and if to get pregnant and parent.⁵¹ Individual and community-level fear of immigration enforcement can impact reproductive health⁵² as can health system barriers, language issues, stress and depression, and discrimination, among other factors.⁵³

Implications for research and clinical intervention

Health care settings and providers are important sources of assistance and refuge for women experiencing RC and IPV and this study suggests that there are concrete steps they can take to aid these women. It is important to clearly inform women what the legal risk of seeking help is and is not, as some women reported that they feared seeking help due to their undocumented status. Trauma-informed social support services that are integrated into health services and provided to all clients are a benefit for women who may not be comfortable asking for help. As part of trauma-informed care, all women should receive information about IPV and RC and be assessed for both. It is clear from these findings that a report of or suspicion for IPV or RC should trigger screening for the other. Despite their flaws, less detectable methods of contraception remain useful strategies of harm reduction for some women experiencing RC, and this study highlights the importance of ensuring access to the full range of contraceptive options for all women, including women without insurance or legal status. Providers should be mindful of the importance of honoring the request when women ask to change methods, particularly when removing a method early is perceived as inconvenient or not cost effective.⁵⁴ While some women may want to remove an implant early due to unrealistic expectations about benign side effects, for example, others may have a partner who is threatening to break it.

Deception, lying and stalling may appear to be less-than-ideal safety strategies that a provider may be reluctant to suggest to women, but our findings suggest that these may be the only tools available to women with limited resources, power, and ability to seek help. As relationships are dynamic and situations change, women may need to use multiple harm reduction strategies, and some may not be ideal but are effective in the short-term as they make decisions for long-term safety. Women, including abused women without the language or the legal status to seek help, have tremendous resources and strength to mobilize when their options are limited. Healthcare providers who work with women, especially Latina and immigrant women, can honor this strength and resilience by listening and providing support and resources based on women’s needs and priorities. Women’s strength and resilience emerged as a vital source of power and endurance for Latina women in this study.

Limitations

Findings should be considered within several limitations. First, findings from this small qualitative study are not generalizable in the way that a random sample of a population would be. The purposive sampling strategy included Latina women attending a clinic that serves predominantly low-income communities in an urban environment who reported experiencing RC. Thus, their experiences may differ from Latinas living in rural settings or with higher socioeconomic status. The sampling strategy of recruiting participants from a population of women who were already seeking social or health services may be biased toward the experience of women in this situation; the experience of women still enduring IPV or RC, without the ability or the resources to seek help, may not be reflected here. It may also be biased toward women experiencing severe enough coercion and abuse that they have ultimately had to seek help. The researchers were non-Latina, which may have influenced aspects of data collection or interpretation of findings. The sample was small but yielded rich data for analysis, and while only women of Mexican and Central American descent were interviewed, this reflects the nativity of the majority of immigrant women in the study locale. Despite these limitations, the powerful voices of the women who participated make a significant contribution to the understanding of RC as experienced by some Latina women in the United States.

CONCLUSION

This study is unique in its focus on a population of women who have not previously been studied in RC research, and its emphasis on manifestations and response to RC in women’s own words. The current definition of RC, partner behaviors that are pregnancy promoting or controlling and that interfere with women’s autonomous reproductive decision-making, is clearly applicable in this sample of Latina women. The impact of interpersonal factors such as RC, situated in the broader context of reproductive justice, illuminates health disparities experienced by Latina women on a population level. Findings from this study will inform practice as well as research and contribute to a broader and more inclusive understanding of RC. Future research should continue to explore the perception of coercion among women experiencing RC behaviors, to further define and respond to this complex phenomenon. Research is needed on Latino cultural norms as sources of strength and positive outcomes. More research is needed to establish risk factors for RC and to support recommendations for safety and harm reduction. Longitudinal research is especially needed to establish harmful outcomes associated with RC behaviors, and to establish the relative benefits of the safety strategies recommended by providers and utilized by women.

Quick Points:

• Partners may exert coercive reproductive control over women by sabotaging contraceptive methods, verbally pressuring them to get pregnant or to end a pregnancy, threatening violence if the woman does not get pregnant or end a pregnancy, or blocking access to contraceptive, abortion, or prenatal services.

• Aspects of reproductive coercion (RC) overlap with intimate partner violence (IPV); power and coercive control are often motivating factors for both, and RC is one type of coercive behavior used by some abusers.

• To assist women to achieve safety, autonomy and reproductive life plans, it is critical that practitioners identify and address RC.

• Latina women in this sample described male partner use of physical restraint or other obstacles to restrict birth control access.

• Women used varied methods to minimize harm caused by RC and IPV; in some cases, immigrant status increased vulnerability by making women afraid to seek help.