I have had some thoughts rolling around in my brain about reproductive coercion for a while now. Until recently, many in the reproductive justice world had not yet taken up the banner of reproductive coercion, but it is starting to be more and more commonly talked about in mainstream circles. In a Committee Opinion last year, the American College of Obstetricians and Gynecologists (ACOG) defined reproductive coercion as the following:
Reproductive coercion is related to behavior that interferes with contraception use and pregnancy (1). The most common forms of reproductive coercion include sabotage of contraceptive methods, pregnancy coercion, and pregnancy pressure. Birth control sabotage is active interference with a partner’s contraceptive methods in an attempt to promote pregnancy (1). Examples include hiding, withholding, or destroying a partner’s oral contraceptives; breaking or poking holes in a condom on purpose or removing a condom during sex in an attempt to promote pregnancy; not withdrawing when that was the agreed upon method of contraception; and removing vaginal rings, contraceptive patches, or intrauterine devices (IUDs). Pregnancy pressure involves behavior intended to pressure a female partner to become pregnant when she does not wish to become pregnant (1). Pregnancy coercion involves coercive behavior such as threats or acts of violence if a partner does not comply with the perpetrator’s wishes regarding the decision to terminate or continue a pregnancy (1). Examples of pregnancy pressure and coercion include threatening to hurt a partner who does not agree to become pregnant, forcing a partner to carry a pregnancy to term against her wishes through threats or acts of violence, forcing a female partner to terminate a pregnancy when she does not want to, or injuring a female partner in a way that may cause a miscarriage.
At my current job we ask everyone who is seeking a birth control method or a pregnancy termination if she is there of her own volition. We ask if a woman wants to use condoms, if she feels as if she can negotiate condom use if she desires her partner to wear a condom.
But there is something that I see that raises the hair on my arms, that I am not sure what to do about. Close to one of my clinics there is a single sex boarding school of types. And on some afternoons this school brings me three or four young women at a time, all to get a birth control method. I ask each and every one of them if they are truly desiring a birth control method. None of them are sexually active in any way that could get them pregnant, and some have not yet had intercourse. Many of them choose methods that are long-term, or what we call Long Acting Reversible Contraceptives (LARCs), like IUDs or the nexplanon (a single rod that is inserted just under the skin of the inner upper arm)
In some way I feel as though these young women are being heavily encouraged, or required in some way to get on a birth control method while they attend this school. I ask each and every one of them if they are freely choosing to be there, and I usually get a quizzical look in response. Of course I’m here by choice, they say. My sister had a baby when she was really young, and I don’t want to do that to my mom again.
So here I am, stuck between the proverbial rock and the hard place, not knowing if I am participating in helping this institution to force young women onto birth control methods. My spidey senses are tingling, and I have learned to trust my instincts as a provider. I have half a mind to call the adults who bring these very young (14,15, and sometimes 16 year olds) women to me into an exam room and ask them a few questions. But what do I ask? Are you forcing these young women onto a birth control method? Is being on a birth control method contingent, or part of the program here?
I am almost guaranteed to not get the truth in these situations. I feel stuck about what to do. All it feels like I can do is just keep asking every young woman I see from this academy if she is truly choosing to seek out a contraceptive method.
I think about this situation a lot, and I don’t know if I am doing the right thing, but what are my choices? Refuse to give these women birth control because I have a feeling they are being coerced into it, but have no proof? I have talked to a few other providers about this scenario, and all of them agree that it is a tough spot to be in. We talk to the young women alone, and ask pointed questions to make sure they are choosing to be there. But at the same time, how would any one of them say to a stranger, to a stranger they may fear will tell on them, that they are not there by choice?
I sincerely do not know what to do, or what my best course of action is anymore. It is conflicting and difficult to think about and attempt to come up with a solution. I don’t want to be complicit in a system that forces women onto a birth control method they may or may not want. But I don’t see a way around it, especially given my ignorance of the program these women are a part of. I struggle with these feelings every time I see these young women, but all I can do is ask, and maybe someday, somebody will know I’m really listening.