As many as a quarter of women attending sexual and reproductive healthcare services have been tricked into getting pregnant by their partners piercing condoms, lying about vasectomies and used emotional blackmail to force them into having a baby.
The women who all attended sexual and reproductive clinics became pregnant against their will and reported they were not being allowed take control of their reproductive lives.
As well as not being able to choose whether to use contraceptives, or start or continue with a pregnancy, this ‘reproductive control’ also takes the form of ‘contraceptive sabotage’, which includes covert removal of a condom during sex.
The concept of reproductive coercion-control over women’s reproductive autonomy by others was first described in 2010.
Scientists at Bournemouth University updated the evidence to 2017 and widened the spectrum of activities to include family pressure and criminal behaviour, such as sex trafficking and exploitation.
They searched relevant databases of medical and social sciences research, looking at women’s experiences of interference with their reproductive autonomy.
They found the practice was common, with as many as one in four women reporting coercion over their reproductive lives.
The research indicates younger women, and in the US, black and racial minority women, seem to be particularly vulnerable.
And in some cultures, the wider family – older female relatives in particular – may have control over reproductive decision-making that is endorsed by society.
Reproductive control covers a wide range of behaviours, from persuasion through emotional blackmail, to threatened or actual infidelity and physical violence.
The evidence showed it is predominantly perpetrated by male partners, but also by the wider family and criminal gangs.
Contraceptive sabotage can include anything from a male partner lying about having had ‘the snip’ (vasectomy), piercing condoms or throwing away or hiding contraceptive pills.
Lead author Professor Sam Rowlands from the Centre of Postgraduate Medical Research and Education at Bournemouth said: “It includes ‘stealthing’, first publicised by Alexandra Brodsky in April 2017.
“This is defined as the non-consensual, surreptitious removal of a condom during sex, when consent has been given only for condom-protected sex.
“Alternatively, a male partner may falsely state that he has had a vasectomy.
“The most common means of contraceptive sabotage are failure to practise withdrawal, as previously agreed, or non-use of condoms.
“Contraceptive sabotage also includes various actions including piercing condoms or other barrier methods, throwing away supplies of oral contraceptives or forcibly removing transdermal patches, vaginal rings or intrauterine devices.
“Contraceptive sabotage interacts and overlaps with sexual coercion and violence.
“In such cases, consent to sex has been given on the understanding that contraception will be used.
“Contraceptive sabotage thus invalidates consent, but there are complicated arguments as to how any legal redress would be sought against saboteurs.
“Currently, in most jurisdictions, it seems likely that cases of contraceptive sabotage taken to court would be unsuccessful.
“However, in Canada, a man did receive an 18 month prison sentence for depriving his partner of her ability to consent to sex.”
The negative consequences include undermining responsibility for contraceptive use, unintended or unwanted pregnancy, a higher risk of abortion, higher rates of testing for sexually transmitted infections and pregnancy and requests for emergency contraception.
In response women may start lying about their use of contraception, pregnancy testing, and risk harm if they try to negotiate contraceptive use in a violent relationship.
The victims may not always be aware that they are being subjected to reproductive control, especially if this isn’t accompanied by physical or sexual violence.
Prof Rowlands said: “The degree of control that a male partner can have will vary from mild to extreme.
“Milder amounts of control may not be perceived by the victim as unhealthy or abusive.
“Women in a long term relationship may become inured to significant levels of reproductive control.”
He urged healthcare professionals to be alert and called for more international research.
He added: “In particular, more research is needed on the non-physical elements of abusive relationships and how coercive control can be resisted
“More understanding of perpetrators’ motivations for engaging in reproductive control is needed.
“Further research should be conducted on the reasons partners engage in reproductive control behaviours, as well as women’s perceptions of partner intent.
“Young people are especially vulnerable to it and research is needed which focuses on the dating relationships of young people.”
The study was published in BMJ Sexual & Reproductive Health.
By Ben Gelblum and Grainne Cuffe