Screen Women and Girls for 'Reproductive and Sexual Coercion,' OB-GYNs Recommend

By Susan Jones | January 25, 2013 | 9:13 AM EST

- The American College of Obstetricians and Gynecologists is recommending that physicians routinely screen women and adolescent girls for "reproductive and sexual coercion." (AP Photo)

( - The American College of Obstetricians and Gynecologists is recommending that physicians routinely screen women and adolescent girls for "reproductive and sexual coercion."

This power-trip behavior by men, according to the Feb. 2013 issue of Obstetrics and Gynecology, includes explicit attempts to impregnate a partner against her will or force her to have sex against her will; control the outcome of a pregnancy by forcing its continuation or abortion; and sabotaging birth control methods by "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."

OB-GYNs, the article states, are in a unique position to address reproductive and sexual coercion -- for example, by educating patients on victim support services -- or by offering them long-acting contraception that is harder for a partner to detect.

"Helping patients to conceal contraceptive methods may be necessary to help protect the patient," the article says. "For example, oral emergency contraception is often packaged in a large box with bold labeling, which could easily be discovered by an abusive partner. Health care providers should consider harm-reduction strategies such as giving a patient a plain envelope for the emergency contraceptive pills. This enables her to remove the packaging so the pills will be less likely to be detected by her partner."

Many women who experience reproductive and sexual coercion also experience physical or sexual violence. And because of that "known link," health care providers should screen women and adolescent girls for intimate partner violence and reproductive and sexual coercion "at periodic intervals such as annual examinations, new patient visits, and during obstetric care (at the first prenatal visit, at least once per trimester, and at the postpartum checkup)."

Incorporating such an assessment into standard reproductive health care practices "can enhance the quality of care and improve reproductive health outcomes," says the American College of Obstetricians and Gynecologists.

The OB-GYNs offer the following examples of questions to be asked of women and girls:

-- Has your partner ever forced you to do something sexually that you did not want to do or refused your request to use condoms?
-- Has your partner ever tried to get you pregnant when you did not want to be pregnant?
-- Are you worried your partner will hurt you if you do not do what he wants with the pregnancy?
-- Does your partner support your decision about when or if you want to become pregnant?

If a patient answers yes to any of those questions, the health care provider "should validate her experience and commend her for discussing and evaluating her health and relationships. She should be reassured that the situation is not her fault and further assessment of her safety should be elicited and discreet contraceptive options reviewed."

Additional support may include hotline numbers, dialed from the doctor's office phone; or referral to a domestic violence advocate.

The article also urges health care providers -- before asking any questions -- to inform women and girls about "limitations of confidentiality and mandatory reporting legal requirements," which vary by state. "It is important to note issues related to dating violence that involve a minor can also raise questions about mandatory child abuse reporting requirements and statutory rape laws."