New Study Explores Contraceptive Use and Reproductive Decision Making in Black and White Women Who Experience Intimate Partner Violence

Although U.S. unintended pregnancy rates have declined in recent years, racial/ethnic differences persist, and women who experience intimate partner violence may be at greater risk of unintended pregnancy. A qualitative study to explore potential mechanisms behind racial differences in pregnancy intendedness among women with histories of partner violence, “Racial Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration,” is the Editor’s Choice selection of the latest issue of the journal Women’s Health Issues. The authors found differences in the kinds of partner violence Black and White women reported and in perceptions of gender-based roles in sexual relationships.

Women’s Health Issues is the official journal of the Jacobs Institute of Women’s Health, which is based in the Department of Health Policy and Management at Milken Institute School of Public Health (Milken Institute SPH) at the George Washington University.

Charvonne Holliday, of the Johns Hopkins Bloomberg School of Public Health, and colleagues analyzed interviews from 44 women ages 18-29 who had low incomes and histories of intimate partner violence (IPV). Participants were recruited from family planning clinics in Pittsburgh, Pennsylvania, as a part of a larger study led by Elizabeth Miller, Children’s Hospital of Pittsburgh of UPMC and University of Pittsburgh School of Medicine, and Jay Silverman, University of California, San Diego, School of Medicine. Forms of partner violence experienced by participants included reproductive coercion (RC) — in which partners actively try to impregnate their partners against their wishes, interfere with contraceptive use, or manipulate condoms — as well as physical and/or sexual violence. The authors compared the sexual and reproductive health narratives of Black and White women with histories of IPV to explore the mechanisms that may drive racial differences in unintended pregnancy in the context of partner violence. 

“In relation to pregnancy, White women described IPV and RC as more commonly physical, more likely to include fatal threats, and used by male partners to leverage control when children were involved,” Holliday and colleagues found. They report that Black women were less likely to describe such physical violence, and to instead describe forms of reproductive coercion such as condom refusal and intentional impregnation by male partners. “Fear of long prison sentences or street-related death may elicit a desire to establish a legacy through procreation,” the authors note. 

“Black women described a greater reliance on male partners in contraceptive decision making relative to White women, which may facilitate or normalize RC behavior,” Holliday and colleagues write. “White women discussed hopelessness and responsibility of the female partner to prevent pregnancy.” The authors recommend that clinicians counseling women about contraception consider exploring women’s pregnancy intentions and the potential roles of male partners and partner violence in reproductive decision-making, and that interventions to address intimate partner violence be tailored to women’s diverse experiences.

“Unintended pregnancies and IPV continue to be two of the most significant women's health issues in the U.S. and around the world, and qualitative studies can provide insights for more effective interventions,” said Amita Vyas, Editor-in-Chief of Women's Health Issues and Associate Professor of Prevention and Community Health at Milken Institute SPH. “This study's findings are particularly powerful for understanding how gender norms relate to both unintended pregnancy and IPV, and they underscore the importance of a norms-based approach to these public health challenges.”

Racial Differences in Pregnancy Intention, Reproductive Coercion, and Partner Violence among Family Planning Clients: A Qualitative Exploration” has been published in the May/June issue of Women’s Health Issues.