One in 20 Australian adults have experienced reproductive coercion and abuse.
That is among the findings of the Australian Study of Health and Relationships, released this week, the first time researchers in Australia have estimated the national prevalence of behaviour used to control a person’s reproductive autonomy.
Reproductive coercion and abuse (RCA) can include interference with contraception by a partner, forced contraception or sterilisation, and control of pregnancy outcomes by forced abortion or forced pregnancy.
Questions about these experiences were added to the country’s largest and most comprehensive study of sexual and reproductive health, conducted once a decade.
Dr Allison Carter, the group leader of the Sexual Health and Reproductive Equity (SHARE) Research Group at the Kirby Institute, presented preliminary findings around RCA prevalence from the third ASHR this week at the International Union Against Sexually Transmitted Infections (IUSTI) world congress in Sydney.
From analysing the survey data collected between 2022-2023 from a nationally representative sample of 14,540 people aged 16-69 years, the researchers found that, among women, 3.9% had experienced contraceptive interference, 2.7% had experienced forced sterilisation or contraception, 4.9% had experienced forced abortion and 1.9% forced pregnancy.
“In all likelihood, it’s probably an underestimation because we know people tend to under report experiences of violence, and also people might not recognise what’s occurring to them,” Carter told Guardian Australia.
“It might come in the form of emotional manipulation or more subtle insidious pressure to get pregnant and to keep a child when you may not want to.
“It might involve more overt threats to keep this child, otherwise ‘I’m going to leave the relationship’ – and if it’s a situation where a female partner has less social and economic power and are dependent on that relationship, they might feel intense pressure.”
It can also be overt or actual physical violence – for example, in the case of forcing a woman to choose a particular pregnancy outcome such as abortion, she said.
While RCA was primarily committed by partners, women did also commonly experience perpetration from their parents, with nearly one in five (19%) women who reported forced abortion saying it was perpetrated by their parents.
The prevalence of RCA rose drastically among socioeconomically marginalised men and women including people in contact with the justice system, people with a history of substance use, individuals with disability, those who experience violence, and gay and bisexual people.
For example, one in four women who had been in prison had experienced contraceptive interference (25.3%) and forced abortion (24.9%), while 15.2% of men living with a disability had experienced contraceptive interference.
The rate of men who reported partner interference with contraception was 8.4% – more than double the proportion of women – while 2.2% had experienced forced vasectomy.
However, Carter cautioned that to understand the data’s significance, researchers are still carrying out further qualitative research interviewing study participants to better understand people’s lived experience.
She also highlighted that when men experience partner interference with contraception, it is occurring through deception, for example a woman lying to a partner about using the pill. While that was not a healthy relationship dynamic, it could be different from the fear and control which characterises RCA among women, she said.
“A lot of the reasons behind women’s deception are rooted in women’s lesser social and economic status, and so if we want to talk about prevention, we really need to be talking about addressing disadvantage,” Carter said.
RCA has strong associations with intimate partner and sexual violence, although it can occur in isolation, making it trickier for healthcare professionals to pick up on “because there’s no other red flags”.
The findings also showed RCA was associated with a range of physical, mental and sexual reproductive health outcomes. “So it’s not just limited to reproductive health, but in effect it can affect all aspects of your life,” Carter said.
“Disagreements about whether or not to have a child are very common, and one person they want it and another may not – that’s normal. What’s important though is that people are able to navigate those disagreements in healthy way.”
Dr Kari Vallury, a research fellow at Griffith University with a focus on reproductive coercion and abuse, said having national prevalence data on the topic for the first time was “incredible”.
Vallury said it was also the first time ever in a national study anywhere in the world that “all four directions of RCA” have been measured – coerced or forced pregnancy or contraception, as well as pressure to end or continue pregnancy. “Historically forced abortion has been left out and it’s only measured contraceptive interference.”
Vallury said previously data has shown a 15% prevalence of RCA among pregnancy options counselling clients, “which you would expect to be high given the cohort but now we can really compare that and have a look at what’s happening in the whole community”.
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