Race and reproductive coercion: a qualitative assessment.
BACKGROUND
Unintended pregnancy is common and disproportionately occurs among low-income and African-American (AA) women. Male partners may influence women's risk of unintended pregnancy through reproductive coercion, although studies have not assessed whether racial differences in reproductive coercion impact AA women's disparate risk for unintended pregnancy. We sought to describe women's experiences with pregnancy-promoting behaviors by male partners and explore differences in such experiences by race.


METHODS
Semistructured interviews were conducted with low-income, AA and White women aged 18 to 45 years recruited from reproductive health clinics in Western Pennsylvania to explore contextual factors that shape women's contraceptive behaviors. Narratives were analyzed using content analysis and the constant comparison method.


RESULTS
Among the 66 participants (36 AA and 30 White), 25 (38%) described experiences with male partner reproductive coercion. Narratives provided accounts of contraceptive sabotage, verbal pressure to promote pregnancy and specific pregnancy outcomes, and potential motives behind these behaviors. AA women in the sample reported experiences of reproductive coercion more often than White women (53% and 20%, respectively). AA women were also more likely than White women to attribute a current or prior pregnancy to reproductive coercion. AA women identified relationship transiency and impending incarceration as potential motivations for men to secure a connection with a female partner via pregnancy.


CONCLUSIONS
Our findings suggest that reproductive coercion may be a factor contributing to disparities in unintended pregnancy. More research, including population-level studies, is needed to determine the impact of reproductive coercion on unintended pregnancy and to understand the social and structural factors associated with pregnancy-promoting behaviors.
Department of Medicine, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania.
Cara
C
Nikolajski
Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania.
Elizabeth
E
Miller
Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania.
Heather L
HL
McCauley
Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania.
Aletha
A
Akers
Department of Medicine, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania; Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee Womens Hospital and University of Pittsburgh, Pittsburgh, Pennsylvania.
Eleanor Bimla
EB
Schwarz
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, Oakland, California.
Lori
L
Freedman
Department of Psychiatry, University of California San Francisco, San Francisco, California.
Julia
J
Steinberg
Center for Health Equity, Research, and Promotion, Philadelphia VA Medical Center, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Said
S
Ibrahim
Department of Medicine, University of Pittsburgh Center for Research on Health Care, Pittsburgh, Pennsylvania; Center for Health Equity, Research, and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. Electronic address: borrerosp@upmc.edu.
Sonya
S
Borrero
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data; D003068:Coercion; D003268:Contraception Behavior; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D000066511:Intimate Partner Violence / Q000208:ethnology* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000208:ethnology* / Q000523:psychology; D011275:Pregnancy, Unwanted / Q000208:ethnology* / Q000523:psychology; D036301:Qualitative Research; D012747:Sexual Partners; D012959:Socioeconomic Factors; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult