“A Huge, Hidden Problem”: Australian Health Practitioners’ Views and Understandings of Reproductive Coercion

2020

J Interpers Violence

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Intimate partner sexual violence (IPSV) is a common yet hidden form of violence against women. It encompasses a range of behaviors, including rape and sexual assault, and also more subtle behaviors such as the use of coercion and blackmail to obtain sex. It is typically described as an aspect of intimate partner violence, yet, although it often co-occurs with physical or psychological abuse, the contextual factors and nuances of sexual violence perpetrated by an intimate partner are likely to be very different. IPSV also differs greatly from sexual assault perpetrated by a stranger or other known person. Despite this, ecological theories and models developed to help understand and prevent violence against women have neglected or excluded IPSV. This is problematic given the serious mental and physical health problems consistently associated with it. In response, this article aims to explore the ecological factors that may be associated with IPSV at the individual, relationship, community, and societal levels. It draws on both inductive and deductive thematic analysis of N = 38 in-depth, unstructured interviews with women victim/survivors. Individual-level factors included sexual inexperience and past trauma (for victims), and fragile masculinity and a sense of entitlement to sex (for perpetrators). Relationship-level factors included a large age gap in the relationship and co-occurring psychological abuse. Community-level factors were identified as failure to talk about sex, isolation, and lack of support, while societal-level factors included the idea that sex is a woman’s duty in a relationship, and that “real rape” is perpetrated by strangers. These factors are incorporated into a proposed ecological model that is unique to IPSV, furthering our understanding of this complex problem and its areas of overlap and difference with intimate partner violence and sexual violence. With refinement and testing through large-scale quantitative studies, this model may be critical in guiding future prevention efforts.

Section: Introductionmentioning

confidence: 99%

Toward an Ecological Understanding of Intimate Partner Sexual Violence

2020

J Interpers Violence

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“…Our full interview guide is reported elsewhere. 5 Interviews ranged in length from 13 minutes to one hour, with the average length being 35 minutes. All interviews were audio recorded and transcribed verbatim for analysis.…”

Section: Data Collectionmentioning

confidence: 99%

“…Despite this positive feedback, however, participants still identified barriers to the effective enactment of a multidisciplinary response, including the lack of a shared understanding around how to identify and respond to reproductive abuse. We have explored the diversity in staff understandings of reproductive abuse in more detail elsewhere, 5 highlighting that it was particularly pronounced between sexual assault services and social work or clinical staff. This was reflected in practice by the lack of referrals between the sexual assault service and other departments within the hospital.…”

confidence: 99%

“…3,4 Although the term 'reproductive coercion' is more commonly used in the extant literature, we have argued that 'reproductive abuse' is a more appropriate term, since it highlights the intentionality of the behaviour and the mechanisms of fear, power and control that are central to this gendered form of violence. 5 There is a dearth of research, both in Australia and internationally, aiming to understand reproductive abuse. However, studies do suggest that it has strong associations with intimate partner violence (IPV) and unintended pregnancy.…”

mentioning

confidence: 99%

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How do health practitioners in a large Australian public hospital identify and respond to reproductive abuse? A qualitative study

Australian and New Zealand Journal of Public Health

Wellington

Marino

et al. 2019

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Objective: Reproductive abuse is defined as a deliberate attempt to control or interfere with a woman’s reproductive choices. It is associated with a range of negative health outcomes and presents a hidden challenge for health practitioners. There is a dearth of research on reproductive abuse, particularly qualitative research. This study aims to address this gap by exploring how health practitioners in a large Australian public hospital identify and respond to reproductive abuse. Methods: We conducted semi‐structured interviews with n=17 health practitioners working across multiple disciplines within a large metropolitan public hospital in Victoria. Data were analysed thematically. Results: Three themes were developed: Figuring out that something is wrong; Creating a safe space to work out what she wants; and Everyone needs to do their part. Conclusions: Practitioners relied on intuition developed through experience to identify reproductive abuse. Once identified, most practitioners described a woman‐led response promoting safety; however, there were inconsistencies in how this was enacted across different professions. Lack of clarity around the level of response required was also a barrier. Implications for public health: Our findings highlight the pressing need for evidence‐based guidelines for health practitioners and a ‘best practice’ model specific to reproductive abuse.

“…2 Although most commonly labelled 'reproductive coercion' in literature and practice, recent research in the area has recommended the word 'abuse' be included since it highlights the intention and effect of the behaviours it describes. 1,3 Male intimate, dating or ex-partners are often perpetrators of RCA, however, family members and other people can be responsible. 4 RCA shares commonalities with both intimate partner violence (IPV) and sexual violence (SV).…”

Section: Introductionmentioning

confidence: 99%

Barriers to Responding to Reproductive Coercion and Abuse in Australian Primary Care

Wellington

Hegarty

2020

Preprint

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Background: Reproductive coercion and abuse is defined as any behaviour that seeks to control a woman’s reproductive autonomy. In Australia, women often access reproductive health care through a primary care clinician, however, little is known about clinicians’ experiences responding to reproductive coercion and abuse. This study aims to address this gap by exploring the barriers to responding to reproductive coercion and abuse in Australian primary care. Methods: Twenty-four primary care clinicians from diverse clinical settings in primary care across Australia were recruited to participate in a semi-structured interview. Data were analysed thematically.Results: Through analysis, three themes were developed: It’s not even in the frame, There’s not much we can do and There’s no one to help us.Conclusions: Many clinicians felt ill-equipped to identify and respond to reproductive coercion and abuse. Some clinicians hadn’t received any formal training, others were trained but had nowhere to refer women. Further complicating responses was a lack of support from referral services. This study highlights the need for more training and a streamlined referral pathways for women who experience reproductive coercion and abuse, as well as better access to reproductive health services in rural areas.