Women's expectations of healthcare providers in the context of reproductive abuse in Australia

Reproductive Coercion and Abortion Care: Care and Surveillance in Abortion Decision-Making in North Carolina, USA

In this article, I explore connections of reproductive coercion and surveillance care through ethnographic research conducted at two independent abortion clinics in North Carolina from 2018 to 2019. Examining the lived experiences of those who seek abortion care shows how patients navigate surveillance during the clinical encounter to receive care. Patients experiencing reproductive coercion often need to maintain existing social ties, involving the providers as mediators to ensure their preferred outcome. Because patients may only receive care if they express an autonomous decision for abortion, providers often observe and negotiate specific social-relational cues, draw-specific ethical conclusions about patient autonomy, and act accordingly.

Women's experiences and expectations of intimate partner abuse identification in healthcare settings: a qualitative evidence synthesis

OBJECTIVES

To explore women's experiences and expectations of intimate partner abuse (IPA) disclosure and identification in healthcare settings, focusing on the process of disclosure/identification rather than the healthcare responses that come afterwards.

DESIGN

Systematic review and meta-synthesis of qualitative studies DATA SOURCES: Relevant studies were sourced by using keywords to search the databases MEDLINE, EMBASE, CINAHL, PsychINFO, SocINDEX and ASSIA in September 2021.

ELIGIBILITY CRITERIA

Studies needed to focus on women's views about IPA disclosure and identification in healthcare settings, use qualitative methods and have been published in the last 5 years.

DATA EXTRACTION AND SYNTHESIS

Relevant data were extracted into a customised template. The Critical Appraisal Skills Programme checklist for qualitative research was used to assess the methodological quality of included studies. A thematic synthesis approach was applied to the data, and confidence in the findings was appraised using The Confidence in the Evidence from Reviews of Qualitative research methods.

RESULTS

Thirty-four studies were included from a range of healthcare settings and countries. Three key themes were generated through analysing their data: (1) Provide universal education, (2) Create a safe and supportive environment for disclosure and (3) It is about how you ask. Included papers were rated overall as being of moderate quality, and moderate-high confidence was placed in the review findings.

CONCLUSIONS

Women in the included studies articulated a desire to routinely receive information about IPA, lending support to a universal education approach that equips all women with an understanding of IPA and options for assistance, regardless of disclosure. Women's suggestions for how to promote an environment conducive to disclosure and how to enquire about IPA have clear implications for clinical practice.PROSPERO registration numberCRD42018091523.

Reproductive coercion and abuse in Australia: what do we need to know?

Reproductive coercion and abuse refers to patterns of controlling and manipulative behaviours used to interfere with a person's reproductive health and decision-making. Unintended pregnancy, forced abortion or continuation of a pregnancy, and sexually transmissible infections all may result from reproductive coercion, which is closely associated with intimate partner and sexual violence. Clinicians providing sexual and reproductive healthcare are in a key position to identify and support those affected. Yet, reproductive coercion and abuse is not currently screened for in most settings and addressing disclosures poses many challenges. This article discusses what reproductive coercion and abuse is, who it affects, how it impacts, and potential strategies to improve identification and response.

A conceptual re-evaluation of reproductive coercion: centring intent, fear and control

BACKGROUND

Reproductive coercion and abuse (RCA) is a hidden form of violence against women. It includes behaviours intended to control or dictate a woman's reproductive autonomy, for the purpose of either preventing or promoting pregnancy.

MAIN TEXT

In this commentary, we argue that there is a lack of conceptual clarity around RCA that is a barrier to developing a robust evidence base. Furthermore, we suggest that there is a poor understanding of the way that RCA intersects with other types of violence (intimate partner violence; sexual violence) and-as a result-inconsistent definition and measurement in research and healthcare practice. To address this, we propose a new way of understanding RCA that centres perpetrator intent and the presence of fear and/or control. Recommendations for future research are also discussed.

CONCLUSION

We suggest that IPV and SV are the mechanisms through which RCA is perpetrated. In other words, RCA cannot exist without some other form of co-occurring violence in a relationship. This has important implications for research, policy and healthcare practice including for screening and identification of women in reproductive healthcare settings.