http://www.nytimes.com/2011/02/15/health/research/15pregnant.html

February 15, 2011

Report Details Sabotage of Birth Control

By RONI CARYN RABIN

Men who abuse women physically and emotionally may also sabotage their partners’ birth control, pressuring them to become pregnant against their will, new reports suggest.

Several small studies have described this kind of coercion among low-income teenagers and young adults with a history of violence by intimate partners. Now, a report being released Tuesday by the federally financed National Domestic Violence Hotline says 1 in 4 women who agreed to answer questions after calling the hot line said a partner had pressured them to become pregnant, told them not to use contraceptives, or forced them to have unprotected sex.

The report was based on answers from more than 3,000 women, but it was not a research study, those involved said.

“It was very eye-opening,” said Lisa James, director of health at the Family Violence Prevention Fund in San Francisco, which worked with the hot line on the report. “There were stories about men refusing to wear a condom, forcing sex without a condom, poking holes in condoms, flushing birth control pills down the toilet.

“There were lots of stories about hiding the birth control pills — that she kept ‘losing’ her birth control pills, until she realized that he was hiding them,” Ms. James added.

One respondent described having to hide in the bathroom to take her pill. Another said that when she got her period recently, her partner was “furious.”

The hot line’s report did not include a comparison group and did not gather information about the participants, who were questioned anonymously; nor was it published in a peer-reviewed journal. It was based on answers to four questions posed to 3,169 women around the country who contacted the domestic violence hot line between Aug. 16 and Sept. 26, 2010, who were not in immediate danger and who agreed to participate. About 6,800 callers refused to answer the questions.

Of those who did respond, about a quarter said yes to one or more of these three questions: “Has your partner or ex ever told you not to use any birth control?” “Has your partner or ex-partner ever tried to force or pressure you to become pregnant?” “Has your partner or ex ever made you have sex without a condom so that you would get pregnant?”

One in six answered yes to the question “Has your partner or ex-partner ever taken off the condom during sex so that you would get pregnant?”

The questions were devised by Dr. Elizabeth Miller, an assistant professor of pediatrics at the School of Medicine at the University of California, Davis, whose earlier papers on reproductive coercion prompted interest in the subject.

“It’s really important to recognize reproductive coercion as another mechanism for control in an unhealthy relationship,” Dr. Miller said. At the same time, she added, younger women and girls dating older men may be confused by the pressure to become pregnant.

“If you can put yourself in the shoes of a 15-year-old dating an 18- or 19-year-old man, which is not an unusual scenario, and he says to her, ‘We’re going to make beautiful babies together,’ that’s pretty seductive.”

But Dr. Miller said more research was needed to understand the men’s motivations.

“One of the things that comes up a lot is: What are the guys thinking?” she said, adding that her own research suggested some answers.

“Some have an intense desire for a nuclear family, and many who had experiences of a dysfunctional family home want something better,” she said. Some young men, she said, “want to leave a legacy, and say, ‘I’m not sure how long I’m going to be around.’ Gang-affiliated young men want the status that comes with having babies from multiple women.”

Dr. Miller’s paper, published last year in the journal Contraception, reported that at five family planning clinics in Northern California, one-third of 683 female patients whose partners were physically abusive said the men had also pressured them to become pregnant or had sabotaged their birth control. Of 191 women who reported birth control sabotage, 79 percent also reported physical abuse, the study found.

The associations help explain why young victims of violence by intimate partners are at an increased risk for unplanned pregnancies and for sexually transmitted diseases.

Ms. James, of the Family Violence Prevention Fund, said that despite the new attention to reproductive coercion, she doubted it was a new phenomenon.

“I just think not enough people have been asking the question,” she said.