A quarter of women said they were subject to control or coercion over their reproductive lives, a British review of American studies has found.
The review found that control over women’s reproductive choices was “common”, with a quarter of women in a series of US studies over seven years reporting that they had experienced it.
One of the report’s authors, Professor Sam Rowlands, said there was no research on UK women so the scale of the problem was unknown, but he imagined the proportion would be similar.
Prof Rowlands, a doctor and visiting professor at Bournemouth University, said UK health professionals were missing chances to help women facing pressure over getting or staying pregnant.
He said: “I think we do need to replicate some of these studies, just to be sure that it’s happening, but most of us who have worked in women’s health, we know from talking to women that this definitely happens, so I think it’s not whether it happens, but it’s whether it happens to the same extent as some countries. And then also people need to be thinking about training, and getting people to raise this a bit more proactively in consultations, and then how to handle it when you find it.”
The report, published in the British Medical Journal, analysed nine studies on the prevalence of reproductive control in women from 2010 to 2017.
It defines the phenomenon as “actions that interfere with a woman’s reproductive intentions and any actions that pressurise or coerce a woman into initiating or terminating a pregnancy”.
Primarily carried out by intimate partners, it can also be perpetrated by the wider family and in organised crime, with young people and ethnic minorities particularly vulnerable. Actions include emotional blackmail, threats of violence, pressure to continue or end a pregnancy or to not use certain types of contraception. It also includes “contraceptive sabotage”, such as a male partner falsely saying they have had a vasectomy, piercing condoms, or “stealthing”, where a condom is covertly removed during sex.
Some women may not have insight into their relationship, especially if there is no physical or sexual violence, as they may become inured to the control being exerted on them, the report says.
Describing how it could manifest, Prof Rowlands said: “I think it is like a spectrum, at the worst extreme end there probably is violence and extreme things going on like food deprivation, on the other end it’s really just a kind of psychologically controlling atmosphere - keeping tabs on everything the woman is doing, maybe being restrictive over when she goes out.”
However, Prof Rowlands said that, for many women, the issue was not being raised during consultations.
He said there were no UK guidelines or advice for health professionals, the majority of whom “were not terribly aware and would not be thinking about raising this”.
Health professionals who were conscious of it were responding on an individual basis to individual patients, he said.
The report is calling for screening to take place in maternity, sexual and reproductive health and abortion services and GP surgeries, with a set of questions already devised.
Professionals should be alert to its possibility when they see women who persistently fail to use contraception, make frequent requests for emergency contraception, and pregnancy or STI testing.
Where women say they are being controlled, professionals may advise them on “concealable” methods of contraception.
It also recommends that women who attend services with an escort are seen alone “so that these sensitive issues can be raised”.