Coercion in Contraceptive Care
What is contraceptive coercion?
Norms, policies, and programs have long encouraged some groups, like wealthy white women, to have children, while discouraging reproduction for others, like poor women and women of color. Enthusiasm for highly effective, long-term birth control methods has also led to the over promotion of methods like IUDs and implants. Sometimes, this focus puts the priorities of healthcare systems and providers ahead of what patients actually want. There is growing concern about these practices, but there has been little research on how often this happens, what it looks like, or how it impacts people’s lives. There is also no standard way to measure this kind of pressure, known as contraceptive coercion.
Our work begins to address this gap by introducing and testing a new way to measure coercion in contraceptive care. We use it to:
- show how common contraceptive coercion is,
- look at how it affects different groups, and
- identify factors linked to experiences of contraceptive coercion.
Featured Publications
Sociolegal Reproductive Coercion: A Framework for Understanding Structural Pressures on Reproductive Decision-Making
Laura E. T. Swan, Klaira Lerma, Lindsay M. Cannon and Fran Linkin introduce the concept of sociolegal reproductive coercion to explain how laws and policies shape reproductive decision‑making in the Journal of Law, Medicine & Ethics.
Reasons for contraceptive and LARC non-use: How preferences and access barriers shape decisions
Laura E.T. Swan and co-authors examined reasons for contraceptive and LARC (long acting reversible contraception, IUDs and implants) non-use across four states.
Lesbian, gay, bisexual, and queer+ patients’ preferences for contraceptive counseling and experiences of coercion in contraceptive care
Authors assessed differences in contraceptive care preferences and coercion across sexual identities and used open-ended survey responses to contextualize participants’ contraceptive coercion experiences.
Research Status
In 2023, we surveyed reproductive-aged people in the United States who were assigned female at birth. We oversampled racial, ethnic, gender, and sexual minorities to ensure a diverse sample that included groups often underrepresented in survey research who are theorized as more likely to experience contraceptive coercion.
2023 Survey Findings
Our survey research has shown:
- Over 1 in 6 participants report coercion during their last contraceptive counseling. And over 1 in 3 report it at some point in their lifetime.
- Upward contraceptive coercion (pressure to use birth control) is more common than downward contraceptive coercion (pressure to not use birth control)
- Groups facing structural oppression, especially Black participants and gay/lesbian participants, appear to be particularly at risk of experiencing contraceptive coercion.
What’s the impact of coercive contraceptive care?
Our research shows that people who experience contraceptive coercion are less likely to be using their preferred contraceptive method(s) and have worse mental health and well-being than people who have not experienced contraceptive coercion.
Participants share that experiences of contraceptive coercion are “traumatic” and make them “feel hopeless, ignored, and frustrated…like [they don’t] possess bodily autonomy.”
They explain that coercion in their contraceptive care leads them to “limit seeking healthcare as much as possible” and/or seek out providers who value their contraceptive preferences.
Current Research
In light of recent policy changes, such as abortion restrictions and cuts to family planning funding, patients and providers are navigating a tense and uncertain environment. This can lead to rushed decisions or pressure to use long-acting birth control methods, even when they don’t align with a person’s preferences. We are conducting qualitative interviews to help us understand these pressures from patient and provider perspectives.
We are also working to improve the existing Coercion in Contraceptive Care Checklist based on feedback from past participants and researchers.
Research Team
Additional research collaborators include:
- Betsy Pleasants, DrPH, MPH (Post Doctoral Research Associate), UNC Chapel Hill
- Jenny Higgins, PhD, MPH (Professor), University of Wisconsin Collaborative for Reproductive Equity (CORE)
- Madison Lands, MPH, MSW (former Research Program Manager), University of Wisconsin Collaborative for Reproductive Equity (CORE)