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 overpromotion 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.
In the spring of 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.
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.
Next Steps
We have big dreams for a future without discrimination and coercion in contraceptive care! We are currently seeking funding to:
- Better understand contraceptive coercion for specific groups who commonly experience it.
- Generate actionable, provider-informed strategies to reduce coercive practices.
- Refine the Coercion in Contraceptive Care Checklist for clinical applications.
If you are a funder who is interested in learning more about our vision, email us at reproequityactionlab@wisc.edu
Research Team
Additional scientific 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)
Our Research
Publications
Lesbian, gay, bisexual, and queer+ patients’ preferences for contraceptive counseling and experiences of coercion in contraceptive care
Lands M, Cannon LM, Higgins JA, Swan LET. The Journal of Sex Research. April 2025.
The importance of patient-centered contraceptive care: Linking provider contraceptive coercion to patient psychological distress and mental well-being
Swan LET, Wasser O, Cannon LM. Sexual & Reproductive Healthcare. March 2025.
Healthcare provider-based contraceptive coercion: Understanding U.S. patient experiences and describing implications for measurement
Swan LET, Cannon L. International Journal of Environmental Research and Public Health. June 2024.
Coercion in contraceptive care: Differences based on racial/ethnic identity, sexual orientation, and gender identity
Swan LET, Cannon LM, Lands M, Higgins JA, Green TL. Contraception. November 2023.
Addressing coercion in contraceptive care
Swan, LET. Scholars Strategy Network. July 2024.
This is an accordion element with a series of buttons that open and close related content panels.
Presentations
- Autonomy, mental health, and well-being: Exploring associations with experiences of coercion in contraceptive care. Symposium presentation at the annual Society for Social Work and Research conference. 2024.
- Coercion in contraceptive care: Differences based on racial/ethnic identity, sexual orientation, and gender identity. Poster presentation at the annual Society of Family Planning conference. 2023.
- Coercion in contraceptive care: Describing patient perspectives, disparities in care, and associations with reproductive autonomy. Oral presentation at the annual Psychosocial Workshop. 2023.
Media Archive
- Contraceptive Technology Update Interview | Patients who perceive contraceptive coercion report psychological distress.
- Dr. Laura Swan [June 2025]
- Contraceptive Technology Update Interview | Many people still report experiencing reproductive counseling coercion.
- Dr. Laura Swan [September 2024]
- Women’s Healthcase Podcast Interview | Contraceptive coercion.
- Dr. Laura Swan [November 2023]