The Impact of Low Household Income on Reproductive Coercion and Violence Among Adults in Rural Appalachia

Background and Purpose: 

Reproductive coercion is recognized as a public health problem. Research indicates that rural communities receive limited access to services and have fewer reproductive health care options. In comparison to their urban peers, individuals in rural areas may report more social norms and attitudes favoring domestic violence, high isolation and lower household incomes. Reproductive autonomy comprises of the ability to control decisions around contraceptive use, pregnancy intention, and birth free from coercion. Many factors influence one’s ability to achieve and maintain reproductive autonomy, such as access to information and health care, and communication with a partner. Women who experience reproductive coercion may also face other negative factors. However, little to no research has examined this area in a rural setting.

Methods:

Researcher(s) received IRB approval and administered surveys in partnership with a local health department in a rural setting. The questionnaires included the Dating Violence Scale, the Reproductive Autonomy Scale (measuring decision making, communication, and freedom from coercion), and the Reproductive Coercion Scale.  The sample consists of 169 participants (female n = 144, male n = 19, and non-binary n = 5).  The sample has a mean age of 30.88 years old (SD = 12.04 ). Nearly half of participants reported a yearly household income below $29,000. Approximately 79% of the sample reported using some form of contraception. Approximately 18% of the respondents have been pregnant when they did not want to be.

Results:

Twenty-six percent of participants were told by their partner not to use birth control, 23% were forced or pressured to become pregnant, and 24% could not tell their partner that they did not want to be pregnant. Univariate and multivariate analysis were employed to analyze the data. Multiple regressions were conducted, which identified predictors of reproductive coercion on experiencing violence. An independent sample t-test revealed that women were more likely than men to be victims of physical violence. Multivariate analysis revealed that making under $29,000 a year, increases the likelihood of experiencing physical violence. Further analysis revealed that using no birth control, experiencing reproductive coercion, and not having good communication around reproductive autonomy were all significantly associated with physical violence victimization. These findings suggest that economic and reproductive injustice can lead to violence victimization in rural Appalachia.

Implications:

Rural social workers should be aware that lower household income rates are associated with health disparities for women. Social work practitioners should use assessments that screen for birth control sabotage and pregnancy coercion. Community programs aimed at preventing intimate partner violence should include comprehensive sex education focusing on reproductive coercion and controlling behaviors in relationships. Future research should examine and evaluate prevention efforts aimed at decreasing reproductive coercion and violence in rural settings.