Reproductive Coercion, Intimate Partner Violence and Pregnancy Risk Among Young Women in Foster Care

Background

The current study is the first to explore the prevalence of reproductive coercion among women involved in the U.S. foster care system. Reproductive coercion (RC), an abusive act of exerting power over an intimate partner by controlling their reproductive choices, has been identified as a major public health concern (ACOG, 2013). RC is associated with higher rates of physical and sexual abuse, STIs, unintended pregnancy, and negative mental health outcomes (Miller et al., 2014; McCauley et al., 2014). In the U.S., an estimated 9-25% of women experience RC in their lifetime (ACOG, 2013; Miller et al., 2010). Members of marginalized groups (e.g., women of color and women who have sex with women) have been identified as having heightened risk for experiencing RC (Holliday et al., 2017; McCauley et al., 2015). The majority of existing RC research has been conducted in either healthcare settings or on college campuses, limiting generalizability to populations which may have unique vulnerabilities to this type of abuse. One such group are youth in the foster care system, who generally report higher rates of pregnancy and risky sexual behavior compared to youth outside the system (King et al., 2014). Youth of color and youth identifying as LGBTQ+ are disproportionately represented in the foster care system as well (Wilson & Kastanis, 2015; Child Trends, 2018), potentially increasing the likelihood of RC exposure given what is known in the literature.

Methods

Cross-sectional survey data was collected from young women, 16-24 years old, seeking services from youth-serving agencies in a county foster care system (N = 136). Participants completed measures assessing RC, physical and sexual violence victimization, risky sexual behaviors, and pregnancy.

Results

The sample was predominantly African-American (66.9%) and largely identified as something other than heterosexual (45.6%). Nearly one-third of the sample (30.2%) reported a history of RC, with the most common form being male partners telling them not to use birth control. Nearly two-thirds (61%) of participants reported a history of physical or sexual violence perpetrated by an intimate partner (IPV), and 36% reported non-partner sexual assault. Lifetime and unwanted pregnancies were reported by 43.4% and 30.9% of the sample, respectively. Participants reporting RC had significantly higher odds of also experiencing IPV (OR = 4.25, 95% CI: 1.71, 10.59) or pregnancy (OR = 3.56, 95% CI: 1.64, 7.72). Risk factors identified at increased odds among participants reporting RC included use of alcohol or drugs before sex (OR = 4.47, 95% CI: 1.98, 10.12), engaging in sex trade (OR = 4.57, 95% CI: 1.53, 13.63), and having sex with a male partner 5 or more years older (OR = 10.63, 95% CI: 4.01, 28.20). No significant differences in RC incidence were identified by sociodemographic group.

Implications

These data suggest women involved in the U.S. foster care system are at an increased risk for experiencing RC. Improved system policies around screening, education, and access to different options of birth control (e.g., long lasting methods which are harder to tamper with) are warranted to improve outcomes for these young women.