Validation of the Short-Form Reproductive Coercion Scale with Appalachian Women

Background: Reproductive coercion refers to behavior, typically perpetrated by an intimate partner, that interferes with autonomous reproductive decision-making. The 9-item Reproductive Coercion Scale (RCS) and the five-item short-form RCS measure reproductive coercion across two domains: pregnancy coercion and condom manipulation. Despite the potential for use of the short-form RCS in research and clinical settings, to date, no studies have provided evidence of its validity with varied samples beyond McCauley et al.’s (2017) original validation. The purpose of this study was to investigate the psychometric properties of the short-form RCS among a sample of Appalachian women. Validation of this scale in an Appalachian sample is particularly relevant because women in Appalachia commonly experience interpersonal violence as well as disparities in reproductive healthcare access and outcomes.

Methods: We recruited a purposive sample of Appalachian women, using targeted Facebook ads to collect data via an online REDCap survey in fall 2019, and participants received $10 gift cards for survey completion. We randomly split our sample into two independent samples and used exploratory factor analysis (EFA) on sample 1 (N = 314) and confirmatory factor analysis (CFA) on sample 2 (N = 314) to cross-validate our findings. After confirming that the two independent samples did not statistically differ in terms of demographic and study variables, we established convergent and divergent validity by conducting bivariate analyses between the short-form RCS and theoretically-related (unwanted pregnancy, intimate partner violence, pregnancy fatalism) and theoretically-unrelated constructs (religious affiliation, insurance status).

Results: Most participants (Sample 1: 89.8%; Sample 2: 90.1%) identified their race/ethnicity as white, and roughly one in six women reported experiencing some reproductive coercion (Sample 1: 15.6%; Sample 2: 16.4%). We retained all five short-form RCS items as they exceeded our a priori criterion of loading at or above 0.50. These five items were internally consistent, demonstrating a Cronbach’s alpha of 0.98 (Sample 1) and 0.97 (Sample 2) and omega of 0.98 (Sample 1) and 0.96 (Sample 2). EFA and CFA results indicated that, in this Appalachian sample, the short-form RCS measured a unidimensional construct and was not comprised of the multiple dimensions of pregnancy coercion and condom manipulation. As expected, intimate partner violence (Sample 1: χ²(1)=10.402, p<0.001; Sample 2: χ²(1)=10.675, p<0.001) and pregnancy fatalism (Sample 1: t(300)=-7.150, p<0.001; Sample 2: t(299)=-7.078, p<0.001) were significantly and positively associated with reproductive coercion while religious affiliation (Sample 1: t(70.9)=-1.272, p=0.207; Sample 2: t(76.5)=0.450, p=0.654) and insurance status (Sample 1: χ²(1)=2.375, p=0.123; Sample 2: χ²(1)=0.042, p=0.838) were not significantly associated with reproductive coercion. These findings support construct validity for the short-form RCS with this Appalachian sample.

Implications: Findings indicated that the short-form RCS is a valid and reliable instrument to assess reproductive coercion among this sample of Appalachian women. While pregnancy coercion and condom manipulation are often considered independent reproductive coercion factors, the current study indicates that, in this Appalachian sample, the short-form RCS measures a single latent reproductive coercion factor. Additional research may be needed to confirm the factor structure of the short-form RCS across populations and geographic conditions.