Autonomy, Mental Health, and Well-Being: Exploring Associations with Experiences of Coercion in Contraceptive Care

Background: High-quality, patient-centered contraceptive care is an integral component of reproductive autonomy. However, research shows that healthcare providers’ personal beliefs and biases can impact the way that they interact with patients, the type of care they deliver, and the contraceptive methods they recommend. Despite the importance of comprehensive and unbiased care, little research has explored the prevalence and impact of healthcare providers’ coercion in contraceptive care. To address this knowledge gap, this study examined the associations between experiences of contraceptive coercion and patient reproductive autonomy, mental health, and well-being in the United States.

Methods: We used Prolific, a national panel of thousands of vetted participants, to recruit 1,500 reproductive-aged people in the United States who were assigned female at birth. Participants completed an online survey about their health and contraceptive care. Our 5-item measure of contraceptive coercion was developed through focus groups with family planning stakeholders and through other prior research. Participants who answered affirmatively to any of the five items were coded as experiencing contraceptive coercion (=1). We used validated measures of mental health and well-being (the Kessler Psychological Distress Scale and the Mental Health Continuum). We conducted chi-square tests, t-tests, and regression analyses to investigate the associations between patient-reported experiences of contraceptive coercion and reproductive autonomy, mental health, and well-being.

Results: One in 6 participants (16%) reported experiencing contraceptive coercion at their last healthcare visit. Participants who experienced contraceptive coercion at their last visit were less likely to be using their preferred contraceptive method(s) than those not reporting coercion (χ2[2]=13.137, p=0.001). Additionally, contraceptive coercion was associated with mental health and wellbeing, with those who experienced contraceptive coercion at their last visit reporting higher levels of psychological distress (t[1473]=-2.984, p=0.001), lower emotional well-being (t[1473]=2.444, p=0.007), and lower psychological well-being (t[1478]=2.062, p=0.020). These associations remained significant after controlling for demographic characteristics in regression analyses.

Discussion: Findings suggest that experiences of coercion in contraceptive care are negatively associated with reproductive autonomy, mental health, and well-being. There is a need for initiatives that address provider biases and coercive practices at both interpersonal and systemic levels. In addition to intersections between bodily autonomy and the social work value of self-determination, these findings are relevant for social work practice as social workers are commonly employed in healthcare settings where contraceptive coercion could occur and because social workers frequently act as a point of intervention for mental health challenges.