Rachel Held Evans asks:

So yesterday I complained about feeling stuck in the middle between pro-life idealism and those progressive policies I think are most likely to actually curb the abortion rate. But today I’m thinking about practical solutions. There are a few I’ve been advocating and supporting for a long time, but I want to crowdsource a bit: What are some key initiatives (both domestically and globally) around which conservatives and liberals could rally that would address the underlying causes of abortion: poverty, expensive healthcare, expensive childcare, lack of access to contraception and comprehensive sex education, domestic violence, etc? If I find the time I’ll share the best in a blog post. Thanks for weighing in! (And let’s keep it positive and practical!)

I love talking about ways to address the underlying issues that lead to abortion. There’s so much that we can do to prevent abortions — IF, as an early feminist wrote in The Revolution, “We want prevention, not merely punishment.” My reply:

***

As other commenters have said, affordable and easy access to contraception is important. The less often people have to go pick up prescription refills, the better — there was a study in L.A. that showed that allowing low-income women to get twelve months’ worth of pills at a time decreased the odds of unintended pregnancy by 30%, and the odds of an abortion by 46%. Even better, IF a woman freely chooses them and can have them removed upon request, are long-acting reversible contraceptives like IUDs and implants that don’t require any action to be taken once they’re in. In general, humans are not great at taking a pill at the same time every day (not just contraceptives). LARCs also can’t be sabotaged by abusive partners.

Speaking of which, we also need to do more to stop rape, and to help women out of abusive relationships. Early research shows that counseling women who come to family planning clinics about reproductive coercion (asking about whether their partners hide their pills, threaten to hurt them or kick them out of the home if they use contraception, etc.) not only reduces unintended pregnancies among women in abusive relationships, it also increases the chance they’ll leave those relationships. Men who father children by rape must not be allowed to have custody or visitation. This is already the case in 35 or so states, but we need to finish the job.

Comprehensive and accurate sex ed, including instruction about how to be safe and responsible about sexual activity if one chooses to use drugs or alcohol.

School and workplace policies that are designed with the idea that workers are human beings who have lives outside of work, not just productivity machines. No more just-in-time scheduling. No more pregnancy discrimination. Paid maternity and paternity leave. Affordable child care.

Nobody should ever be in a position where they don’t feel like they can bear a child because they won’t be able to pay rent or feed their other kids. More power for workers would mean better wages, and a real social safety net (one that’s not premised on the false idea of recipients as moochers who need to be humiliated) would alleviate some of the financial fear that often leads to abortion. Better yet, a guaranteed basic income and/or a child allowance. It’s disgraceful that in a country as rich as ours, hundreds of thousands of abortions happen every year because mothers are afraid they can’t afford to give their children life.

***

The above comment was dashed off quickly, but I would also add perinatal hospice, so that abortion doesn’t seem like the only option for parents whose children are diagnosed in the womb with fatal conditions. Also, there needs to be community support for parents of children with disabilities. Asking them to go it alone, with all the added stress and expense and work that can be involved, overwhelms many parents. They can’t see themselves handling all that, especially if they also have other kids. They shouldn’t have to handle it without help.

And while it’s not a policy issue, in general we need to foster a sexual ethic that emphasizes care for the health and well-being of oneself, one’s partner, and for any child who might be conceived. Not just safe sex, but caring sex. Wise sex. Sex that acknowledges that we aren’t pleasure-seeking islands, but are connected to — and affect — our fellow human beings.

[Author’s note: this article was originally published in Life Matters Journal, Volume 2, Issue 1.]

The consistent life ethic is traditionally seen as a way to draw connections among issues that do not seem related at first glance, such as war, the death penalty, and abortion. However, the connections between forms of violence and injustice are sometimes more immediate. Recent research, including a study published in August 2012 by the Guttmacher Institute, has highlighted connections between intimate partner violence, poverty, and abortion.

Intimate partner violence and abortion

Multiple studies from countries around the world have established a link between intimate partner violence (sometimes also known as domestic violence) and unintended pregnancy and abortion.[i],[ii],[iii],[iv]

The increased abortion rate among women who have experienced intimate partner violence begins with an increased prevalence of unintended pregnancy. A health survey in Massachusetts found that 40% of women who reported being abused had experienced one or more unintended pregnancies in the past five years, compared to 8% of non-abused women.[v]

Women in abusive relationships who become pregnant face numerous pressures to abort. These include fear of being punished if their partner doesn’t welcome the pregnancy, fear that the child will be abused, and the belief that having a child will make it impossible to leave the abusive partner for good. Among women who had abortions in the United States in 2008, about 7% reported having been physically or sexually abused by their child’s father, compared with about 1% of women in the general population who report experiencing physical or sexual abuse in the previous 12 months.[vi]

Reproductive coercion

In 2010, University of California-Davis researcher Elizabeth Miller and colleagues conducted the largest study to date of a phenomenon Miller has termed reproductive coercion[vii]. Miller’s team surveyed women aged 16-29 seeking reproductive health services in five clinics in northern California. Of these women, 53% had ever been physically or sexually abused by a partner. Nineteen percent had experienced pregnancy coercion, defined as a male partner using emotional or physical pressure or threats to get a woman to agree to become pregnant. Fifteen percent had experienced birth control sabotage, in which their partner had deliberately interfered with their efforts to use birth control. Miller uses the umbrella term reproductive coercion to cover pregnancy coercion and birth control sabotage.

Reproductive coercion is often associated with intimate partner violence and may partly explain why intimate partner violence is associated with high rates of unintended pregnancy.

Guttmacher study of “disruptive life events” and abortion

In August 2012, the Guttmacher Institute published a study in the Journal of Family Planning and Reproductive Health Care about the circumstances under which women have abortions. The researchers surveyed 9493 women who had abortions, and found that most had experienced at least one “disruptive life event” in the last year, such as unemployment, divorce or separation from a partner, getting behind on the rent or mortgage, moving two or more times, or having a baby.[viii]

The women in the study who were living in poverty experienced more disruptive life events – and hence, more abortions – than the women who were making greater than poverty incomes. Women living in poverty were also more likely to report having been physically or sexually abused by their partners.

In addition to the quantitative survey, researchers conducted in-depth interviews with 49 women. Nearly half of these women said that disruptive events interfered with their ability to use contraception consistently. Women reported losing health insurance and having trouble affording prescription contraception and getting to doctor’s appointments. Consistent use, not simply any use of contraception, is key to preventing unintended pregnancy. Poverty and disruptive life events appeared to make consistent use more difficult.

There were no questions on the quantitative survey about reproductive coercion, but six of the 49 women interviewed in-depth reported experiencing it.

Conclusions

Intimate partner violence and poverty both make it more difficult for women to avoid unintended pregnancy and to carry to term if they become pregnant.

For pro-life advocates who are working to reduce the demand for abortion, these data suggest two courses of action. The first is working to end poverty and abuse themselves, and ensuring a strong social safety net to buffer against the effects of disruptive life events. Second, it is also important to ensure that women currently experiencing poverty and abuse have the information and health care access they need to prevent unintended pregnancy, as well as social and material support if they do conceive.

Mitigating the effects of injustice and working to end the injustice itself are not mutually exclusive approaches. As one example, Elizabeth Miller and colleagues reported in 2011 on a pilot program that tested a new harm reduction intervention for women experiencing abuse or reproductive coercion.[ix] Their intervention enhanced standard intimate partner violence counseling with information on reproductive coercion and strategies for minimizing the risk of unintended pregnancy by using birth control methods that were concealable or hard to tamper with. The enhanced intervention both reduced the incidence of reproductive coercion and increased the likelihood that women would leave abusive male partners.

Protecting lives that are threatened by poverty and intimate partner violence also turns out to be a way to protect lives that are threatened by abortion.

 


[i] Christina C. Pallitto, Claudia García-Moreno, Henrica A.F.M. Jansen, Lori Heise, Mary Ellsberg, Charlotte Watts, on behalf of the WHO Multi-Country Study on Women’s Health and Intimate partner Violence, Intimate partner violence, abortion, and unintended pregnancy: Results from the WHO Multi-country Study on Women’s Health and Intimate partner Violence, Int J Gynecol Obstet 2012. Published online in advance of print September 6, 2012. Available at: http://dx.doi.org/10.1016/j.ijgo.2012.07.003. Accessed September 17, 2012.

[ii] Lockart I, Ryder N, McNulty AM. Prevalence and associations of recent physical intimate partner violence among women attending an Australian sexual health clinic. Sex Transm Infect 2011; 87(2): 174-176.

[iii] Alio AP, Salihu HM, Nana PN, Clayton HB, Mbah AK, Marty PJ. Association between intimate partner violence and induced abortion in Cameroon. Int J Gynecol Obstet 2011; 112(2): 83–87.

[iv] Fanslow J, Silva M, Whitehead A, Robinson E. Pregnancy outcomes and intimate partner violence in New Zealand. Aust N Z J Obstet Gynaecol 2008; 48(4): 391–397.

[v] Futures Without Violence. The Facts on Reproductive Health and Partner Abuse. Available at: http://www.knowmoresaymore.org/wp-content/uploads/2008/07/The-Facts-on-Reproductive-Health-and-Partner-Abuse.pdf. Accessed September 17, 2012.

[vi] Jones RK, Moore AM, Frohwirth LF. Perceptions of male knowledge and support among U.S. women obtaining abortions. Women Health Iss 2011; 21(2):117-23.

[vii] Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, Schoenwald P, Silverman JG. Pregnancy coercion, intimate partner violence and unintended pregnancy. Contraception 2010; 81(4):316-22.

[viii] Jones RK, Frohwirth L, Moore AM. More than poverty: disruptive events among women having abortions in the USA. J Fam Plann Reprod Health Care 2012; published online in advance of print August 20, 2012. Available at: http://dx.doi.org/10.1136/jfprhc-2012-100311. Accessed September 17, 2012.

[ix] Miller E, Decker MR, McCauley HL, Tancredi DJ, Levenson RR, Waldman J, Schoenwald P, Silverman JG. A family planning clinic partner violence intervention to reduce risk associated with reproductive coercion. Contraception 2011; 83(3):274-80.

 

Today is World Contraception Day 2012. In recognition, I’d like to call your attention to a sample of our writings discussing the ways in which the freedom to choose whether and how to prevent conception can save and improve the lives of women and their children.

We are also participating in discussions on Twitter using the hashtags #sheparty and #WCD2012. Join us!

It's appropriate that October is both Domestic Violence Awareness Month and Respect Life Month, as domestic violence (also known as intimate partner violence) and abortion are closely linked.

1 in 3 women worldwide are subjected to gender-based violence, including intimate partner violence (IPV), which may involve:

  • Sexual assault and contraceptive sabotage–thus heightened risk for/ incidence of unintended pregnancies.
  • Inhospitable circumstances for women to continue pregnancies and raise their children, leading more women to see abortion as their only choice.
  • Directly forced abortions.
  • Homicide of mother and/or child.

This fact sheet from Know More, Say More summarizes the research into the connection between domestic violence and unintended pregnancy, abortion, miscarriage, and homicide in the United States. The link between IPV and induced abortion has identified by studies from many other countries as well (including Australia, Bangladesh, Cameroon, and Italy). Some of these also link IPV and miscarriage.

Any strategy to reduce the incidence of abortion must address intimate partner violence and reproductive coercion. If you work with a pro-life group or crisis pregnancy center and would like to learn more about how your organization can serve abused women, please contact us.

Busy day today, but I wanted to draw people's attentions to a few items:

Groundbreaking Bill Integrates Pregnancy and Violence Prevention Strategies for Young People of Color

The “Communities of Color Teenage Pregnancy Prevention Act,” HR 2678, recognizes that a broader approach is needed to address teen pregnancy in communities of color, including the role coercion and violence plays in unintended pregnancy, and invests in getting young people of color the information and skills they need to build healthy relationships.  It further addresses the need among racial or ethnic minority and immigrant communities for culturally appropriate information and education on issues of reproductive and sexual health.


Know Your Rights: A Conference Call for Pregnant and Parenting Students!

Wednesday, August 10, 3pm Eastern

Pregnant and parenting students have a right to equal educational opportunities! Interested? Get more information about protections for students against discrimination.


Court: No tax-funded abortion in healthcare law

"Whether it is possible, under contingent circumstances, that at some point in the future, upon the execution of x, y, and z, that the [Patient Protection and Affordable Care Act] would not prevent taxpayer funded abortion is entirely different from providing for 'tax-payer funded abortion,'" the opinion states. "The express language of the PPACA does not provide for tax-payer funded abortion. That is a fact, and it is clear on its face."

(Our first of two posts for Blogging Against Disablism 2011.)

Blogging Against Disablism Day, May 1st 2011 More often than not, issues of reproduction and disability are approached solely in terms of ablebodied parents and disabled children. Of course issues like prenatal diagnosis and abortion of disabled unborn children are critical parts of the story.

But not all people with disabilities are children, whether unborn or already-born. Some of us are in fact adults, even if we are overlooked or infantilized. Like other humans, we are sexual and reproductive beings. And we face many forms of reproductive violence and injustice ourselves.

Namely:

  • Poverty, un or underemployment, poor housing conditions, poor nutrition, poor access to medical care, transportation barriers, and other problems that often severely undercut our ability to exercise our own sexual and reproductive preferences, whatever those may be.
  • Stereotypes that we are either asexual, or grotesque sexual predators.
  • Stereotypes that reproduction is a nonsequitur for us, or that we are by definition “unfit” parents whose “monstrous” breeding must be forcibly stopped.
  • Heightened vulnerability to sexual assault and other abuse.
  • Sex education that omits or glosses over us.
  • Interference with our freedom to seek out and marry the partners of our own choosing.
  • A long history of outright forced sterilizations and other pressures to use family planning methods we do not want, at the same time we are denied access to contraceptives we do want and that best fit our particular needs.
  • Interference with our freedom to seek out fully supported parenthood, whether biological, adoptive, or foster.
  • Intense pressure to abort when we become pregnant or partner to a pregnancy.

 

These injustices intersect mightily with the injustices resulting, for example, in the abortion or infanticide of children with disabilities. When I was pregnant with my daughter, for instance, a physician pressured me to have an abortion because he feared she might be “defective.” “You mean, just like me?!” I responded angrily. Hell if I was going to let him have his way with us!

Despite all the difficulties of that decidedly unplanned pregnancy- poverty, my ill health, disrupted life plans for me and my boyfriend, among other problems-I did have some resources for resistance, including the confidence that I could be a good mother. But what about other women who have disabilities and/or carry potentially disabled children-what if they lack the necessary resources? I already know the answer to that question. It is saddening beyond measure.

Even when and where it starts in the womb, the prevention and healing of reproductive violence and injustice against people with disabilities must continue ever after birth. And, as the disability rights slogan says, "Nothing About Us, Without Us." All of us.

Marge Berer, editor of the journal Reproductive Health Matters, makes this highly problematic claim: "In my opinion, it is only possible to be anti-abortion if you will never be the one left holding the baby, nor be around to see or take responsibility for what happens to those who are." Really?

What about All Our Lives supporters and kindred spirits, in the present and in the past, who not only believe but live their lives as if prolife means what it says: the taking on, not the disavowal, of such active, thorough responsibilities? We can't possibly exist?

If respect and reverence for all life means anything, it means that you bother to hold the baby, or at the very least offer your helping hands to any and all baby holders, in your own family, community, nation, planet. You not only bear witness to their situations-you do whatever you can to ease their difficulties.

And that set of conjoint responsibilities begins towards both mother and child as soon as you know about the pregnancy. In fact, you should have long since already assumed the responsibilities that began well before the present pregnancy.

With the mother's and the father's own conceptions and beyond, with nonviolent and fully socially supported parenting, with sex education for all stages of life, with measures to prevent and abolish reproductive coercion and violence against women, with complete, informed, voluntary access to family planning.

Marge Berer, we do exist. We are not impossibilities by definition-let alone decree. And if you would like our help in reducing abortion, just ask.

Great article by Lynn Harris at sexreally.com about recognizing and resisting reproductive coercion: 15 Warning Signs He Doesn’t Support Your Contraceptive Choices.

A sample:

  1. Does he refuse to wear a condom? “That’s near-universal with reproductive coercion, and can start on sexual-date-one,” says Heather Corinna, founder and director of Scarleteen and author of S.E.X.: The All-You-Need-To-Know Progressive Sexuality Guide to Get You Through High School and College.
  2. Does he equate birth control with cheating? As one woman (“Erika”) reported to the FVPF: “He said the pill made women want to have sex all the time, and that I’d cheat because I wouldn’t need to use a condom.”
  3. Do you go behind his back to get contraception? “Erika” snuck to a clinic for the pill. “For a year, I made sure he never saw them,” she says.

As they say, read the whole thing. And then pass it along to someone who might need this information.

The Family Violence and Prevention Fund has a new fact sheet on reproductive health and partner abuse (PDF).

Sexual coercion and violence is a costly and pervasive problem, and women of reproductive age – in particular, those ages 16 to 24 – are at greatest risk.1 Violence limits women’s ability to manage their reproductive health and exposes them to sexually transmitted diseases. Abuse during pregnancy can have lasting harmful effects for a woman, the developing fetus and newborns. A growing body of research indicates that the strong association of intimate partner violence and unintended pregnancy, abortion and sexually transmitted disease results from male coercive behaviors around sex and contraception.

This is an area where I'd like to see more activism from pro-life advocates outside of the establishment Movement. Most of us agree that a woman has the right to make her own decisions about contraception, and all of us agree that she has the right to make her own decisions about whether and when to have sex. A concerted educational and activist campaign against reproductive coercion could make a real difference in the rates of unintended pregnancy and abortion — not to mention in the lives of women.

We're having a discussion on the All Our Lives Facebook page about the recent article in The Nation, When Teen Pregnancy is No Accident. The Nation article looks at "reproductive coercion" — a form of partner abuse in which men deliberately try to make their partners get pregnant by tampering with their birth control or simply refusing to use any.  Sometimes these men then force their pregnant partners to have an abortion; other times they force them to bear the child.

 

How should the reproductive peace community respond to reproductive coercion without promoting the violence of abortion? How can we best empower women to escape abusive relationships and maintain control over their choice to use contraception?  Please feel free to comment here or, if you use Facebook, on our Facebook page.