Authors: Susan Saldanha, Desireé LaGrappe, Jessica R Botfield, Danielle Mazza
Categories: Public Health, PUBLIC HEALTH, Reproductive medicine, Risk Factors, 1506, 1724
Source: BMJ Open
Authors: Susan Saldanha, Desireé LaGrappe, Jessica R Botfield, Danielle Mazza
Reproductive coercion (RC) describes behaviours that interfere with an individual’s reproductive autonomy and decision-making. RC can be a form of intimate partner violence and overlaps with other forms of gender-based violence, such as sexual violence. Health settings are well placed to identify and intervene to support patients experiencing RC, however, the lack of conceptual clarity on RC means that health providers are not easily able to identify those at risk of experiencing RC. To facilitate appropriate identification and development of interventions, there is a need to understand the risk factors related to experiencing RC and associated health consequences.
To assess the current scope of evidence in relation to risk factors and health consequences of experiencing RC.
Eligible articles for inclusion in the scoping review will be original peer-reviewed literature that describe risk factors and health consequences of any type of RC. Studies on humans published in English since 2010 will be included. The proposed scoping review will be conducted in accordance with the JBI Methodology. This protocol is reported according to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Five electronic databases, OVID Medline, CINAHL, Scopus, PsychINFO and Embase, will be searched for relevant literature from 1 January 2010 to 23 January 2023. Two reviewers will individually screen and review articles for eligibility, and conflicts will be resolved by a third reviewer. Data will be charted and reported using a tool developed for the purpose of this review.
Findings will be disseminated in publications and presentations to relevant stakeholders. Ethical approval is not required as data from publicly available literature sources will be used. Available evidence will be mapped across the breadth of eligible studies to identify associated risk factors and health consequences of RC.
Research on reproductive coercion (RC), a burgeoning area of scholarship, is characterised by conceptual ambiguity surrounding its definition, measurement, related antecedents and consequences. Nevertheless, the past 3 years have witnessed a surge of research on RC following the COVID-19 pandemic, highlighting its importance for practice and policy and a need to better understand RC.
Despite evolving discourse on the definition of RC, it can be commonly understood as behaviours that interfere with an individual’s reproductive autonomy and reproductive decision-making.1–3 These behaviours may include pregnancy coercion, contraception sabotage, pregnancy outcome control (such as coerced abortion) and forced sterilisation.1–3 Although RC research has predominantly focused on male partner control of a female’s reproductive decisions and autonomy, emerging research and dialogue suggests that RC can be perpetrated by other actors such as family members, health providers and institutions.3 A form of gender-based violence disproportionally affecting women and girls of reproductive age, RC can also be experienced by any individual, regardless of their age, gender assigned at birth, or sexual orientation.3
RC, currently recognised as a discrete type of violence, is known to occur in conjunction with other types of physical, sexual and psychological violence.1–4 Decades of violence research have consistently documented that those who have experienced violence access health settings more frequently than those who have not.5 This suggests that those who experience RC may more often seek health services, especially to access covert forms of contraception, pregnancy care, abortion services, and other sexual and reproductive health support.6 Therefore, health settings such as general practice, sexual and reproductive health clinics, abortion clinics, gynaecology and obstetrics, maternal and child health settings are likely to encounter people experiencing RC.7
The WHO has underscored the importance of the above healthcare services as effective settings to identify and respond to intimate partner violence and sexual violence more broadly,8 and they may therefore be a suitable setting to also identify and respond to RC. However, the lack of conceptual clarity on RC means that health providers are not easily able to identify those at risk of experiencing RC and how they may present within health consultations. Consensus on RC risk factors and health consequences that a health provider must recognise as associated with a current or prior experience of RC, can facilitate appropriate identification within a health setting and support multidisciplinary collaboration across sectors to support those experiencing RC.9
RC, originally termed by Miller and colleagues in 2010, considered the elements of contraception sabotage and pregnancy coercion as behaviours of RC that occurred within the context of interpersonal relationships, specifically among intimate partners.10 In the time since, RC research has conceptually evolved to also include other elements such as coerced abortion, coerced sterilisation, and the role of structures and systems in controlling reproductive health decision-making.3 In 2021, conceptual work led by Tarzia and Hegarty further provided a distinct taxonomy for all RC behaviours occurring within the interpersonal context, that is, reproductive coercion and abuse (RCA).1 The term RCA centres fear and intent in its definition and reflects the abusive and multifaceted nature of the harm. However, RCA is conceptualised at the interpersonal level of intimate partner and family relationships. RCA is situated within but distinct from the broader structural/systemic context which enables coercive practices over reproductive autonomy by healthcare providers, governments and religious communities, among other institutions and organisations.
Within health settings, providers may encounter patients experiencing interpersonal and/or structural forms of RC.3 Despite the potential variations in future interventions and policies targeting each form of RC, considering the interplay of interpersonal and structural RC has significant implications on accessing healthcare among individuals experiencing RC. By using the term ‘RC’, instead of ‘RCA’ there is flexibility to acknowledge and analyse the structural determinants that contribute to control over reproductive autonomy, such as legal restrictions, lack of access to healthcare and social inequalities. This broader exploration of the problem is important as previous reviews on RC have only focused on coercion within the interpersonal context and mostly within intimate partner relationships.
Previous systematic reviews2 11 12 have explored the relationship between contraception sabotage and pregnancy coercion, its association with other types of violence, and health consequences, particularly sexual and reproductive health outcomes. However, no study has synthesised the scope of evidence on the risk factors and health consequences of all RC behaviours, especially considering new evidence published since the COVID-19 pandemic. This warrants an updated synthesis of evidence, to understand the interplay of risk factors between both interpersonal and structural forms of RC and how someone experiencing RC of any type may present to a health provider.
Thus, the aim of this scoping review is to assess the scope of evidence on the risk factors and health consequences of RC. Findings of this review may assist health providers in identifying who is at risk of experiencing RC or is currently experiencing RC; and inform prevention and intervention efforts in health settings.
A preliminary search of Open Science Framework, PROSPERO, MEDLINE, Cochrane Database of Systematic Reviews and JBI Evidence Synthesis in January 2023 found no current or proposed reviews on risk factors and health consequences of RC. RC research is still evolving, and understanding of its various domains and definitions may vary across studies. Furthermore, there exists measurement challenges with a range of validated and non-validated questions being used across studies, making it problematic to use criteria that is too specific. A scoping review methodology provides an opportunity to explore and clarify the concepts, definitions, and terminology related to RC, thus ascertaining the extent and strength of global evidence3 relating to the risk factors and health consequences of experiencing RC.
This protocol is reported in compliance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols.13 The scoping review will be conducted with guidance from the JBI Methodology for Scoping Reviews14 and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews.15 Any changes to this protocol will be tracked systematically to promote transparency and reproducibility.
The JBI Methodology for scoping reviews was chosen as it provides a contemporary framework that facilitates knowledge translation within health research and point-of-care decision-making.14 According to the guidance of JBI, the steps that will be employed as part of the scoping review (1) identifying title and review questions, (2) developing the inclusion criteria, (3) defining the search strategy, (4) evidence screening and selection, (5) data extraction, (6) data analysis and (7) presentation of the results.14
This research is conducted within The National Health Medical and Research Council Centre of Research Excellence in Sexual and Reproductive Health for Women in Primary Care (SPHERE). The development of the protocol involved a multidisciplinary team of national and international experts in sexual and reproductive health and primary care. Collaborative input has informed the development of the research questions for this scoping review.
The scoping review will map evidence pertaining to the following research
Development of the inclusion criteria was guided by the Population-Concept-Context strategy.14
The scope of this review will not be limited to a specific population (ie, there will be no restrictions on age, gender, etc) or the type of RC behaviour. Animal studies will be excluded.
Although there is no agreed definition of RC, this review will consider it as any behaviour that interferes with an individual’s reproduction, particularly their reproductive autonomy and decision-making. Articles that discuss scientific/biological control of reproduction, without mention of any RC behaviours, will be excluded. Articles will not be excluded based on perpetrator identity or the type of RC behaviour. Articles that discuss only behaviours that interfere with sexual autonomy and decision-making (without mention of influence on reproduction) will be excluded. Articles will be considered if any of the two research questions are addressed.
The scope of the study is global and will not be limited by geographic region. The term ‘reproductive coercion’ was first coined by Miller et al10 in 2010; therefore, only articles since 2010 will be included.
To optimise the veracity of the review findings, only published peer-reviewed articles will be included. Reviews, grey literature, conference abstracts, commentaries, dissertations, book chapters, editorials and protocols will be excluded. Original research articles with qualitative, quantitative and mixed-method study designs, including primary and secondary analysis of data, will be included.
The search strategy was developed by the research team with assistance from a medical librarian. The following databases will be searched for relevant literature in English OVID Medline, CINAHL, Scopus, PsychINFO and Embase. The decision to limit the search articles in English was founded on a precursor scoping review which included all languages for RC and its synonyms, and found a very limited number of papers (<1%) on the topic in languages other than English (OSF https://osf.io/rhck8/). The search was piloted on OVID MEDLINE (see online supplemental file 1) where the database was searched from 2010, and this search will be adapted for each database.
All identified papers will be collated and uploaded into Covidence (Veritas Health Innovation, Melbourne, Australia). Duplicates will be removed. Title and abstract will be screened by two independent reviewers for assessment against the inclusion criteria. To create a shared understanding of the inclusion criteria and to discuss any challenges that may arise, the research team will meet frequently during the study selection process. The full text of selected citations will be assessed independently by two reviewers. Any conflicts that arise during title, abstract or full text screening will be resolved by a third reviewer. Results of the search strategy and selection processes will be provided as a flow diagram in line with PRISMA 2.0 standards.
A data extraction form (see online supplemental file 2) will be tested by the two reviewers, who will begin by independently extracting data from the same 10 articles, refining the variable definitions as required. They will review their results and discuss any discrepancies until they reach consensus. If required, a third team member will be consulted to make the final decision. Extraction variables will be further developed based on pilot tests, inconsistencies between reviewers, as well as emerging information from the articles. Following pilot testing of the data extraction form, one reviewer will extract information from the remaining articles which will be cross-checked by a second reviewer. Modifications will be documented, and a final list of extracted variables will be appended to the full scoping review.
Due to heterogeneity in the types of literature drawn on, a narrative approach will be taken when summarising and presenting the results. Presentation of the results will be guided by the review questions and will include a mix of tables, conceptual mapping and diagrammatic representation. During this process, the evidence in support of each risk factor and/or health consequence will be charted (eg, study design, quality, strength of association if available). In general, the review will rely on the results reported in the published studies; however, the authors may request additional information or clarification from the corresponding authors of the studies if needed. A critical quality appraisal of articles is not routinely undertaken when conducting a scoping review.14 Therefore, a critical quality appraisal will not be conducted as the aim of this review is to only scope the breadth of research on RC risk factors and health consequences and provide a descriptive account of available research.
No patients or members of the public will be involved in this study.
The protocol for this scoping review has been reported to prevent duplication and improve the transparency of the review process. As the review involves a secondary analysis of data collected in prior research, of which findings are publicly available, ethical approval is not required.
The scoping review will be undertaken as part of a larger doctoral project led by the primary author, designed to understand the risk factors and associated health consequences of RC within general practice. Findings of the scoping review will inform the development of a context specific survey instrument to assess risk factors and health consequences in Australian general practice.
Results of the scoping review will be published in a peer-reviewed journal. Findings will also be disseminated via presentations at relevant local, national, and international committees and conferences, through social media and other communication channels.