UPMC study finds that sexually active teens and young women report pressure to get pregnant
Troubled relationships between men and women can veer into “reproductive coercion” — when a person pressures a partner to become pregnant when they don’t want to be. Coercion is prevalent among sexually active teen girls and young women, according to a study from UPMC Children’s Hospital of Pittsburgh, although researchers couldn’t pinpoint what makes one young person at risk more than another.
The results show it’s important that doctors screen adults and teens for relationship abuse, according to the study’s lead author Amber Hill, an M.D./Ph.D. student at the University of Pittsburgh School of Medicine. The Centers for Disease Control and Prevention estimates in high school girls in relationships, 1 in 5 have experienced physical and/or sexual dating violence.
“We know we need to talk to our patients about [coercion and relationship abuse],” Ms. Hill said. “We need to make sure we have these conversations with everyone.”
Published in the August edition of “Obstetrics Gynecology”, the study analyzed data from an earlier healthy relationships at eight schoolbased health centers in California during the 2012- 13 school year. It focused on information on 550 sexually active female teens ages 14 to 19 in grades 9-12 and measured reproductive coercion and patterns of seeking health care.
The study found almost 1 in 8 of the teens experienced recent reproductive coercion. It reported no difference among demographic groups (age, race, ethnicity, socioeconomic status) or patterns in how the young people used health care (contraception, pregnancy tests, sexually transmitted infection testing). Previous studies about coercion and health care use found disparities among adult women.
“We really didn’t see any patterns or difference,” Ms. Hill said. “But because we didn’t see any difference, maybe we can’t rely on these clues.”
Subjects in the study were selected from the 771 females from the original school health center study. They responded to questions about coercion in the previous three months, as well as relationship abuse and forced sex. For example, asking if someone tried to pressure them to become pregnant, threatened to leave if they didn’t get pregnant or put holes in a condom so they would get pregnant.
Researchers found that 12% reported reproductive coercion, ranging from 6.7% of those in grade 9 to 13.6% in grade 12.
from11% in grade 10 to 21.7% in grade 9.
The first call
The American College of Obstetricians and Gynecologists’ Committee on Health Care for Underserved Woman made its first call for regular screening for reproductive and sexual coercion in 2013.
As part of the effort to improve their patients’ health, the ACOG opinion said, doctors then can offer help with education, counseling and contraception methods thatare hard to detect by partners.
Dr. Jamila Perritt, vice chair of the ACOG committee, said the new study could not find a way to target certain students to prevent abuse, confirming the need to screen everyone.
“Universal assessment continues to be an important thing,” she said. “One in eight women experience reproductive coercion. It’s common.”
The latest study is part of ongoing research into programs that promote healthy relationships among young people for study coauthor Dr. Elizabeth Miller, chief of adolescent and young adult medicine at Children’s. Adult women experiencing reproductive coercion have resources available to help them, Dr. Miller said.
“We’re incredibly fortunate in Western Pennsylvania to have multiple clinics and organizations like Pittsburgh Action Against Rape and women’s shelters,” she said. Partnering with them, her research on women’s health includes reproductive coercion.
“We use this approach to talk about health and unhealthy relationships,” she said. “With all the studies, we have some really nice saturation in talking about this in Western Pennsylvania, including at Adagio Health clinics and Planned Parenthood.
“The next step of our work is working with pediatricians about this, into adolescence. In visits with health professionals, the goal is primary prevention.”
The Pittsburgh researchers conceded that confidentiality and trust are key for young people to be able to tell health professionals about their intimate relationships.
Reporting abuse
Another concern is that health care providers must follow mandatory reporting laws if child sexual abuse is suspected. The study found that older partners were a factor in a teen’s risk of abuse and coercion.
“Girls that had physical or sexualrelationship abuse with reproductive coercion were more likely to say they had a partner five years older or more,” Ms. Hill said.
Dr. Perritt said providing private spaces and staff training so teens and young adults can speak freely about their experiences is something doctors can do. At least a portion of every appointment should include a private conversation between doctor and patient, she said.
“Contraception, pregnancy and sexual activity are in a context,” she said. “We have to make sure we do screening in general, in all kinds of things that put people at risk.”
Dr. Perritt and Dr. Hill noted that age differences between a patient and partner might mean an imbalance in power in a relationship. Learning about power, autonomy and control in relationships used to be part of sex education in high schools, Dr. Perritt said.
Sexual activity hasn’t changed, but sex education has turned to a focus on abstinence, she said: “What we’re teaching in our classrooms is really inhibiting our young people to stay safe and keep themselves safe.”
Talking about keeping their bodies safe should start in the pediatrician’s office and in the classroom, Dr. Perritt said. As patients move into adolescence, she said, it should continue in family doctors’ offices, even before a young woman goes to a gynecologist.
At Adagio Health clinics across Western Pennsylvania, providers have received training and have been doing reproductive and sexual screening for all their clients, according to Linda Snyder, Adagio’s senior director of Title X programs.
Among its programs, Adagio has launched a healthy relationships project led by Dr. Miller with the Adagio clinic in New Castle,said Ana Kay Yaghoubian, director of education programs. It involves the high school and middle school, law enforcement and training for service professionals. Part of its goal is to connect students who go to the school nurse’s office with information and resources.
“We want to reach teens where they are [living],” Ms. Yaghoubian said.