By
Karen Moldovan,
CCASA's
Program Manager
Throughout
my career, I’ve consistently worked with women (and girls) who are
pregnant. As an advocate at a domestic violence shelter, it was not
uncommon for pregnant women to access residential and other supportive
services. When I became a teacher at a Florence Crittenton program, all
of my students were pregnant and/or parenting teen girls, between the ages of
12 and 18. In those settings, it wasn’t uncommon to have conversations
about morning sickness, baby names, back aches, and the logistics of getting to
and from countless OBGYN appointments. While those conversations came
easy, I gradually realized how complicated it was to have conversations beyond
the more mundane pregnancy and birth talk. As I was able to build trust
with the women and girls I worked with, I slowly learned about the mounting physical
and emotional safety needs that were often a quiet struggle. One student
was a twelve year old 7th grader, who flatly refused to tell anyone,
anything about the male who was no doubt involved in her pregnancy.
Yet other students would quietly murmur about how the biological father was a
grown man, and she didn’t want to get him in trouble. Apparently her
family didn’t want to get him in trouble either, because he did have steady
employment and would be able to financially provide for the baby.
Still
to this day, it’s painful to think about the struggles of many of these young
women. Pregnancy was often closely intertwined with intimate partner
violence, incest, inter-familial sex trafficking, and rape. There was a
young women who refused to speak about or even acknowledge her pregnancy, a
young woman who confided that she could not hold her baby daughter without
breaking down into tears due to the flood of traumatic memories she could not
stop, and the young woman who flatly refused seeking any sort of child support
because the most important thing was being away from the man who impregnated
her. I bring up these cases because they changed me as an Advocate.
Now I look back and see that the context of the pregnancy was often the
“elephant in the room.” As an advocate, baby names and OBGYN appointments
felt okay to bring up, but I really didn’t talk integrate the following facts
into my work:
- Approximately one in five young women said they experienced pregnancy coercion and one in seven said they experienced active interference with contraception (National Crime Victimization Survey, 2005).
- Girls who are victims of dating violence are 4 to 6 times more likely than non-abused girls to become pregnant (Silverman, 2004).
- As many as two-thirds of adolescents who become pregnant were sexually or physically abused some time in their lives (Leiderman, 2001).
- Homicide is the second leading cause of traumatic death for pregnant and recently pregnant women in the U.S. (Chang, 2005).
Considering
what we know about perpetrators of intimate partner violence (and the power and
control they demand), it should not be surprising that sexual coercion and
forced pregnancy are frequently used as tools of abuse. This abusive
behavior may manifest as threats and/or violence if a partner does not comply
with the perpetrator’s wishes regarding contraception or the decision whether
to terminate or continue a pregnancy. It may manifest as intentionally
interfering with the couple’s birth control, or forcing invasive fertility
treatments.
In
my own personal life, my partner and I have spent the past two years seeking
medical advice and intervention regarding (in)fertility. In our journey
to try and become parents, we’ve seen numerous doctors and medical
professionals. When exchanging small-talk before or after an appointment,
they’ve all asked me what I do for work. As I explain CCASA, the tone of
the conversation shifts, and more than one Fertility Specialist has shared case
examples of reproductive coercion. One case involved a couple coming in
to seek in-vitro fertilization (IVF). The Doctor just sensed something
wasn’t right and (smartly) decided to talk to the husband and the wife
separately. When separated, the wife confided to the Doctor that she
didn’t want to be pregnant and didn’t want to do IVF, but that her husband was
forcing her. Another Doctor told me about a situation where she had
performed an Intrauterine Insemination (IUI) procedure for a couple, which was
successful and resulted in twins. Shortly after, the couple was back with
the husband demanding IVF. The Doctor was perplexed by both his urgency
and demeanor. Within a couple months of that appointment, the husband was
arrested for both child abuse and domestic violence. When these stories
have been relayed to me, the Doctors each seemed incredibly saddened, baffled,
and unsure of how to both identify warning signs and respond
appropriately.
Because October is Domestic Violence Awareness Month,
I think it’s important for all of us to think about how we can collaboratively
improve outreach and awareness around reproductive coercion and the unique
considerations of survivors who are pregnant. I’ve found that health care
providers want assistance with these issues, yet are often just too busy to be
the ones outreaching to community agencies. The good news is resources are
available. Futures Without Violence (www.futureswithoutviolence.org)
has numerous, groundbreaking tools for addressing reproductive coercion and
facilitating cross training and collaboration between health care providers and
advocates. Penny Simkin and Phyllis Klaus’s book, “When Survivors Give
Birth: Understanding and Healing the Effects of Early Sexual Abuse on
Childbearing Women” is a must-read for anyone working directly with survivors
who are pregnant. Research determines that a physically-abused woman also
experiencing forced sex [is] over seven times more likely than other abused
women to be killed (Campbell, 2003). In light of this horrific statistic,
these conversations are absolutely worth having.
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