Every woman has the right to choose what she does with her body.
Yet repeatedly these internationally accepted human rights are being violated by controlling partners, intrusive family members and patriarchal powers. What’s worse is that these violations are so common, many of us don’t even realise we had rights to begin with – let alone that they are being abused.
A study published in BMJ Sexual & Reproductive Health has found that as many as one in four women accessing sexual and reproductive healthcare services say they are not allowed to take control of their own reproductive lives.
Examples of reproductive coercion included forcing someone to have a baby or forcing someone to get rid of a baby through threats of violence.
Examples of reproductive coercion included forcing someone to have a baby by means of "physical violence, threats of violence or forced sex", forcing someone to get rid of a baby through threats of violence and, in some of the most extreme cases, spiking the woman’s food or drink with medication that induces abortion.
Families, too, can be guilty of undermining a woman’s reproductive agency. On the issue of involvement from parents-in-law, the study states: "Deprivations commonly inflicted on a daughter-in-law are restrictions to the supply of food, confining her to the house, and other insults and humiliations."
Stealthing is the practice of a man removing a condom without the knowledge of the woman he is having sex with.
And then there is contraceptive sabotage. This includes the recently coined 'stealthing', during which an intimate partner removes a condom without the knowledge of the woman he is having sex with. A form of rape, stealthing invalidates consent by going against the terms under which it was initially given.
Several women told Refinery29 about their experiences of contraceptive control and stealthing.
Janye, 34, said that the disregard her casual partner had for stealthing her left her feeling confused and upset.
"I had always struggled to understand and name what happened to me. I had sort of figured that it was some sort of assault and thinking about it logically afterward, I thought it was a bit rapey – but I couldn't quite bring myself to say that that's what it was."
Hanna, 29, was having sex with her boyfriend when he decided to take a condom off without her consent because he "thought it would be fun".
"Because his reaction was so nonchalant, it made me feel as if I’d made too much of a big deal out of it. I felt really upset and angry with myself for bringing it up. There wasn’t a lot of information out there about stealthing, so I was left with confusion, self-hatred and anger."
More than one woman made the gruesome discovery that their partner had stealthed them after finding a condom inside their vagina days later.
Contraceptive sabotage also involves men binning women’s contraceptive pills, poking holes in the end of a condom, not withdrawing on climax when they’ve agreed to, lying about having had a vasectomy, or forcibly removing an intrauterine device. Yes, that does mean violently yanking a coil from a woman’s cervix.
Simone, 32, told Refinery29 that she had been coerced into taking the contraceptive pill because her partner didn’t want to wear a condom. She was against taking hormonal contraception due to mental health issues she was suffering at the time, but he persisted and she reluctantly agreed. Upon splitting up a few months later, he made a brutal admission.
"He admitted that he had been having unprotected sex with people he had met on nights out," she said.
"This made me feel cheap, stupid and not important. He sacrificed my sexual health so he could have a slightly better orgasm."
With domestic violence as prevalent as it is, it comes as no surprise to learn that many of these behaviours overlap with other aspects of control within romantic relationships. According to the Office for National Statistics, two women a week in England and Wales are killed by their partner or ex-partner. In the year ending March 2017, an estimated 1.2 million women experienced domestic abuse. Reproductive coercion is more likely to occur in long-term relationships.
Young women are more likely to be affected by reproductive control, while in the US, black and multiracial women are particularly vulnerable.
The authors of the BMJ study gathered the evidence by pooling research and findings from hundreds of separate studies from international medical and social science databases about women’s experiences between 2010 and 2017. While it acknowledged that men and people in same-sex relationships could find themselves under reproductive control, the study focused on women in heterosexual relationships. They found that young women are more likely to be affected by reproductive control, while in the US, black and multiracial women are particularly vulnerable.
The negative effects of reproductive control on women are manifold. Not only is there the trauma inflicted by physical beatings or tearing out contraceptive implants, but there are higher rates of sexually transmitted infections, overuse of emergency contraception, unwanted pregnancies and terminations with unwanted side-effects. It also has a detrimental effect on women’s mental health. Frequently women who try to protect themselves risk violence.
Dr Anatole Menon-Johansson, medical director of Brook sexual health clinics, says that there are some less obvious ways in which women can maintain reproductive control.
"The contraceptive injection is one of the most private ways they can do this. There are no pills to find, no threads to feel inside the vagina as there are in intrauterine devices… It’s the best option contraception-wise that we have."
The availability of things like flushable pregnancy tests has been beneficial, as has the slowly increasing accessibility of medical abortion pills that can be taken at home.
Dr Menon-Johansson also spoke about safeguarding assessments that sexual health practitioners can conduct with their patients – something the BMJ study describes as essential in tackling the problem.
"Making women aware of their autonomy, that their choices need to be respected and supported, is really important. So we try to see women alone and will ask them questions about how they feel about the pregnancy and about their relationship at every appointment.
"Sometimes you don’t hear about anything until the second or third consultation. Then we give them as much support as possible."
Malorie, 25, was repeatedly hassled by her partner about getting an abortion, although she didn’t want to. At eight months pregnant, he violently and deliberately assaulted her, which resulted in her child being stillborn. He was found guilty of child destruction and received a life sentence of 32 years with a 16-year minimum. The sentence was later reduced by two years after an appeal.
"So many women have been in contact with me about this," says Dr Menon-Johansson. "Police might say that they don’t have much of a case. If she isn’t 28 weeks pregnant, then her attacker won’t go to prison – he might get an assault charge but that’s it."
Stealthing is a sexual offence and could be tried as rape. However, with conviction rates at a 10-year low, getting justice seems unlikely. In the UK, no one has ever been found guilty of stealthing – although a landmark case in Switzerland resulted in a man receiving a 12-month suspended sentence for removing a condom during sex without his partner’s consent.
"As well as a criminal redress, there is also a civil redress, which can prove more successful. Because of the impact of someone’s behaviour they could be compensated for the physical and mental pain they suffer. It’s not easy for people that do it, but in most cases it is rarely about the money. Women seek civil action to get some sort of recognition for what they’ve been through."
One thing the study doesn’t address – and admits is woefully under-investigated – is the motivation behind reproductive coercion. Why do men want to control women’s reproduction?
Theories centre on the idea of male dominance over women, supported by a society which places men firmly in charge. Abusive partners may wish to seek permanent connection to their victim by having children with them. There may be religious or cultural reasons why a family may want a woman to produce more children. In some parts of India, for example, having male children is highly prized. And then there’s a lack of regard for women's emotions; a pervasive selfishness that consistently sees some men put their needs far above a female partner’s.
The study concludes by highlighting the need for better education, not just to empower women by making sure they understand their reproductive rights – and can recognise when they are being violated – but also for perpetrators, to understand consent and respect women.
According to the BMJ, an educational intervention was found to reduce the odds of pregnancy coercion by 71% – and significantly increase the odds of ending an unhealthy relationship.
"More people need to be educated in reproductive coercion," Malorie concludes.
"Women don’t know where to turn, what to do, and left to fend for themselves when they’re in a vulnerable state. This has to change."
If you have been affected by any of the issues raised and need support, visit Women’s Aid or contact the National Domestic Violence Helpline on 0808 2000 247.