Women and health workers' conceptualisations of reproductive coercion and abuse: a comparative synthesis from Brazil, Nepal, Palestine, and Sri Lanka.

backgroundReproductive coercion and abuse (RCA) is a hidden form of violence against women, involving controlling behaviours by a partner or family member to manipulate a woman's reproductive autonomy, either to prevent or promote pregnancy. It correlates with partner violence, unintended pregnancy, contraceptive non-adherence, and poor sexual and reproductive health. However, research often oversimplifies RCA, treating it as a uniform phenomenon and neglecting its diverse manifestations. Additionally, there is scarce evidence on RCA in low- and middle-income countries. This study examines the conceptualisation and discourse surrounding reproductive coercion among health workers and women victims/survivors in Brazil, Nepal, occupied Palestinian Territories, and Sri Lanka. The main objectives include: 1) Investigating acts of reproductive coercion reported by women and health workers. 2) Exploring how health workers approach reproductive coercion in their practice. 3) Understanding the structural, institutional, and social barriers affecting victim/survivors encounters with reproductive coercion.

methodsWe conducted 62 qualitative interviews with health workers and domestic violence victims/survivors across the four countries, plus three focus groups with women in Nepal. Data were analysed thematically.

resultsThe findings reveal that reproductive coercion emerged as a form of domestic violence across all settings studied. Reported acts of coercion and violence by both women and health workers included attempts to force pregnancy against a woman's wishes and to hinder contraceptive use, driven by jealousy or the desire to promote pregnancy. Perpetrators, mainly husbands and family members (particularly in-laws in Nepal and Sri Lanka), employed various coercive behaviours such as pressure, decision-making control, threats (e.g., leaving the partner or violence), verbal harassment, and physical violence. The analysis also underscored broader structural and social challenges constraining women's reproductive choices and health workers' responses, encompassing religious beliefs surrounding contraception and abortion, cultural norms regarding son preference (notably in Nepal), and restrictive health policies concerning abortion and spousal consent for family planning (observed in Nepal and Sri Lanka).

conclusionsThe study emphasises the necessity for further research to comprehensively understand acts of reproductive coercion and abuse and guide health workers in effectively addressing this issue.