Delayed Visits for Contraception Due to Concerns Regarding Pelvic Examination Among Women with History of Intimate Partner Violence

Abstract

BACKGROUND: Concern regarding pelvic examinations may be more common among women experiencing intimate partner violence. OBJECTIVE: We examined women's attitudes towards pelvic examination with history of intimate partner violence (pressured to have sex, or verbal, or physical abuse). DESIGN: Secondary analysis of data from a cluster randomized trial on contraceptive access. PARTICIPANTS: Women aged 18-25 were recruited at 40 reproductive health centers across the USA (2011)(2012)(2013). MAIN MEASURES: Delays in clinic visits for contraception and preference to avoid pelvic examinations, by history of ever experiencing pressured sex, verbal, or physical abuse from a sexual partner, reported by frequency (never, rarely, sometimes, often). We used multivariable logistic regression with generalized estimating equations for clustered data. KEY RESULTS: A total of 1490 women were included. Ever experiencing pressured sex was reported by 32.4% of participants, with 16.5% reporting it rarely, 12.1% reporting it sometimes, and 3.8% reporting it often. Ever experiencing verbal abuse was reported by 19.4% and physical abuse by 10.2% of participants. Overall, 13.2% of participants reported ever having delayed going to the clinic for contraception to avoid having a pelvic examination, and 38.2% reported a preference to avoid pelvic examinations. In multivariable analysis, women reporting that they experienced pressured sex often had significantly higher odds of delaying a clinic visit for birth control (aOR 3.10 95% CI 1.39-6.84) and for reporting a preference to avoid pelvic examinations (aOR 2.91 95% CI 1.57-5.40). We found no associations between delay of clinic visits or preferences to avoid a pelvic examination and verbal or physical abuse. CONCLUSIONS: History of pressured sex from an intimate partner is common. Among women who have experienced pressured sex, concern regarding pelvic examinations i s a potential b arrier to contraception.Communicating that routine pelvic examinations are no longer recommended by professional societies could potentially reduce barriers and increase preventive healthcare visits.

Factors associated with unintended pregnancy and contraceptive practices in justice-involved adolescent girls in Australia

“…The degree to which this impacts contraceptive decision making within the Australian correctional system remains under-explored however the phenomena is well documented with the US Correctional system [37,38]. These issues are compounded by reports of racial profiling by healthcare providers when offering contraception options [39][40][41][42][43][44] as well as women & girls with abuse histories being less likely to be comfortable with IUDs and other vaginally inserted contraception devices [45,46]. Within this context, the need for shared and informed decision making between provider and patient is crucial [47] and understanding factors that may be associated with use and non-use within a justice involved Australian population are needed.…”

Untitled

“…The degree to which this impacts contraceptive decision making within the Australian correctional system remains under-explored however the phenomena is well documented with the US Correctional system [37,38]. These issues are compounded by reports of racial profiling by healthcare providers when offering contraception options [39][40][41][42][43][44] as well as women & girls with abuse histories being less likely to be comfortable with IUDs and other vaginally inserted contraception devices [45,46]. Within this context, the need for shared and informed decision making between provider and patient is crucial [47] and understanding factors that may be associated with use and non-use within a justice involved Australian population are needed.…”

Untitled

“…The degree to which this impacts contraceptive decision making within the Australian correctional system remains under-explored however the phenomena is well documented with the US Correctional system [37,38]. These issues are compounded by reports of racial profiling by healthcare providers when offering contraception options [39][40][41][42][43][44] as well as women & girls with abuse histories being less likely to be comfortable with IUDs and other vaginally inserted contraception devices [45,46]. Within this context, the need for shared and informed decision making between provider and patient is crucial [47] and understanding factors that may be associated with use and non-use within a justice involved Australian population are needed.…”