Reproductive Autonomy in Appalachia: An Investigation into Perceived Contraceptive Pressure

Abstract

The reproductive autonomy of persons who can give birth can be impeded through forms of interpersonal violence and coercion. Moreover, macro-level factors (e.g., poverty, discrimination, community violence, legislative policies) may impede the reproductive autonomy of entire communities. This study investigates a form of violence we term perceived contraceptive pressure in Appalachia, an understudied region of the Eastern U.S., regarding reproductive health and decision-making. Through targeted Meta advertising, participants ( N = 632) residing in Appalachian zip codes completed an online survey on reproductive health. The focus of this study was to investigate the prevalence of perceived contraceptive pressure, who was at increased risk of experiencing pressure, and the source(s) of perceived pressure. Binomial regressions were conducted on three different dependent variables: perceived pressure to be sterilized, perceived pressure to use birth control, and perceived pressure not to use birth control. Approximately half of all respondents (49.5%) reported experiencing at least one type of pressure targeting contraceptive decision-making. The most prevalent source of perceived pressure to use birth control was from the healthcare provider (67.4%), and the most prevalent source of perceived pressure not to use birth control was the respondent’s partner (51.1%). Recommendations for providers serving clients in the Appalachian region include pursuing education regarding contraceptive pressure at the individual level and macro-level. In addition, Appalachian residents may benefit from educational programming on reproductive autonomy, healthy relationships, and how to navigate pressure in relationships.

Health care provider bias in the Appalachian region: The frequency and impact of contraceptive coercion

“…More than one in three participants reported ever experiencing some contraceptive coercion. This frequency is slightly lower than that reported by Huslage et al 27 who found that half of Appalachians in the same sample reported perceptions of contraceptive coercion, because the previous study included an additional measure of sterilization pressure, and examined pressure from others, including partners and family members, in addition to pressure from health care providers.…”

“…However, we know very little about the types and impacts of coercion in contraceptive counseling in the Appalachian region. In one of the only existing studies on this topic in Appalachia, approximately half of participants reported experiencing at least one form of contraceptive coercion 27 . This high rate of contraceptive coercion indicates a need for research exploring how these coercive practices manifest and how they may impact the health and autonomy of Appalachian patients.…”

Turkish adaptation of the reproductive autonomy scale: Validity and reliability study

“…2 It consists of 14 items and 3 subscales. In the scale, the subdimensions of freedom from coercion (5)(6)(7)(8)(9) and the communication subdimension (10)(11)(12)(13)(14) comprised of five items, and the decision-making subscale consists of four items (1-4) is formed. The subscale of freedom from coercion is coded as a reverse item.…”

“…Obstacles against women's reproductive autonomy include hiding contraceptive methods, restricting women's access to family planning services, making holes in condoms, forcing women to get pregnant, and using violence. [6][7][8] These emerging situations cause severe consequences in women, such as unwanted pregnancy, abortion, sexually transmitted infection, adverse pregnancy outcomes, and psychological trauma, which endanger the health of the woman and the baby. 4,6,9,10 Consequently, reproductive autonomy is an issue that needs to be emphasized because it affects the health of both the woman and the baby.…”

“…It is stated that the prevalence of reproductive pressure in women varies between 9% and 74%. Obstacles against women's reproductive autonomy include hiding contraceptive methods, restricting women's access to family planning services, making holes in condoms, forcing women to get pregnant, and using violence 6–8 . These emerging situations cause severe consequences in women, such as unwanted pregnancy, abortion, sexually transmitted infection, adverse pregnancy outcomes, and psychological trauma, which endanger the health of the woman and the baby 4,6,9,10 …”