Reproductive Coercion: When Someone Controls Your Contraception

TL;DR: Reproductive coercion is when a partner tries to control your contraception or pregnancy decisions, for example by sabotaging your pills or condoms, pressuring you to get pregnant, or forcing you to continue or end a pregnancy. It is a form of abuse. Long-acting methods like the implant, the injection and the IUD are harder for a partner to interfere with, emergency contraception is an option after sabotage, and you can ask any clinician to see you alone.

Maybe your pills keep going missing. Maybe the condom "broke" again, and something about the way he said it did not sit right. Maybe a partner keeps saying a proper wife would have given him a child by now, or that you will have no choice but to end a pregnancy if it happens. If any of this sounds familiar, you are not imagining it, and you are not being dramatic. There is a name for it: reproductive coercion. Yesterday we wrote about how abuse affects women's health. Today we focus on one form that often hides inside the bedroom and the clinic.

What is reproductive coercion?

Reproductive coercion is behaviour meant to keep power and control in a relationship through someone's reproductive health. The American College of Obstetricians and Gynecologists (ACOG), in its committee opinion on reproductive and sexual coercion, describes it as coming from someone who is, was, or wants to be in an intimate or dating relationship with you. It includes trying to get a partner pregnant against her will, controlling the outcome of a pregnancy, forcing unprotected sex, and interfering with contraception.

It can happen with or without physical violence. That matters, because many women who experience it would never call their relationship abusive.

What does it look like in everyday life?

Reproductive coercion usually falls into two overlapping patterns.

Birth control sabotage means tampering with your contraception so you are more likely to get pregnant. Examples include:

• Hiding, throwing away or swapping your pills
• Damaging condoms, or removing a condom during sex without your agreement
• Pulling out an IUD, or pressuring you to have it or your implant removed
• Stopping you from attending a family planning appointment or collecting a refill

Pregnancy pressure and coercion means pushing your decisions about pregnancy in a direction you have not chosen:

• Pressuring or threatening you to get pregnant, including threats to leave or to take another wife
• Forcing you to continue a pregnancy you do not want
• Forcing you to end a pregnancy you want to keep

That last point is important. Coercion is about control, not about one particular outcome. Pressure in either direction counts.

Family members can add to the pressure too. In many households, a mother-in-law asking when the next baby is coming is ordinary conversation. It becomes coercion when it is used to override your choices, especially when a partner backs it with threats.

How common is it?

It is more common than many people think. In nationally representative surveys of partnered women who needed contraception in Burkina Faso, Côte d'Ivoire and Kenya, between 6.4% and 7.8% had experienced reproductive coercion in the past year. Around a third to almost half of those women reported no other form of partner violence, which is why it is so easy to miss. A longitudinal study across eight sites in sub-Saharan Africa found that in Uganda, past-year reproductive coercion rose from 15.8% to 17.8% between survey rounds, and in Burkina Faso women who experienced it were more likely to stop using contraception.

The same Burkina Faso, Côte d'Ivoire and Kenya study found women facing reproductive coercion were far more likely to use contraception covertly, meaning without their partner knowing. In Kenya, the odds were almost six times higher. Many women quietly protect themselves this way, and if that is you, you are in good company.

Which contraception is harder for a partner to interfere with?

Long-acting methods that do not rely on a daily pill or a condom are harder to sabotage, and ACOG recommends offering long-acting contraception that is less detectable to partners to women experiencing coercion.

• The implant is a small flexible rod placed under the skin of your upper arm. The NHS says it is over 99% effective and works for 5 years.
• The injection is given every 8 to 13 weeks depending on the type, and is more than 99% effective if you get it on time. There is nothing to keep at home, though you do need to return for each dose.
• The copper IUD (coil) sits inside the womb, contains no hormones, is over 99% effective and lasts 5 or 10 years depending on the type. A hormonal coil is another option.

Each method has trade-offs, including side effects, how visible it might be and how often you need appointments. Ask your clinician what a partner might notice with each one, so you can choose the method that fits your situation. Our guide to contraception methods compared walks through the wider options.

Remember that none of these methods protects against sexually transmitted infections. If condoms are being refused or removed, regular testing is a sensible step. Our guide to STI symptoms, prevention and treatment explains more.

What if my contraception has already been sabotaged?

Emergency contraception can still help. According to the NHS, the levonorgestrel pill should be taken within 3 days (72 hours) of sex and the ulipristal acetate pill within 5 days (120 hours). A copper IUD fitted within 5 days is the most effective type, and it then keeps working as ongoing contraception. The sooner you act, the better it usually works. We cover timing, myths and where to get it in our emergency contraception guide.

If you are already pregnant and feel pressured in either direction, you deserve to make your own decision. A clinician can talk you through your options confidentially, including what care is available and legal where you live.

How can clinicians help?

ACOG advises that health workers screen for intimate partner violence and reproductive coercion at routine visits such as annual check-ups, new patient appointments and during pregnancy care, including at the first antenatal visit, at least once each trimester and at the postnatal check. Suggested support includes explaining how coercion affects health, talking through harm-reduction strategies, and offering less detectable methods.

What that means for you in practice:

• You can ask to be seen alone. Saying "I would like to speak to the nurse privately" is a normal request, at a clinic in Ibadan, Kisumu or Croydon.
• You can ask what will appear on records or bills, and whether reminders will be sent to a shared phone.
• You can ask for a method that suits your safety, not only your medical history.

If you are a clinician reading this, asking every patient a simple question, such as "Has a partner ever tried to get you pregnant when you did not want to be, or interfered with your birth control?", gives women permission to answer.

Where to get support

Reproductive coercion is abuse, and specialist services can help you plan. In the UK, the free 24-hour National Domestic Abuse Helpline is 0808 2000 247. In Kenya, the toll-free 1195 helpline is open 24 hours a day. In Lagos, the Domestic and Sexual Violence Agency lists 08000 333 333. We list these and more, along with tips on staying safe online, in how abuse affects women's health, and where to get help. If you are in immediate danger, call your local emergency number.

How Asele can help

Tracking your cycle can help you notice a late period early and act within the window for emergency contraception or a pregnancy test. Asele lets you track your cycle and log symptoms, and Amara can answer questions about contraception in Yoruba, Hausa, Igbo, Swahili, French or English. The Asele Health Brief gives you a pre-visit summary to bring to a family planning appointment. If someone else checks your phone, consider whether it is safe to keep this information on it. You can find us at Asele.

This post is education, not medical advice. Speak to a clinician or sexual health service about the right method for you.

References

1. ACOG Committee Opinion No. 554: Reproductive and sexual coercion. Obstetrics and Gynecology, 2013. pubmed.ncbi.nlm.nih.gov
2. Wood SN, et al. Intersection of reproductive coercion and intimate partner violence: cross-sectional influences on women's contraceptive use in Burkina Faso, Côte d'Ivoire and Kenya. BMJ Open, 2023. pubmed.ncbi.nlm.nih.gov
3. Wood SN, et al. Longitudinal impact of past-year reproductive coercion on contraceptive use dynamics in sub-Saharan Africa. eClinicalMedicine, 2025. pubmed.ncbi.nlm.nih.gov
4. NHS. Contraceptive implant. nhs.uk
5. NHS. Contraceptive injection. nhs.uk
6. NHS. IUD (intrauterine device) or copper coil. nhs.uk
7. NHS. Emergency contraception. nhs.uk