Reproductive coercion poses serious risks to health and wellbeing, yet remains poorly recognised in general practice, according to new Monash University research.
A series of research studies by Ms. Susan Saldanha, Research Fellow from the SPHERE Centre of Research Excellence at Monash, examined why reproductive coercion is an important issue for general practice and why it should be better recognised and prioritised.
Ms Saldanha's research highlights a range of scenarios in which reproductive coercion can result in significant sexual, reproductive and mental health harms, covering two main areas:
- Promoting pregnancy includes using forced sex to cause conception, threats of abandonment or isolation if pregnancy does not occur, deception about being infertile or having had a vasectomy, or refusing contraception or abortion on religious grounds.
- Preventing pregnancy includes assault to cause miscarriage, emotional pressure to force contraception or sterilisation, financial threats for continuing a pregnancy, coercing abortion due to gender preference or using legal threats such as deportation.
In another study, she documents the results of interviews with 25 Australian health and social service professionals, including GPs, nurses, social workers, domestic violence practitioners and obstetrician/gynaecologists. A spectrum of coercive behaviours were described:
- Explicit coercion: Control that is overt and direct, being clearly told, forced or threatened about pregnancy, contraception or abortion decisions.
- Implicit coercion: Control that is indirect and subtle, ongoing pressure, manipulation or comments that imply what someone 'should' do.
- Tacit coercion: Control that is unspoken and internalised, expectations shaped by culture, family, religion, or fear that leads people to restrict their own choices.
In a further study, Ms Saldanha interviewed 10 general practitioners and six practice nurses to explore potential approaches to responding to reproductive coercion in general practice.
GPs and nurses identified 'red flags' they may see during consultations, including partners dominating consultations, patients showing discomfort, and inconsistent contraception use. One nurse recalled: "He spoke for her the whole time… She wasn't allowed."
The study found that responding safely is especially complex when carers or parents influence consent, such as with adolescents or women living with disabilities.
GPs and nurses described strategies such as using telehealth, discreet communication, safety planning, and team‑based vigilance – all insights that will inform future guidelines for better recognising and responding to reproductive coercion in general practice.
A subsequent study also demonstrated how healthcare providers can, often without intention, limit reproductive autonomy through biased advice, failing to refer patients, or through restrictive practices.
Ms Saldanha explained that tackling both conscious and unconscious provider bias is vital to delivering person‑centred, non‑coercive reproductive care. Based on health practitioner views, Ms Saldanha emphasised the need for clear guidance, bias‑aware training, and reliable referral pathways.
Ms Saldanha found that general practice cannot address reproductive coercion alone. "A coordinated, system‑level response integrating sexual and reproductive health, domestic and family violence, and primary care services is essential," she said.
"True reproductive autonomy means not only being free from interference, but having the space, safety and support to choose."
The series of studies includes:
- Reproductive coercion: the role of clinicians in general practice: Australian Journal of Primary Health
- Australian health and social service providers' perspectives on interpersonal and structural forms of reproductive coercion: Social Science and Medicine
- Recognising and responding to reproductive coercion in general practice: a qualitative study: BMJ Sexual and Reproductive Health
- Healthcare provider perspectives on their role in perpetrating and perpetuating reproductive coercion: a qualitative study: BMC Health Services Research
If you or someone you know is experiencing violence or abuse, you can call 1800RESPECT on 1800 737 732, text 0458 737 732 or visit the website
*Please note: A clinician with expertise in this field would also be available for an interview on request.
