Nearly one in eight sexually active high school girls is pressured by a partner to become pregnant or not use birth control, a study from the University of Pittsburgh Medical Center Children’s Hospital suggests.

The research, published last week in Obstetrics & Gynecology, explored what experts call reproductive coercion — a type of relationship abuse in which one partner tries to control the other’s reproductive decisions. That can involve everything from poking a hole in a condom or removing a condom during sex to tampering with birth control pills or threatening to leave a partner if she does not get pregnant. Victims can be left with unwanted pregnancies, sexually transmitted infections, and long-term psychological damage.

“Young people are experiencing relationship abuse at alarming rates,” said Elizabeth Miller, a co-author of the study and director of adolescent and young-adult medicine at UPMC Children’s.

The U.S. Centers of Disease Control and Prevention reports that, in 2017, 7 percent of high schoolers experienced sexual violence and 8 percent reported physical violence by a dating partner — statistics that have led many medical experts to call teen relationship abuse a public health issue.

But because reproductive coercion is not legally classified as physical or sexual abuse, it hasn’t been measured as well, Miller said. This study aimed to begin addressing that gap.

The researchers used data collected from a previous project that was focused on healthy relationship counseling in eight northern California schools during the 2012-2013 school year. From that data set, they analyzed the responses of 550 sexually active girls, ages 14 to 19.

The researchers found that approximately one in eight sexually active high school girls had experienced reproductive coercion within the last three months. An even higher portion — about one in six — reported physical or sexual abuse in a relationship in the last three months.

“This problem is prevalent enough that we really think providers should be universally inquiring about relationship abuse routinely,” Miller said.

Elizabeth Miller is the director of adolescent and young-adult medicine at the University of Pittsburgh Medical Center Children's Hospital.
Courtesy UPMC
Elizabeth Miller is the director of adolescent and young-adult medicine at the University of Pittsburgh Medical Center Children's Hospital.

The American College of Obstetricians and Gynecologists recommends that gynecologists regularly ask patients whether they’re being pressured to have sex or get pregnant. But studies have shown those guidelines are not always followed.

Miller and her colleagues found that girls who suffered both reproductive coercion and physical or sexual abuse were more likely to have partners that were at least five years older, have two or more recent sexual partners, and use only hormonal contraception methods such as birth control pills rather than a condom.

But there was no distinct pattern in the way teens who experience reproductive coercion use medical services, said Amber Hill, lead author of the study and a medical and doctoral student at the University of Pittsburgh School of Medicine.

With adult women, relationship abuse is often linked with greater use of emergency contraception and pregnancy tests, Hill explained. But researchers did not find that to be the case for adolescents in this study. That means universal screening for relationship abuse is even more critical for adolescents, Hill said.

“We can’t necessarily rely on these little cues or flags as health-care providers,” she said. “Instead, we need to approach this issue with everybody.”

Amber Hill is a MD/PhD student at the University of Pittsburgh School of Medicine.
Courtesy UPMC
Amber Hill is a MD/PhD student at the University of Pittsburgh School of Medicine.

More education on the issue in schools could also help prevent teen relationship abuse, Miller said. And the discussion needs to go beyond explaining hidden contraception methods that a woman can use without her partner knowing. Prevention education must explain how condom manipulation is a form of abusive behavior, researchers wrote in the paper.

“We need to educate people on what healthy versus unhealthy relationships are,” Hill said, “and provide people with resources regardless of whether they disclose.”

The findings can’t necessarily be applied to all teenage girls because it was based on data from a relatively small number of teens in northern California. The data in this study were also collected at a single point in time, so it’s unclear how patterns of reproductive coercion in teen relationships might have changed over time.

There was some indication that Latina and black girls are at higher risk for experiencing reproductive coercion — a trend earlier studies have shown among adult women — but further research is needed.

Still, Hill said, the study shows that this is an “unfortunately common issue that affects young adolescents” and “we need to talk about it with all patients.”

If you or someone you know needs help, contact the National Domestic Violence Hotline at 1-800-799-7233, the Rape Abuse & Incest National Network Hotline at 1-800-656-4673, or visit www.futureswithoutviolence.org.