Healthcare Provider-Based Contraceptive Coercion: Understanding U.S. Patient Experiences and Describing Implications...

Area of Science:

• Reproductive Health
• Medical Sociology
• Psychometrics

Background:

• Concerns about coercion in contraceptive care are rising, yet its frequency and manifestations are understudied.
• There is a lack of established quantitative methods to measure contraceptive coercion.

Purpose of the Study:

• To describe the frequency and nuances of contraceptive coercion experiences.
• To introduce and psychometrically test a novel measure: the Coercion in Contraceptive Care Checklist.

Main Methods:

• A survey of 1197 reproductive-aged individuals in the US (assigned female at birth) regarding their contraceptive care experiences in early 2023.
• Analysis of open-ended descriptions to understand coercion nuances.
• Psychometric testing of the Coercion in Contraceptive Care Checklist, including factor analysis and reliability/validity assessments.

Main Results:

• Over 18% of participants reported coercion during their last contraceptive counseling, and over 42% reported it in their lifetime.
• Being forced to use or continue using birth control pills was the most common form of coercion (14.62% lifetime frequency).
• The Coercion in Contraceptive Care Checklist demonstrated two-factor dimensionality, strong reliability (inter-item correlations, p < 0.001), and construct validity through associations with family planning quality and healthcare discrimination measures.

Conclusions:

• Contraceptive coercion is prevalent and manifests in various ways, with specific methods like forced pill use being common.
• The Coercion in Contraceptive Care Checklist is a valid and reliable tool for measuring contraceptive coercion.
• Findings highlight the need for further research and refinement of the checklist to improve contraceptive care quality and reduce coercion.