Systematic Review of Factors Associated with Reproductive Coercion and Abuse in the United States

Reproductive coercion and abuse (RCA) refers to deliberate behaviors that undermine an individual's reproductive decisions, such as sabotaging contraception or pressuring someone to continue or end a pregnancy. Recent legislative changes, such as the Dobbs v. Jackson Women's Health Organization decision, highlight the timeliness of understanding how RCA manifests in the United States. We conducted a systematic review to synthesize and critically assess evidence on the prevalence of RCA and associated factors in the United States. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched PubMed, Embase, CINAHL, PsycINFO, and Web of Science for quantitative studies published in English through April 2024. Risk of bias was assessed using Joanna Briggs Institute's Critical Appraisal Tools. Twenty-three cross-sectional studies were included. Lifetime prevalence of RCA ranged from 7.8% to 37.8%. Prevalence of birth control sabotage ranged from 1.1% to 25.3%, while pregnancy coercion ranged from 6.4% to 19%. Most studies identified a strong association between RCA and intimate partner violence. Several studies also reported associations with age, race, ethnicity, and number of sexual partners, though findings were mixed. Evidence related to socioeconomic status, health behaviors, and partner characteristics was limited. All studies were rated as having a moderate or high risk of bias, as many failed to assess intent or use validated instruments to measure RCA. These limitations raise concerns about the trustworthiness and interpretability of findings. Future studies should examine conceptual clarity and measurement of RCA to improve data quality and inform evidence-based interventions, clinical screening practices, and policy efforts.