Development of a comprehensive measure of reproductive coercion and abuse for global use: a Delphi study

Reproductive coercion and abuse describes controlling behaviours to undermine another person's reproductive autonomy, predominantly affecting women and gender minorities with pregnancy capacity. Debate exists about how this form of gender-based violence should be measured and whether available measures developed over a decade ago adequately capture current conceptual understandings. To address this, our study aimed to develop a comprehensive measure of reproductive coercion and abuse for global population-level use. A modified e-Delphi technique was used to determine consensus on measurement items generated from pre-existing literature and formative qualitative research. Global experts (n = 30) with research, clinical, and/or lived expertise were recruited from low- to middle- and high-income countries and asked to rate items against COSMIN criteria. Participants represented 15 countries and five global regions (Africa, Asia, Europe, North America, Oceania). They suggested 12 new items in addition to the 62 candidate items. Consensus was not reached on 17 of 74 items. After incorporating final feedback, 59 items were selected for future pilot testing. The Delphi panel did not reach consensus on structure of response options or how to ask about intent. Experts agreed measuring the distinct interpersonal relationships in which reproductive coercion and abuse can occur is important. We developed a robust set of new items to measure reproductive coercion and abuse within multi-country comparative studies that fills a measurement gap in sexual and reproductive health. With future psychometric evaluation, the measure will enable more sensitive, specific, and consistent prevalence estimates across contexts, critical to inform practice and policy locally and globally.