Intimate partner violence (IPV) is widespread in the United States and constitutes a serious public health crisis, often significantly impacting women’s sexual and reproductive health and rights (SRHR). A new analysis in the Guttmacher Policy Review argues that addressing the needs of those experiencing IPV requires an integrated approach that includes the full range of sexual and reproductive health services. The analysis also examines key federal policies at the intersection of IPV and SRHR, and finds that safety-net family planning providers are particularly well-positioned to connect women experiencing IPV to the care and resources they need.

IPV encompasses multiple forms of aggression or violence perpetrated by a current or past intimate partner, which can lead to a broad range of negative effects on individuals and families, including economic instability and mental and physical health consequences. Women of reproductive age are most likely to experience IPV, which has specifically been linked to negative sexual and reproductive health outcomes.

"Among the many issues related to IPV, there are compelling reasons to specifically examine the impact of intimate partner violence on women’s sexual and reproductive health and autonomy," says Kinsey Hasstedt, lead author of the new analysis. "For women experiencing IPV, the full range of sexual and reproductive health services must be accessible, confidential and affordable. This includes contraceptive supplies and counseling, STI testing and treatment, maternity care and abortion." 

Two forms of IPV have particularly direct and harmful effects on SRHR. The first includes acts of sexual violence, such as rape, other forced or unwanted sexual contact, and unprotected sexual contact intended to expose an intimate partner to STIs. The second is reproductive control, where a male partner uses intimidation, threats or violence to impose his own intentions on a woman’s reproductive autonomy, regardless of her own reproductive choices and goals. Acts of reproductive control include sexual violence, contraceptive sabotage, and pressuring a woman to become pregnant against her will, as well as coercing a woman to either carry a pregnancy to term or have an abortion.

Hasstedt details the scientific evidence on how IPV can contribute to negative sexual and reproductive health outcomes, including:

• Unintended pregnancy and subsequent abortion: U.S. women who are most at risk of experiencing IPV are also likely at high risk of experiencing an unintended pregnancy. And women who experience an unintended pregnancy as a result of sexual violence or reproductive control may be highly motivated to terminate that pregnancy.
• Poor maternal and newborn health: IPV can negatively impact the health of pregnant and postpartum women and their infants. IPV before and during pregnancy has also been linked to many pregnancy complications.
• HIV and other STIs: The evidence shows associations between lifetime experience of IPV and lifetime acquisition of an STI. Specific acts of reproductive control, such as refusal to wear a condom, can also increase the risk of acquiring an STI.

At the policy level, some reproductive health advocates have criticized federal programs addressing IPV for not doing enough to address SRHR-related needs of women experiencing IPV, including not making emergency contraception accessible and not considering access to abortion services. Despite these shortcomings, however, the IPV advocacy and service communities have increasingly focused on meeting the broader health needs of women experiencing IPV, and on ways safety-net family planning providers in particular can best serve these women.

Indeed, there is considerable overlap between groups of U.S. women at highest risk for experiencing IPV and those seeking care from Title X–supported safety-net providers, making these health centers a critical component in serving those affected by IPV. In addition, Title X program guidelines have long stressed the importance of confidential care for especially vulnerable groups of clients, including women experiencing or threatened by IPV.

"Achieving an integrated approach to caring for those experiencing IPV requires collaboration on many levels among IPV and SRHR service providers, policy experts and advocates," says Hasstedt. "Safety-net family planning providers are well-positioned to connect with women experiencing IPV, to confidentially meet their particular family planning needs, and to connect them to broader resources. But real barriers to a thoroughly integrated approach remain, including political concerns around family planning and abortion, policy shortcomings and lacking resources at the service delivery level. These barriers must be understood, and overcome."

Full analysis: "Understanding intimate partner violence as a sexual and reproductive health and rights issue in the United States," by Kinsey Hasstedt and Andrea Rowan