Abusers often seek to control the health choices of their partners, even when they are pregnant. Reproductive coercion, when an abuser tries to control reproductive health choices, is particularly important to understand in the context of pregnancy. Abusers may restrict victim-survivors' access to birth control or they may tamper with their partners' birth control. Reproductive coercion also includes the limitation of choice around pregnancy by either forcing someone to continue an unwanted pregnancy or forcing them to terminate a pregnancy against their wishes, according to Muñoz et al. Pregnancy and healthcare options available in a specific state can further complicate the issue. While in Maine abortion is legal and protected by state law, since Roe v. Wade was overturned in 2022, survivors in other states have been forced to navigate restrictions in access and total bans on abortion. These restrictions give more power to abusers and create fewer options for survivors to make their own decisions regarding pregnancy.

Sometimes, people who are abusive escalate violence during their partner’s pregnancy or adopt new tactics to control their partners. They may use pregnancy as a time to intensify accusations of cheating. They may question if the baby is truly theirs or become jealous of the time their partner is spending preparing for the baby. They may worry that regular visits to a healthcare provider during pregnancy could expose their abuse.

When pregnant people experience intimate partner violence, there can be many negative impacts. The most serious concern is that someone may die as a result of domestic violence while pregnant. Homicide is a leading cause of death for pregnant women in the United States. According to the Harvard T.H. Chan School of Public Health, pregnant women and women who have recently given birth in the US are more likely to be killed by a partner than they are to die from obstetric causes, including hypertensive disorders (like preeclampsia), blood loss or sepsis. Firearms are a major risk factor for pregnant and immediately post-partum women who are experiencing domestic abuse. In a study of violent deaths of pregnant women, firearms were involved in 68% of deaths.

Experiencing intimate partner violence can have other very serious impacts on the health and well-being of pregnant women. Low birth weights, pre-term labor, early deliveries, insufficient weight gain, miscarriage, depression and injury are all potential outcomes of domestic abuse. These may be the direct result of physical violence and abuse, or they may develop from the stress that current or past abuse puts on both the mind and the body, according to the World Health Organization. Additionally, a study by Alhusen et al. found that, to cope with abuse, pregnant survivors may use drugs, smoke or drink alcohol, which carry additional health risks.

People experiencing intimate partner violence are often isolated by their partners from others who can help them, including healthcare providers. A study by Coker et al. found they are less likely to have access to prenatal care, may delay care and frequently neglect their own basic needs, such as nutrition. 

Healthcare providers, especially OB-GYNs, midwives and mental health professionals who often see pregnant patients, are in a unique position to help support survivors. They can work to address the health impacts caused by violence and they can make connections to other resources to address their patients' safety. Screening patients for domestic abuse is the first step. Providers can proactively ask patients if they are currently or have ever been impacted by domestic abuse.

An important part of New Hope Midcoast’s support is strengthening connections with healthcare providers to ensure that survivors' health and safety needs are met, including those of pregnant survivors. Community educators offer training to providers, helping them feel better equipped to screen their patients and empowered to respond when needed, including making referrals to domestic violence resource centers. Advocates supply pregnant survivors with information and options about their healthcare and refer them to providers and community organizations that can support them. 

If you or someone you know is experiencing reproductive coercion, please reach out to New Hope Midcoast by calling our 24/7 helpline at 1-800-522-3304.

New Hope Midcoast is one of Maine’s Regional Domestic Violence Resource Centers and a member of the Maine Coalition to End Domestic Violence. The nonprofit organization supports people impacted by domestic abuse, dating violence and stalking through housing and legal advocacy, education and prevention programs, and a 24/7 helpline. The organization serves Sagadahoc, Lincoln, Knox and Waldo counties. New Hope continues to meet clients where they are and recognizes that the impact of domestic abuse is widespread. We are survivor-led and believe that, together, we can address social concerns that continue right here in our communities.