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Intimate Partner Violence and Abortion Access

By Eliza Friend

The following contains discussion of sensitive topics, including domestic abuse and sexual assault.

Intimate Partner Violence

              Intimate partner violence (IPV) is physical, sexual, and/or emotional abuse perpetrated against an individual by their current or former romantic partner.[1] Although anyone, regardless of gender, can be affected by IPV, the majority of victims are women and girls.[2] Globally, among women that have had a romantic partner, approximately one in four has been subjected to physical or sexual violence by a partner at some point in her life.[3]

              Risk factors for IPV fall under three categories: those that relate to the individual (gender, age, education level, past exposure to violence, etc.), those that relate to the relationship (dissatisfaction, male dominance, multiple partners, etc.), and those that relate to the society in which the couple live (patriarchal social norms, poverty, armed conflict, etc.).[4] In part due to these factors, women in low income countries and middle income countries are disproportionately affected by intimate partner violence; though, this varies widely—reported IPV in Armenia is less than 5%, whereas it is up to 40% in Afghanistan.[5] There is also notable divergence within individual countries, with “richer and more empowered women [reporting] less IPV” and “younger women and those living in rural areas [tending] to be more exposed to IPV.”[6]

              Additionally, there may be significant difference in experience depending on the marginalized identities of the individual, most notably sexual orientation, gender identity, and immigrant status. Bisexual women are 1.8 times more likely than heterosexual women to report being victims of IPV; bisexual men are likewise more likely than their heterosexual counterparts to report IPV.[7] Though research is limited, studies have stated that the lifetime prevalence of intimate partner violence and sexual abuse among transgender people is between 25% and 47%.[8] Finally, a study found that immigrant women in New York City “are disproportionately represented among female victims of male-partner-perpetrated homicide,” suggesting that immigrant women may be at greater risk of isolation and victimization at the hands of an intimate partner.[9]

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Source: “World Health Statistics 2022: Monitoring Health for the SDGs, Sustainable Development Goals.”

Source: Brown and Herman, “Intimate Partner Violence and Sexual Abuse Among LGBT People.”

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Source: Coll et al., “Intimate Partner Violence in 46 Low-Income and Middle-Income Countries.”

Literature Review: Reproductive Coercion

              Reproductive coercion is a type of intimate partner violence, characterized by behavior that interferes with the “autonomous reproductive decision making” of an individual that is able to become pregnant.[10] It may take multitude forms including, but not limited to, birth control sabotage, sexual assault, coercion to become pregnant, and coercion to terminate or carry a pregnancy to term.[11] Reproductive coercion is often referred to as an invisible, or hidden, form of domestic abuse and is most often perpetrated by heterosexual cisgender men against heterosexual cisgender women; though, cases of intergenerational reproductive coercion—in which an individual is coerced by a family member to carry a pregnancy—have also been recorded, as well as cases in which LGBTQ+ individuals and heterosexual cisgender men are victims.[12]

              The term, reproductive coercion, was introduced in 2010 by Elizabeth Miller (et al.) in her article, “Pregnancy Coercion, Intimate Partner Violence and Unintended Pregnancy”[13] and, since 2010, there has been significant discussion regarding the conceptual clarity of reproductive coercion and the applicability of existing definitions in non-academic settings. In their article “Reproductive Coercion and Legal Recognition: Views of Domestic Violence Support Workers and Lawyers,” Nicola Sheeran, Heather Douglas, and Laura Tarzia identify the term “coercion” as a possible source of ambiguity.[14] Per Sheeran, Douglas, and Tarzia, “‘reproductive abuse’ may be a more accessible description to use in engaging both with clients and with legal processes.”[15] Further, Laura Tarzia and Kelsey Hegarty argue in their article, “A Conceptual Re-Evaluation of Reproductive Coercion: Centering Intent, Fear and Control,” that reproductive coercion “cannot exist without some other form of co-occurring violence in a relationship,” underscoring the dire need for a consistent definition of this type of abuse, to be applied internationally and across legal, social, and healthcare settings.[16]

              In an editorial published in Contraception, Elizabeth Miller (et al.) reports that there is an association between reproductive coercion and unintended pregnancy.[17] Further, she states that victims of both reproductive coercion and a co-occurring form of IPV are twice as likely to report an unintended pregnancy.[18] Victims of reproductive coercion and other types of IPV may additionally face a higher likelihood of contracting a sexually transmitted infection (STI).[19] This places healthcare professionals in a unique position to prevent reproductive coercion and support individuals that have already been victimized. Illustrating this, in a study that examined the effects of specialized, intervention-focused healthcare clinics, there was a 71% “reduction in the odds of pregnancy coercion among [women reporting past-3-months IPV] in intervention clinics compared to participants in the control clinics that provided standard of care.”[20]

Abortion Access and IPV

Abortion Access: Global Trends

              In the last twenty-five years, the world has seen tremendous improvement in abortion access; according to the Center for Reproductive Rights, nearly fifty countries have “[liberalized]” their reproductive laws, with changes ranging from “incremental” to “truly transformative.”[21]

              Alongside this progress, however, there has also been significant backsliding. In the United States, decision-making power on the legality of abortion was returned to state governments with the overturning of Roe v. Wade, creating a patchwork system in which an individual’s reproductive rights appear and disappear as they cross state lines.[22] In autocracies, such as China, Russia, and Egypt, reproductive healthcare has become a political tool with which dictators consolidate their power.[23]

              These global trends, both positive and negative, have had and will continue to have significant effects on women, transgender people, and non-binary people throughout the world, particularly those that are marginalized by their communities and those that have experienced victimization by an intimate partner.

Center for Reproductive Rights: World's Abortion Laws Map Progress

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Council for Foreign Relations: Abortion Laws Around the World

Abortion Access as Personal Security

              At the core of the prior mentioned issues—intimate partner violence, reproductive coercion, and abortion access—are intersecting questions of control. Who is the decision-maker in matters of reproduction and reproductive health—a domineering partner, the state, or the individual? Is there a causal relationship between IPV and abortion access? Finally, and most importantly, how can the safety and autonomy of the individual be maximized?
              Simply put, in a world in which intimate partner violence against women and other marginalized groups is commonplace, access to abortion is a matter of self-determination and personal security. 
              Importantly, pregnancy and the postpartum period are uniquely dangerous times for many people, particularly young women (age twenty-four or below) and African-American women in the United States.[24] For some, pregnancy is not just a question of parenthood; but, rather, one of life and death. Homicide, most commonly by an intimate partner, is the leading cause of maternal mortality in the United States and, in 2020, pregnant American women were 35% more likely than their non-pregnant counterparts to be killed.[25] Though it seems that greater study is required to accurately compare such homicides across countries, a review of international literature on the topic refers to global rates of homicide during pregnancy as “much higher than one might expect.”[26] Reproductive healthcare and abortion services can be lifelines; they provide victims of intimate partner violence with the opportunity to seek help or, at the very least, reduce their risk of dying by homicide.
              In a study conducted by Caterina Muratori of the University of Reading, a Texas state law limiting abortion access was shown to increase gender violence. Texas House Bill 2 (HB2), which was signed into law on July 18, 2013, “imposed expansive and difficult-to-implement requirements on abortion facilities.”[27] Provisions within the bill included a requirement that the physician must “have active admitting privileges at a hospital that…is located not further than 30 miles from the location at which the abortion is performed or induced.”[28] Abortion facilities additionally, were required by the bill to “meet the requirements of an ambulatory surgical center.”[29] Though an injunction was quickly put in place, the number of abortion providers in Texas dropped from 42 to 19 following the enaction of HB2.[30]
              In her study, Muratori found that “depending on the initial distance, a one-minute increase in time needed to reach the nearest abortion clinic is estimated to increase the number of reported cases of gender violence per municipality by 0-0.17%.[31] Further, Muratori states that “a large part of the effect of the restrictions on abortion access on gender violence is driven by its impact on IPV.”[32] Simply put, the closures caused by HB2 are associated with an increase in gender violence, with individuals far away from abortion clinics being at greater risk of victimization. Additionally, while a 0-0.17% per minute increase may seem to be negligible, it is likely indicative of even greater trend, as cases of intimate partner violence and gender violence are often underreported.[33]
              Though Muratori’s study focuses on Texas, her findings are broadly significant, as they demonstrate a relationship between abortion access and IPV risk factors. According to Muratori, limitations on abortion access “[have] been found to affect violence especially through a decrease in women’s socio-economic conditions.”[34] Lower socio-economic standing increases an individual’s vulnerability and has been associated, in some social contexts, with greater reliance on a partner and justification of IPV.[35] Access to reproductive healthcare, according to Muratori, reduces negative socio-economic effects and returns autonomy to victimized individuals.
              Additionally, data from the Turnaway Study— “the largest study to examine women’s experiences with abortion and unwanted pregnancy in the United States”[36]—demonstrates that abortion access “is associated with a reduction in physical violence from the man involved in the pregnancy” and that “women who are denied access to abortion are…more likely to be trapped in abusive relationships for longer.”[37]
              None of this is to say that reproductive healthcare and abortion access are catch-all remedies for intimate partner violence and gender-based violence. Not only are these larger societal problems, but individuals that are affected by IPV and other forms of violence often suffer from physical, mental, and reproductive health consequences long after the abuse has ended.[38] There is no quick-fix. When executed correctly and available widely, however, reproductive healthcare and abortion access provide victimized individuals with autonomy and an opportunity for a secure, self-determined future.

Advocacy and Agendas

              Particularly in the states of the Global North, there is a notable separation between advocacy efforts regarding intimate partner violence and abortion access, respectively. The American Civil Liberties Union in the United States, for example, operates distinct Women’s Rights and Reproductive Freedom Projects.[39] According to Caroline Bettinger-Lopez of the University of Miami, this separation is emblematic of a larger separation in American and European political frameworks—that of so-called “negative rights” of individuals and “affirmative obligations” of government; within progressive circles, reproductive rights are counted among “negative rights” such as a right to privacy and liberty, whereas violence against women is discussed within the context of “affirmative obligations” of government, such the duty to protect citizens from violence.[40] Per Bettinger-Lopez, however, “this dichotomy does not always hold up in practice,” and, as previously demonstrated, issues of IPV and abortion access are often interrelated.[41] The way forward therefore requires a shift in framing. The clear links between IPV and abortion access must be widely recognized and studied, and a comprehensive intervention framework centered on reproductive healthcare access put in place.[42] The governments of the world must do more to protect and empower their citizens, particularly women, girls, LGBTQ+ people, and all those who are marginalized and victimized.

  1. “Violence against Women and Girls – What the Data Tell Us - World Bank Gender Data Portal,” accessed March 12, 2023, https://genderdata.worldbank.org/data-stories/overview-of-gender-based-violence/.

  2. Claudia Garcia-Moreno, Alessandra Guedes, and Wendy Knerr, “Intimate Partner Violence,” Understanding and Addressing Violence Against Women (World Health Organization, 2012), https://apps.who.int/iris/bitstream/handle/10665/77432/WHO_RHR_12.36_eng.pdf.

  3. “World Health Statistics 2022: Monitoring Health for the SDGs, Sustainable Development Goals” (World Health Organization, 2022).

  4. Garcia-Moreno, Guedes, and Knerr, “Intimate Partner Violence.”

  5. Carolina V. N. Coll et al., “Intimate Partner Violence in 46 Low-Income and Middle-Income Countries: An Appraisal of the Most Vulnerable Groups of Women Using National Health Surveys,” BMJ Global Health 5, no. 1 (January 1, 2020): 46, https://doi.org/10.1136/bmjgh-2019-002208.

  6. Coll et al., “Intimate Partner Violence in 46 Low-Income and Middle-Income Countries.”

  7. Taylor N T Brown and Jody L Herman, “Intimate Partner Violence and Sexual Abuse Among LGBT People,” 2015, https://williamsinstitute.law.ucla.edu/wp-content/uploads/IPV-Sexual-Abuse-Among-LGBT-Nov-2015.pdf.

  8. Brown and Herman.

  9. Anita Raj and Jay Silverman, “Violence Against Immigrant Women: The Roles of Culture, Context, and Legal Immigrant Status on Intimate Partner Violence,” Violence Against Women 8, no. 3 (March 2002): 367–98, https://doi.org/10.1177/10778010222183107.

  10. Karen Trister Grace and Jocelyn C. Anderson, “Reproductive Coercion: A Systematic Review,” Trauma, Violence, & Abuse 19, no. 4 (October 1, 2018): 371–90, https://doi.org/10.1177/1524838016663935.

  11. Nicola Sheeran, Heather Douglas, and Laura Tarzia, “Reproductive Coercion and Legal Recognition: Views of Domestic Violence Support Workers and Lawyers,” International Journal for Crime, Justice and Social Democracy 10, no. 4 (December 2021): 117–30, https://doi.org/10.3316/agispt.20211206057907.

  12. Grace and Anderson, “Reproductive Coercion”; Laura Tarzia and Kelsey Hegarty, “A Conceptual Re-Evaluation of Reproductive Coercion: Centring Intent, Fear and Control,” Reproductive Health 18, no. 1 (April 27, 2021): 87, https://doi.org/10.1186/s12978-021-01143-6.

  13. Elizabeth Miller et al., “Pregnancy Coercion, Intimate Partner Violence and Unintended Pregnancy,” Contraception 81, no. 4 (April 1, 2010): 316–22, https://doi.org/10.1016/j.contraception.2009.12.004.

  14. Sheeran, Douglas, and Tarzia, “Reproductive Coercion and Legal Recognition.”

  15. Sheeran, Douglas, and Tarzia.

  16. Tarzia and Hegarty, “A Conceptual Re-Evaluation of Reproductive Coercion.”

  17. Elizabeth Miller et al., “Reproductive Coercion: Connecting the Dots between Partner Violence and Unintended Pregnancy,” Contraception 81, no. 6 (June 1, 2010): 457–59, https://doi.org/10.1016/j.contraception.2010.02.023.

  18. Miller et al.

  19. Ariadna Capasso, Ralph J. DiClemente, and Gina M. Wingood, “Pregnancy Coercion as a Risk Factor for HIV and Other Sexually Transmitted Infections Among Young African American Women,” Journal of Acquired Immune Deficiency Syndromes (1999) 82, no. 2 (December 1, 2019): S155–61, https://doi.org/10.1097/QAI.0000000000002174.

  20. Elizabeth Miller et al., “A Family Planning Clinic Partner Violence Intervention to Reduce Risk Associated with Reproductive Coercion,” Contraception 83, no. 3 (March 1, 2011): 274–80, https://doi.org/10.1016/j.contraception.2010.07.013.

  21. “The World’s Abortion Laws,” Center for Reproductive Rights, accessed April 3, 2023, https://reproductiverights.org/maps/worlds-abortion-laws/.

  22. “Abortion Law: Global Comparisons,” Council on Foreign Relations, accessed April 3, 2023, https://www.cfr.org/article/abortion-law-global-comparisons.

  23. Erica Chenoweth and Zoe Marks, “Revenge of the Patriarchs,” Foreign Affairs, February 8, 2022, https://www.foreignaffairs.com/articles/china/2022-02-08/women-rights-revenge-patriarchs?_gl=1*tg7eho*_ga*NDI5OTE0NzUwLjE2NzY5OTA4MTQ.*_ga_N9V4J2JY26*MTY4MDUxMzEyMi4xMS4wLjE2ODA1MTMxMjIuMC4wLjA.*_ga_24W5E70YKH*MTY4MDUxMzEyMi4yMy4wLjE2ODA1MTMxMjIuMC4wLjA.*_ga_5PHCCVN7B8*MTY4MDUxMzEyMi4xMS4wLjE2ODA1MTMxMjIuMC4wLjA.

  24. Caroline Orr Bueno et al., “How Abortion Access Can Save Women From Violence,” The New Republic, December 15, 2021, https://newrepublic.com/article/164711/abortion-bans-violence-against-women.

  25. “Homicide During Pregnancy and the Postpartum Period in the U...: Obstetrics & Gynecology,” accessed April 3, 2023, https://journals.lww.com/greenjournal/Abstract/2021/11000/Homicide_During_Pregnancy_and_the_Postpartum.10.aspx; “Science Update: Pregnancy-Associated Homicides on the Rise in the United States, Suggests NICHD-Funded Study,” https://www.nichd.nih.gov/, September 16, 2022, https://www.nichd.nih.gov/newsroom/news/091622-pregnancy-associated-homicide.

  26. Charlotte Cliffe, Maddalena Miele, and Steven Reid, “Homicide in Pregnant and Postpartum Women Worldwide: A Review of the Literature,” Journal of Public Health Policy 40, no. 2 (June 2019): 180–216, https://doi.org/10.1057/s41271-018-0150-z.

  27. Muratori Muratori, “The Impact of Abortion Access on Violence Against Women” (University of Reading, 2021), https://www.reading.ac.uk/web/files/economics/emdp202103.pdf.

  28. “83(2) HB 2 - Enrolled Version - Bill Text,” accessed April 5, 2023, https://capitol.texas.gov/tlodocs/832/billtext/html/HB00002F.HTM.

  29. Muratori, “The Impact of Abortion Access on Violence Against Women.”

  30. “Supreme Court and Abortion: Why Whole Woman’s Health v. Hellerstedt Matters,” accessed April 5, 2023, https://www.usnews.com/news/blogs/data-mine/2016/01/11/supreme-court-and-abortion-why-whole-womans-health-v-hellerstedt-matters.

  31. Muratori, “The Impact of Abortion Access on Violence Against Women.”

  32. Muratori.

  33. Enrique Gracia, “Unreported Cases of Domestic Violence against Women: Towards an Epidemiology of Social Silence, Tolerance, and Inhibition,” Journal of Epidemiology & Community Health, accessed April 5, 2023, https://jech.bmj.com/content/58/7/536.

  34. Muratori, “The Impact of Abortion Access on Violence Against Women.”

  35. Eve Waltermaurer et al., “An Examination of Domestic Partner Violence and Its Justification in the Republic of Georgia,” BMC Women’s Health 13, no. 1 (November 1, 2013): 44, https://doi.org/10.1186/1472-6874-13-44; “Domestic Abuse Is an Economic Issue – for Its Victims and for Society,” CPAG, December 6, 2019, https://cpag.org.uk/news-blogs/news-listings/domestic-abuse-economic-issue-%E2%80%93-its-victims-and-society.

  36. “The Turnaway Study,” ANSIRH, accessed April 5, 2023, https://www.ansirh.org/research/ongoing/turnaway-study.

  37. Bueno et al., “How Abortion Access Can Save Women From Violence.”

  38. Garcia-Moreno, Guedes, and Knerr, “Intimate Partner Violence.”

  39. Caroline Bettinger-Lopez, “Gender Justice and Human Rights: Revisiting the Links between Domestic Violence and Reproductive Rights Advocacy,” SSRN Scholarly Paper (Rochester, NY, January 24, 2011), https://papers.ssrn.com/abstract=1789904.

  40. Bettinger-Lopez.

  41. Bettinger-Lopez.

  42. Claudia García-Moreno et al., “The Health-Systems Response to Violence against Women,” The Lancet 385, no. 9977 (April 2015): 1567–79, https://doi.org/10.1016/S0140-6736(14)61837-7.

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