Opinion: When the condom breaks

Recently here in Sacramento, some 50 domestic violence and sexual assault experts, policy-makers, community organizers and health care providers gathered to talk about how to find effective solutions to a problem that has long been hidden, cloaked in silence and stigmatized – sexual and reproductive coercion. It’s a groundbreaking event that was long overdue, and one that should be replicated in communities all across the state and country. Simply lifting the silence is tremendously powerful.

Most of us think the same thing when we hear that a condom broke during sex, “I am not ready to be a parent, and I certainly don’t want HIV or a sexually transmitted infection.” But for some women, the condom breaking is something entirely different. It’s no accident at all. Instead, it’s a form of sexual and reproductive coercion that is a terrible fact of everyday life.  This coercion may include being raped or having your birth control sabotaged. It’s all part of a pattern of control and terror that teens and women experience all the time. Young women are at particular risk.

Research conducted by Child Trends finds that some 18 percent of women age 18 to 24 report having experienced forced sexual intercourse. In every community, there are young women who, in dating or other relationships, are raped or coerced into sex, prevented from using protection, and if they become pregnant are forced into choices that are not their own.

Sexual and reproductive coercion has a devastating impact on women’s physical and emotional health and well-being. Victims are at risk for sexually transmitted infections, unintended pregnancies and HIV. Some suffer miscarriages when they want to carry their pregnancies to term. Others become mothers before they are ready. Others lose their fertility and never have that experience. Many have emotional trauma that can last for years.

But there can be light at the end of the tunnel. Research conducted by Dr. Elizabeth Miller of UC-Davis and colleagues at the Harvard School of Public Health, found that women who were asked and counseled about sexual and reproductive coercion were 70 percent less likely to continue to experience it, and 60 percent more likely to end a relationship they then recognized as unhealthy.

As a society, we  need to have a conversation about how we can help youth avoid teen and unplanned pregnancy by addressing reproductive coercion. And we need to explore ways that doctors, nurses and other providers at family planning clinics and elsewhere can help screen patients for coercion and abuse, and offer help to those who need it. California’s Family PACT/FPACT, which has a network of more than 3,000 health providers who provide reproductive health services to 1.6 million women and men each year, is uniquely positioned to do that. But providers need tools and training so they know how to integrate screening for abuse into the care they provide. We need to make it our mission to ensure that they get those tools and that training.

Young women need to stay safe so they can be healthy – free from domestic violence, dating and sexual violence – as well as coercion.  Teaching young people to recognize and avoid unhealthy relationships, and build healthy ones, is essential.

We can all play a role in bringing abuse and coercion out of the shadows, and creating a culture where such behavior is unacceptable. And we can all support efforts to put in place a system that supports health care providers so they can screen and intervene to stop sexual and reproductive coercion.

Sex and pregnancy should never be coerced. So let’s remember that if the condom breaks – or has holes poked in it or if the birth control pills keep going missing – chances are that something else is going on. We all have a stake in recognizing, understanding and stopping it.