TRAUMA, VIOLENCE, & REPRODUCTIVE RIGHTS

In June 2022, the Supreme Court overturned Roe v. Wade with the Dobbs decision (Davis, 2022). Early media coverage turned attention to whether so-called state “trigger” laws outlawing abortion care made exceptions in cases of rape or incest. The media frame relegated abortion access to an issue after victimization and a matter specific to sexual violence (Cineas, 2022). We assessed things differently as researchers working on intimate violence from disciplinary perspectives that span clinical psychology, social epidemiology, and social work. After all, our fields had a name for forcing people to stay pregnant: reproductive coercion, defined as behavior “that interferes with the autonomous decision-making” about reproductive health (Grace & Anderson, 2018).

At the time of the Dobbs decision, research on reproductive coercion had been growing, documenting the prevalence and correlates of this form of intimate violence (Basile et al., 2018; Grace et al., 2022; Miller et al., 2010). A 2018 systematic review by Grace and Anderson outlined three interconnected forms of reproductive coercion: birth control sabotage (interfering with contraceptive and condom use), pregnancy coercion (threatening or pressuring a partner to get pregnant), and abortion coercion (threatening or pressuring a partner to get or not get an abortion). Empirical studies documented that reproductive coercion begins as early as adolescence (Hill et al., 2019; PettyJohn et al., 2021), and disproportionately affects marginalized and minoritized groups (Alexander et al., 2016; Holliday et al., 2017; McCauley et al., 2015).

Yet, much remained unknown, particularly in terms of the structural determinants underpinning early patterns as well as the ways that broader family systems, communities, and governments may perpetrate reproductive coercion to maintain inequitable power systems. It was our sense at the time – and remains so today – that research would be critical to revealing the scope of the problem of reproductive coercion at this time of enormous policy change. Furthermore, we believed that trauma science and practice has an especially important role to play because of the field’s approach to understanding that individual, community, and system dynamics work together to shape risk for, response to, and healing from traumatic stress.

Thus, this Special Issue of the Journal of Trauma & Dissociation (JTD) explores the intersection of trauma, violence, and reproductive rights. We include six articles that present theory, literature review, and empirical data to advance discourse about trauma and reproductive rights in the context of rapid sociopolitical change. Together, these articles inspire interdisciplinary, community-engaged research and practice that moves the field toward action and public impact (DePrince et al., 2022).

Expanding Theory on Trauma and Reproductive Rights

Authors in this special issue emphasize the need for expanding the lenses that researchers and practitioners use to understand and prevent reproductive coercion and reproductive injustice. In “Violence, Trauma, and Colonialism: A Structural Approach to Understanding The Policy Landscape of Indigenous Reproductive Justice,” BlackDeer (this special issue) introduces readers to several frameworks relevant to understanding reproductive coercion and other intimate violence perpetrated against Native women, from social ecological to historical oppression frameworks. Rooted in recognition of the long legacy of settler colonialism, the article invites trauma scholars and practitioners to consider individual experiences and consequences of reproductive coercion and intimate trauma in the context of policies and systems. Drawing on a brief history of federal Indian policies as well as the recent Dobbs decision, BlackDeer encourages us to focus on reproductive justice, and, in so doing, consider rights beyond abortion access. In particular, the author explores the concept of bodily autonomy as central to reproductive justice, including the rights to have a child, not have a child, and parent children.

Coleman, Hellberg, and colleagues (this special issue) also challenge readers to examine reproductive coercion in a broader sociocultural and community context with their article, “Situating Reproductive Coercion in the Sociocultural Context: An Ecological Framework Model to Inform Research, Practice, and Policy in the United States.” To date, much of the research on reproductive coercion has focused on the individual level and scholars have argued that the body of work conflates reproductive coercion with other forms of intimate violence (Tarzia & Hegarty, 2021). This article uses Bronfenbrenner’s ecological systems theory to draw connections between transgenerational trauma, institutional racism, and other forms of systemic oppression to understand reproductive coercion disparities that have been documented in previous research (Holliday et al., 2017), with implications for the health and well-being of communities post-Roe. Indeed, the authors argue that legislation restricting abortion access is a form of reproductive coercion as it interferes with the autonomous decision-making of pregnant people with dire health and social consequences.

Centering Marginalized and Minoritized Communities in Discourse on Reproductive Health and Justice

Several articles in this special issue encourage readers to ask who is missing from research, clinical work, and public discourse about reproductive health and justice. For example, in “Experiences of Exploitation and Associations with Economic Abuse in Adolescent Dating Relationships: Findings from a U.S. Cross-Sectional Survey,” Scott and colleagues (this special issue) leverage a large sample of more than 1700 adolescents to reveal interconnections between economic abuse in adolescent romantic relationships, financial dependence, and reproductive coercion. While adolescents who are marginalized by poverty and housing instability are often missing from research (Begun et al., 2020), this work opens an especially important window into dynamics that are essential to understand in terms of adolescent health and development. For example, the study points out the importance of studying economic abuse in adolescent relationships – not only in adult relationships, where most work has focused to date (Postmus et al., 2020). In this sample, economic abuse was linked with reproductive coercion as well as transactional sex and dependence on a partner to pay for contraception or birth control. At a time when abortion access is so severely restricted, the constellation of transactional sex, dependence on others for access to contraception, and reproductive coercion is particularly alarming for the risk of unwanted or unintended pregnancies, which can in turn, further worsen survivors’ economic stability at a time of growing economic insecurity in the U.S.

Greer and colleagues (this special issue) center the experiences of people with autism, summarizing the ways that restricted abortion access may uniquely jeopardize the rights and health of people with disabilities. In their article, “Barriers to Reporting and Lack of Equitable Support: Abortion Access for Adults with Autism Experiencing Rape-Related Pregnancy Post-Roe,” the authors explain that people with autism are more likely than their neurotypical counterparts to experience sexual violence and less likely to receive comprehensive sexual and reproductive health care and education. What is more, sexual violence is often perpetrated by someone the survivor knows, making it difficult for people with autism to report the abuse and rape-related pregnancy they experienced if it was perpetrated by a caregiver. This article provides recommendations for sexuality educators, formal sexual violence support resources, law enforcement, and policymakers that highlight the need for trauma-informed, survivor-centered approaches for people with disabilities. In particular, future work should aim to challenge perceptions of how a survivor “should” act or express what happened to them (Dinos et al., 2015) given the unique communication needs of people with autism. Further, it will be important for professionals working across the service continuum to collaborate to connect survivors with autism to the sexual and reproductive health care they need and deserve.

Linking Reproductive Justice and Health

The last two articles in this special issue explore the links between reproductive justice and health. The article “When Reproduction is No Longer Autonomous: Feeling Respected by Maternity Care Providers Moderates the Association between Autonomy in Decision Making and Birth-related Trauma Symptoms in a Community Sample of Postpartum Black Women,” by Lathan and colleagues (this special issue) highlights the role of maternal health providers’ in socioeconomically vulnerable Black women’s reproductive care. The authors introduce a critical perspective, demonstrating how health professionals, charged with caring for women and their reproductive health, can impact mental health outcomes by supporting or undermining women during pregnancy, labor, and delivery. This work draws attention to how other sources, beyond a romantic partner, can influence women’s well-being by impacting their autonomy during pregnancy and to the timing of reproductive coercion. Calling attention to medical professionals’ impact on women’s autonomous decision-making throughout pregnancy, labor, and birth expands our understanding of reproductive coercion by bringing attention to how institutions that are meant to serve its members contribute to women’s systematic oppression. Furthermore, by focusing on women’s autonomy during pregnancy, labor, and delivery, the temporal window in which undue reproductive influences can occur expands beyond pre-conception (e.g., restricting access to birth control), intercourse (e.g., removing a condom during sex), and once an individual is compelled to terminate or carry a pregnancy to term (e.g., being denied an abortion), which are the periods that are often the focus of reproductive coercion research. Indeed, understanding the impact of institutions broadly (e.g., legislative, religious, medical, and educational) on women’s reproductive autonomy across lifespan, is vital in dismantling harmful power imbalances through advocacy, cultural change, and legislation.

Muñoz and colleagues (this special issue) examine associations between reproductive coercion and adverse mental and behavioral health outcomes among a sample of 368 young adult women originally recruited in public high schools in Texas. Research has largely focused on associations among reproductive coercion and sexual and reproductive health. The article “Reproductive Coercion Victimization and Associated Mental Health Outcomes Among Female-Identifying Young Adults,” extends this work to provide further evidence linking this form of intimate violence to depression, anxiety, and symptoms of post-traumatic stress disorder. Authors explore the intersections of reproductive health, rights, and mental and behavioral health, highlighting research that has found that individuals who are denied access to abortion services experience poorer mental health outcomes compared with those who have access to the reproductive health services they seek. This article also considers how reproductive coercion is related to intimate violence more broadly; such conceptual clarity could result in more encompassing trauma-informed approaches to address reproductive coercion in clinical practice.

Future Directions for Research and Practice on Trauma and Reproductive Rights

The articles in this special issue underscore the contexts and consequences of systems that undermine the reproductive autonomy of its communities. Importantly, the special issue authors also remind us that reproductive coercion is not a new phenomenon. Rather, histories of forced sterilization, forced pregnancy, forced childbirth, and limited access to necessary reproductive health care have targeted Communities of Color dating back hundreds of years (Borrero et al., 2012; Roberts, 2014). While contemporary research has focused on reproductive coercion at the individual level, largely perpetrated by intimate partners, parents, or in-laws (Alexander et al., 2021; McCauley et al., 2014), this special issue challenges the field to more comprehensively explore the ways that reproductive coercion has been and continues to be perpetrated by state actors. Going forward, researchers will have an important role to play in assessing the myriad potential health and social outcomes in the wake of the Dobbs decision, a decision that interferes with the autonomous reproductive decision-making of pregnant people. Further, research will be needed to evaluate whether state policies, such as the Dobbs decision, increase reproductive coercion by intimate partners, parents, or in-laws.

With evidence that reproductive coercion disproportionately affects marginalized and minoritized communities, we must learn from articles in this special issue (BlackDeer; this special issue; Coleman et al., this special issue) that challenge researchers to ground their work in theory. Specifically, research on trauma and reproductive rights must be intersectional and acknowledge historical systems of privilege and oppression that shape exposure to harm and access to resources (McCauley et al., 2019). Theory-informed research will help us move beyond the “what” of reproductive coercion, to the “why,” allowing us to develop comprehensive prevention and intervention strategies at multiple layers of the social ecology.

Our efforts to build a society where all members have the rights and resources to control their sexuality, gender, work, and reproduction will also be strengthened by leveraging multidisciplinary collaborations in trauma science and practice (DePrince, 2022; In Our Own Voice, 2023). Notice that this special issue brings together authors from diverse fields and subfields – social work, psychiatry, psychology, adolescent medicine, and public health, among others. Collectively, their perspectives underscore that trauma and violence interfere with the reproductive health and rights of pregnant people and their families, with implications spanning health, law, and policy. Given the consequences for both individuals and communities, reproductive injustice should matter to us all, regardless of our genders or other identities (DePrince et al., 2022). Further, shifting deeply entrenched systems is not a task achievable by any of us alone, nor by any one discipline. As DePrince (2022) explains, “to disrupt the status quo of trauma and violence requires a radical acknowledgment of trauma and its complex interconnections with injustices as well as a commitment to healing and systemic change.”

That commitment to healing change will require much of us as individuals and a field. As illustrated by this collective of articles, for example, we must continue to ask who has been excluded, and work to expand our proverbial table to be in conversation with one another, across life experiences and disciplines. In addition, those of us holding privileged identities and positions of power need to recognize, use, and share that power to advance trauma-informed change that centers decision-making of marginalized and minoritized communities and embraces multiple ways of knowing. Ultimately, it will be necessary for each one of us to move to action to create communities that promote reproductive justice for one and all.