Beyond Partner Tactics: Assessing Survivor Resistance and Sentiment to Enhance Measurement and Understanding of Reproductive Coercion

Abstract

Intimate partner reproductive coercion (IPRC) is a form of intimate partner violence that not only threatens the reproductive health and autonomy of those who experience it, but also compromises the public’s health and wellbeing by contributing to poor birth outcomes, adverse mental health consequences, sexually transmitted infections, and unintended or unwanted pregnancies. While the clinical significance of IPRC is recognized and appreciated by many providers of sexual and reproductive healthcare, there is no standard measure that they can use to screen for it in among their patients. Furthermore, current understanding of IPRC’s public health burden is limited because population-level surveys have used scales that only operationalize a narrow sliver of the phenomenon. In this dissertation, we seek to begin closing these gaps—both in clinical toolkits and in population-level IPRC research—by developing and administering a novel scale. In Chapter 1, we use quantitative and qualitative evidence to winnow a large pool of items down to the subset that best measured our intended latent construct of IPRC. Our findings about the suitability of certain items (and the coherence of certain item combinations) have implications for the conceptualization of IPRC. For example, our finding of essential unidimensionality among a set of items that includes not just behaviorally specific tactics, but also the respondent’s reactions to and sentiment regarding a coercive partner, support the idea that IPRC can be understood as an ongoing relational dynamic rather than a set of discrete actions. In addition to providing insight into IPRC’s conceptualization, our analyses in Chapter 1 prepare us to develop and refine an informative scale of optimal length. In Chapter 2, we use item response theory (IRT) to remove uninformative scale items, support interpretation of scores on the novel instrument, and identify a threshold score signaling severe IPRC exposure. The final 9-item scale, called the Intimate Partner Reproductive Coercion Scale (IPRCS), is highly informative at a clinically meaningful threshold. Scale scores are correlated with IPV-related comorbidities and health outcomes known to co-exist with IPRC, providing convergent validity evidence for use of the score as a measurement of IPRC. Although score use validity will require further study in clinical settings before the IPRCS can be implemented widely as a screening tool, our analyses in Chapter 2 provide sufficient evidence of the validity of the scores’ usage in a national population for us to estimate the prevalence of IPRC in the U.S. in Chapter 3. In Chapter 3, we apply the IPRCS to a nationally representative probability sample of AFAB adults with a sexual history ages 18-50. Using our sample’s answers to the 9 final scale items to calculate their IPRCS scores, we estimate that close to 35% of the national population had been exposed to IPRC in their lifetime—more than 4 times the prevalence estimated by the NISVS. We also examine the associations between IPRC and several demographic and household variables. These analyses can begin to fill a gap in the literature concerning the population-level burden of IPRC.