# Prevalence and correlates of reproductive coercion in the months before pregnancy: cross-sectional findings from pregnant women in Ethiopia

## TL;DR

One-third of pregnant women in Ethiopia experienced reproductive coercion before pregnancy, with higher risks in certain regions and among cohabiting or previously married women.

## Contribution

This study provides the first cross-sectional evidence on the prevalence and correlates of reproductive coercion among pregnant women in Ethiopia.

## Key findings

- 27.3% of pregnant women reported any past-year reproductive coercion, with 14.3% experiencing more severe forms.
- Higher household wealth and residence in Amhara were risk factors for reproductive coercion.
- Having two or more children and more than secondary education were protective against reproductive coercion.

## Abstract

Reproductive coercion (RC), a form of intimate partner violence involving pressure, threats, or manipulation to control women’s reproductive decisions—including contraceptive use and pregnancy—poses significant threats to women’s health and rights by constraining their ability to make autonomous choices. This study examined the prevalence and correlates of past-year RC among pregnant Ethiopian women.

Cross-sectional data collected between October and December 2019 from the Performance Monitoring for Action-Ethiopia population-based cohort of pregnant women (N = 2169) were used. Past-year RC was assessed as a binary (any RC) and categorical (none, less severe, more severe) variable. Descriptive analyses were conducted to examine RC and sample characteristics. Estimated marginal effects were used to predict the probability of RC in the year before pregnancy. Binary and multinomial logistic regression were used to identify correlates of RC.

27.3% of pregnant women reported any past-year RC (16.2% less severe; 11.1% more severe). The adjusted probability of any RC in the year before pregnancy was 32.6% (95% CI: 26.1–39.2; 18.2% less severe; 14.3% more severe). Risk factors for any RC included higher household wealth (aOR highest quintile = 2.57, 95% CI: 1.50–4.13) and residence in Amhara (aOR = 1.82, 95% CI: 1.21–2.75); protective factors included having 2 + children (aOR2-3 children = 0.57, 95% CI: 0.41–0.80; aOR4+ children = 0.49, 95% CI: 0.34–0.72), or more than secondary education (aOR = 0.39, 95% CI: 0.22–0.64). Higher household wealth relative to the poorest households was a risk factor for less severe RC (aRRR highest quintile = 4.16, 95% CI: 2.32–7.44); whereas residing in Afar (aRRR = 0.35, 95% CI: 0.13–0.94) and having 2 + children (aRRR2-3 children = 0.60, 95% CI: 0.42–0.87; aRRR4+ children = 0.42, 95% CI: 0.27–0.68) were protective. Living in Amhara (aRRR = 2.40, 95% CI: 1.34–4.04), cohabitating (aRRR = 2.04, 95% CI: 1.06–3.94), and having a previous marriage or cohabitating relationship (aRRR = 1.84, 95% CI: 1.22–2.78) were associated with increased risk of more severe RC, whereas having 2 + children (aRRR2-3children = 0.54, 95% CI: 0.32–0.91) or more than secondary education (aRRR = 0.16, 95% CI: 0.07–0.40) were protective.

In Ethiopia, many women experience RC before pregnancy. Having two or more children and more than a secondary education are protective against RC. Risk factors for the most severe forms of RC include residing in Amhara, greater household wealth, cohabitation, and previous marriage or cohabitating relationships. Findings highlight the need for targeted interventions that address modifiable factors in high-risk populations and settings, such as engaging boys and men to prevent RC, and integrating RC response into pregnancy care to enhance women’s reproductive autonomy.

Reproductive coercion (RC) is a form of intimate partner violence where a husband or partner uses pressure, threats, or manipulation to control a woman’s reproductive choices, such as whether or when to use contraception or become pregnant. RC is a serious public health issue that affects women’s health and limits their ability to make independent decisions about contraception and pregnancy. We examined how common RC is among pregnant women in Ethiopia and what factors are associated with it. A total of 2,169 pregnant women from six regions were surveyed about whether, in the past year, their husband or partner engaged in any of the following pregnancy promoting behaviors: 1) told her not to use family planning; 2) said he would leave her if she didn’t get pregnant; 3) said he would have a baby with someone else if she didn’t get pregnant; 4) took away her family planning or kept her from going to the clinic; or 5) hurt her physically because she did not get pregnant. We measured RC in two ways: with a binary variable to indicate whether RC happened at all in the past year and a categorical variable to show the severity of RC (none, less severe, more severe). An estimated one-third of women experienced RC in the year before becoming pregnant, with 14.3% facing the most severe forms. The likelihood of experiencing the most severe forms of RC was higher among women living in Amhara, those who were cohabiting, and those who had a previous marriage or cohabitating relationship before their current partner. On the other hand, having more education and more children were protective against more severe RC. Results suggest many women in Ethiopia experience RC before pregnancy and highlight the need for interventions that address modifiable risk factors, educate boys and men, and integrate RC response strategies into pregnancy care to protect women's reproductive autonomy.