# Reproductive coercion experienced by women living with HIV – a global scoping review

## TL;DR

Women with HIV face reproductive coercion in healthcare settings globally, including forced sterilization and abortion, which affects their health and rights.

## Contribution

This scoping review is the first to synthesize global evidence on reproductive coercion experienced by women living with HIV in clinical settings.

## Key findings

- Reproductive coercion among women with HIV is severe and pervasive, with sterilization being the most common form.
- Coercion occurs in diverse regions including Mexico, the United States, and South Africa, with significant variation in definitions and reporting.
- Healthcare providers often prioritize preventing HIV transmission over respecting women's reproductive choices, leading to negative health impacts.

## Abstract

Biomedical advancements in HIV prevention and treatment have provided opportunities for women living with HIV to move through pregnancy, give birth, and breastfeed while effectively removing the risk of vertical transmission of HIV to their child. However, existing evidence suggests that the reproductive health and rights of women living with HIV are threatened through coercive practices in healthcare settings because of their HIV status. The objective of this scoping review was to synthesise evidence and identify gaps in the literature on reproductive coercion experienced by women living with HIV in clinical settings. This review focused specifically on reproductive coercion in the context of clinical healthcare globally, as opposed to intimate partnerships, and included forced or covertly performed sterilisation, forced abortion, restricted or forced contraceptive methods, forced or denied caesarean sections, and general coercion by healthcare providers regarding fertility-, sexual-, and reproductive-related decision-making. We searched three databases (Embase, PubMed, and LILACS) for quantitative, qualitative, and mixed methods studies. After 2888 unique publications were screened, thirteen publications met the inclusion criteria. Sterilisation was the most common coercion type assessed, and Mexico, the United States, and South Africa were common study settings. Variation in reproductive coercion definitions, study methods, and reporting was observed. Evidence from these studies suggests that reproductive coercion among women living with HIV is severe and pervasive. Therefore, there is a need to expand research on coercion and stigma that women living with HIV face while navigating reproductive healthcare. Additionally, prevention mechanisms and resource expansion for survivors beyond legal settings should be implemented globally.

Women living with HIV face barriers to quality healthcare, including stigma and discrimination. One barrier is reproductive coercion in healthcare settings. This broad term includes multiple types of human rights violations (including forced sterilisation and abortion) committed by healthcare providers on women seeking reproductive health services. To date, there has not been a formal synthesis of peer-reviewed research into reproductive coercion experienced by women living with HIV. We searched Embase, PubMed, and LILACS databases and screened over 2800 unique publications. The thirteen publications that met our search criteria spanned studies in Latin America, Sub-Saharan Africa, North America, and Southeast Asia. There were four main themes: 1. Common situations and types of healthcare visits where coercion takes place; 2. Power dynamics preventing women from making informed decisions about their reproductive health; 3. Negative health impacts of coercion; and 4. Prioritisation of preventing vertical HIV transmission over listening to women seeking care. This thematic analysis suggests that reproductive coercion among women living with HIV is varied, occurring globally, and greatly impacting women’s health and well-being.