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36 | COLUMBIA SOCIAL WORK REVIEW, VOL. X 

STATE REPRODUCTIVE COERCION AS 
STRUCTURAL VIOLENCE

GIANNA DEJOY

Editorial note: The legal landscape in the reproductive justice space is 
changing rapidly. The information contained in the following article is 
current at the time of publication and is provided with no guarantees of 
ongoing completeness, accuracy, or timeliness.
 

INTRODUCTION
Violence against women and other marginalized groups takes many 

forms among individuals and in society. The coexistence of interpersonal 
and structural violence is especially pronounced in the realm of reproductive 
autonomy. Reproductive coercion, a form of intimate partner violence, 
finds its structural-level twin in state policies on reproductive health care 
that are coercive in impact. Communities that are already underserved 
by the health care system and disproportionately affected by anti-choice 
reproductive health policies—including women of color, young women, low-
income women, and undocumented women—are also the most at risk of 
reproductive coercion (Katz & Tirone, 2015).

Those who experience interpersonal reproductive coercion are 
additionally burdened by policies that shut down reproductive health care 
centers and make contraception and abortion care less accessible. Moreover, 
it is arguable that gendered and/or racialized power dynamics permeate 
many efforts to control a person’s bodily autonomy and reproductive 
health. The influence of these power dynamics is observable whether 
control is exerted by a partner perpetrating intimate partner violence or a 
policymaker creating anti-abortion laws. This paper contends that policies 
that interfere with an individual’s reproductive autonomy are systems-level 
manifestations of coercive intimate partner violence, likely influenced by 
the same power dynamics and desire to exert control, and with outcomes 
that replicate existing sociopolitical inequities.

While state reproductive coercion is a broad phenomenon, and 
multiple sites of reproductive coercion are considered herein, this paper 
will examine in more depth the role of reproductive health care centers in 
coercive reproductive health care policy (see Chamberlain & Levenson, 
2012). Reproductive health care centers are the physical and ideological 
space in which interpersonal and structural levels of coercion collide. For 
the purposes of this paper, reproductive health care centers will be defined 
as licensed health care clinics whose primary purpose is the provision of 
comprehensive reproductive health services, including abortion care. 



COLUMBIA SOCIAL WORK REVIEW, VOL. X | 37 

 STATE REPRODUCTIVE COERCION

Reproductive health care centers are primary sites of intervention for 
victims of reproductive coercion. They are also uniquely threatened by 
anti-choice policies.

This paper is divided into five parts. The first section, Reproductive 
Coercion, will provide an overview of interpersonal reproductive coercion. 
The second section, Structural Coercion, details federal and state-level 
policies that reduce access to abortion care and contraception. Disparate 
Impacts discusses demographic disparities in access to reproductive health 
care as well as risk factors for interpersonal reproductive coercion. Next, The 
Right to Bear Children addresses the flip side of this phenomenon, describing 
the ways in which some populations have faced coercive policies designed to 
restrict their ability to have children. The fifth section, Reproductive Health 
Centers: On the Front Lines, describes the important role that reproductive 
health care centers can play in screening for and intervening in intimate 
partner violence, including reproductive coercion. That section will also 
address the rising tide of policies designed to shut down these clinics. 
Overall, this paper will argue that historical and contemporary U.S. anti-
choice policies are not simply parallel phenomena to, but also structural 
manifestations of, interpersonal reproductive coercion, and should be 
considered forms of violence unto themselves.

REPRODUCTIVE COERCION
Reproductive coercion is a form of intimate partner violence 

characterized by interference in a person’s reproductive health and 
autonomy as a means of asserting power and control. Most commonly, 
reproductive coercion manifests as a male partner attempting to make a 
female partner pregnant against her will (Thaller & Messing, 2016). Miller 
et al. (2010) divide reproductive coercion into three categories: pregnancy 
coercion, birth control sabotage, and pregnancy outcome coercion. 
Pregnancy coercion includes demanding the partner become or remain 
pregnant and extends to sexual violence and threats of physical violence. 
Birth control sabotage involves hiding or destroying birth control pills, 
intentionally breaking condoms or covertly removing a condom during sex, 
or any other means of ensuring that a partner’s contraceptive method be 
ineffective (Chamberlain & Levenson, 2012; Miller et al., 2010). Pregnancy 
outcome coercion is interference with an individual’s decision of whether 
to terminate a pregnancy (Miller et al., 2014).

As research into the prevalence of reproductive coercion has mainly 
comprised community sampling, reported rates of this type of violence 
vary across studies. A review by Thaller and Messing (2016) found that 
close to five percent of women in the U.S. reported having experienced 
reproductive coercion, while results of a 2010 national survey found that 9% 
of U.S. women had experienced reproductive coercion at some point in their 
lifetimes (Black et al., 2011), and other estimates range up to 16% (Kovar, 



38 | COLUMBIA SOCIAL WORK REVIEW, VOL. X 

2018). Thaller and Messing’s (2016) review reported that between 14% and 
74% of teenage mothers and women seeking reproductive health care or 
domestic violence services reported experiencing reproductive coercion. 
In their study of family planning clinics in the San Francisco area, Holliday 
et al. (2017) reported that reproductive coercion is significantly associated 
with race (p < 0.001). 

For all women, other forms of intimate partner violence (defined herein 
as physical, sexual, or psychological harm by a current or former partner) are 
strongly associated with reproductive coercion (Thaller & Messing, 2016). 
One study of female undergraduate students found an association between 
contraceptive interference and psychological abuse, physical assault, 
and sexual assault (Katz & Sutherland, 2017). Experiencing reproductive 
coercion is also associated with a host of negative sexual health outcomes, 
including STIs (Kovar, 2018; Davis et al., 2018). There is a strong association 
between experiencing intimate partner violence and unintended pregnancy 
(Kovar, 2018; Moore, Frohwirth, & Miller, 2010; Silverman & Raj, 2014; 
Pallitto et al., 2013), which Miller et al. (2010) posit may be explained by 
the co-occurrence of reproductive coercion.

STRUCTURAL COERCION
Coercion regarding an individual’s reproductive decision-making is a 

structural as well as an interpersonal phenomenon (Schoen, 2005; Solinger, 
2007). The U.S. has a long history of laws and policies that assert power 
and control over childbearing people by interfering with their reproductive 
autonomy.1 Individuals who experience reproductive coercion at the 
interpersonal level are often additionally burdened by such policies, further 
compromising their ability to control their own reproductive health and 
future (Heise, Moore, & Toubia, 1995). 

Since the Supreme Court’s decision in Roe v. Wade (1973), a primary 
issue in the fight over reproductive autonomy has been the de facto rather 
than de jure right to terminate a pregnancy. An example of reproductive 
health policy that is coercive in nature—but that does not explicitly defy the 
law as established by Roe v. Wade—is the Hyde Amendment, enacted in 1976, 
which bars federal funding for abortion except in cases of rape, incest, or 
life endangerment of the pregnant person (Hyde Amendment of 1976). The 
effect of this policy is that a low-income woman experiencing reproductive 
1 The legal history of contraception in the U.S. provides a rich illustration of this point. The 
Comstock Act of 1873 forbade sending through the mail anything related to preventing con-
ception—a ban that was not lifted until 1938 (Act of the Suppression of Trade in, and Circu-
lation of, Obscene Literature and Articles of Immoral Use of 1873). Although the pill was ap-
proved by the U.S. Food and Drug Administration for contraceptive use in 1950, many states 
banned the pill until the Supreme Court’s 1965 decision in Griswold v. Connecticut,which 
ruled that married couples’ right to privacy included the use of this form of contraception 
(Nikolchev, 2010; Griswold v. Connecticut, 1965). It was not until the Supreme Court’s 1972 
decision in Eisenstadt v. Baird that the pill was legalized as a form of contraception for all, 
regardless of marital status (Eisenstadt v. Baird, 1972). 

STATE REPRODUCTIVE COERCION



COLUMBIA SOCIAL WORK REVIEW, VOL. X | 39 

STATE REPRODUCTIVE COERCION

coercion who becomes pregnant unintentionally would not be able to utilize 
Medicaid to cover abortion care (Barot, 2012). The coercive partner may be 
unlikely to facilitate the termination of the pregnancy. Given the frequent, 
or even near-universal, co-occurrence of financial abuse with other forms 
of intimate partner violence (Adams, 2011), that woman is unlikely to have 
her own funds available to pay for an abortion out of pocket. In this way, 
a woman experiencing reproductive coercion in her home is met with the 
coercive impact of federal policy when she seeks reproductive health care. 
That is, on both the interpersonal and institutional levels, a woman’s choice 
as to whether she continues her pregnancy is subject to coercive pressure.

Many more restrictions on access to birth control and abortion exist 
at the state level. Nineteen states ban abortion after 20 weeks gestation, 
with varying degrees of exception for conditions that threaten the pregnant 
person’s life or health (Guttmacher Institute, n.d., “An Overview”). For 
someone experiencing abuse and/or trying to raise the funds for an abortion, 
these bans may mean that their abortion is illegal by the time they are able 
to access it (Finer et al., 2006; Donohoe, 2005). Twenty-six states require a 
provider to administer an ultrasound or share information about receiving 
an ultrasound before performing an abortion (Guttmacher Institute, n.d., 
“Requirements”). Twenty-seven states mandate a waiting period of 18 to 
72 hours between receiving state-written counseling and the abortion 
procedure in most cases (Guttmacher Institute, n.d., “Overview”). Some 
states, such as Virginia, require that in most cases, the waiting period follow 
the mandated ultrasound (Guttmacher Institute, n.d., “Requirements”). It 
is apparent that these policies are designed to inconvenience and dissuade 
the pregnant person from choosing abortion. Much like interpersonal 
reproductive coercion, these types of laws interfere with an individual’s 
reproductive health decision-making by causing psychological distress and 
presenting material barriers (Ely et al., 2017).

New coercive reproductive health policies are being enacted at a fast 
rate. For example, new 2018 federal regulations (first introduced as Interim 
Final Regulations in October 2017) expanded the kinds of exemptions 
employers can claim from the Patient Protection and Affordable Care Act’s 
contraception coverage guarantee (82 FR 47838; Sobel, Salganicoff, & 
Rosenzweig, 2018). As a result, more people who receive health insurance 
from their employer or university may not be able to afford contraception 
(Goldstein, 2018; Sobel et al., 2018; Dreweke, 2018). Another example of 
policies that are coercive in effect is the 2017 reinstatement of the Mexico 
City Policy (Mexico City Policy of 2017). This policy denies federal funding to 
foreign nongovernmental organizations that provide services or information 
related to abortion (Mexico City Policy of 2017). More recently, this “gag 
rule” has been extended to American organizations (Compliance With 
Statutory Program Integrity Requirements, 2019). If upheld by the courts, 
this rule would restrict domestic, Title X-funded organizations’ ability to 



40 | COLUMBIA SOCIAL WORK REVIEW, VOL. X 

STATE REPRODUCTIVE COERCION
offer information about or referrals for abortion care. This would deny tens 
of thousands of people vital information on the full range of reproductive 
health care options available to them (American Academy of Pediatrics and 
Society for Adolescent Health and Medicine, 2018; New York State Office of 
the Attorney General, 2019). In addition, the new rule may have the effect 
of shutting down some health care centers and influencing the services 
provided by others, including Planned Parenthood, due to the requirement 
of having “physical and financial separation” between institutions providing 
abortions and those relying on Title X funding (Compliance With Statutory 
Program Integrity Requirements, 2019). 

DISPARATE IMPACTS
Communities most at risk of experiencing interpersonal reproductive 

coercion are also those most impacted by coercive state policies. A 2012 
Planned Parenthood fact sheet on reproductive coercion reports that 
women in low-income households, as well as Black, Indigenous, and 
immigrant women, experience sexual assault and intimate partner violence 
at higher rates than White and high-income women (Planned Parenthood 
Federation of America, 2012). Meanwhile, research shows that women of 
color and teenagers who are pregnant or raising children are at higher risk 
of reproductive coercion (Holliday et al., 2017; Miller et al., 2010; Thaller 
& Messing, 2016). In one study, 37% of Black women, 29.2% of multiracial 
women, 24% of Latina women, and 18.4% of Asian, Pacific Islander, or other 
non-White women had experienced reproductive coercion, compared to 18% 
of White women (Holliday et al., 2017). 

Dehlendorf, Rodriguez, Levy, Borrero, & Steinauer (2010) found 
that racial and socioeconomic disparities in family planning outcomes 
are influenced by health system factors, such as the scarcity of abortion 
providers in rural areas and limits on Medicaid funding. Reproductive health 
services, which are already difficult to access for low-income, uninsured, 
rural, or young patients, are made even less accessible by policies that make 
abortion and contraception more expensive and reproductive health centers 
less geographically widespread. For example, the American Academy of 
Pediatricians and Society for Adolescent Health and Medicine warned 
that the aforementioned Title X “gag rule” would disproportionately impact 
Black, Latinx, and young low-income people and exacerbate existing racial 
and socioeconomic disparities in access to care (AAP & SAHM, 2018). 

In other words, many of the demographic risk factors for interpersonal 
reproductive coercion also signal more vulnerability to reduced reproductive 
health care access in the face of coercive policies (Dehlendorf et al., 2010). 
When it comes to reproductive health and autonomy, the actions of 
individual abusers and anti-choice policymakers mutually reinforce one 
another within a system that burdens certain groups of women more than 
others.



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STATE REPRODUCTIVE COERCION

THE RIGHT TO BEAR CHILDREN
While both abusive partners and abusive policies can attempt to force 

an individual into continuing an unintended pregnancy, interpersonal 
and structural reproductive coercion can also take the form of preventing 
healthy pregnancy and childbirth. In relationships where interpersonal 
reproductive coercion is present, an abusive partner may force a partner 
who becomes pregnant into having an abortion or may physically abuse 
them to induce a miscarriage (Silverman & Raj, 2014). In the United States, 
state legislatures, judges, and physicians have long held the political and 
socioeconomic power to prevent those deemed unfit from becoming parents. 
There is a distinction to be made between the act of coercing one’s partner 
into ending a pregnancy and policies that mandate sterilization or coerce 
individuals into long-term forms of birth control; that distinction is the level 
of power behind the coercion, not the coercive intent. 

Miller and Silverman (2010) discuss control of pregnancy outcomes 
as a form of reproductive coercion, stating: “. . . [O]nce their female partner 
is pregnant, abusive male partners may enact behaviors to control the 
outcomes of the pregnancy including violent acts to attempt to induce 
miscarriage and coercion to . . . terminate the pregnancy” (p. 511). Anecdotal 
research also suggests that abusive partners may force women to get 
sterilized (Hathaway, Willis, Zimmer, & Silverman, 2005).

Just as abusers may coerce a partner into not getting pregnant or into 
terminating a pregnancy, the state also has a long history of interfering with 
an individual’s right to become pregnant and have children. Perhaps the 
most glaring example of this type of interference in reproductive autonomy 
is the role of eugenics-oriented ideology in U.S. public policy. The American 
eugenics movement was born in the late 19th century and reached its peak in 
the 1930s, targeting poor people, people of color, people with disabilities, and 
people with mental illnesses 2 (Washington, 2008). Margaret Sanger, who 
was at the time developing the network of family planning clinics that would 
become Planned Parenthood, was a vocal and active supporter of eugenics 
(Latson, 2016). By the 1930s, more than 30 states had laws mandating 
sterilization for people with intellectual disabilities, people receiving 
welfare, and/or anyone deemed to have genetic defects; these policies 
were upheld and encouraged by the Supreme Court in Buck v. Bell (1927) 
(Washington, 2008). As late as the 1960s, “southern states subjected black 
patients to medically unnecessary sterilizations in state-run hospitals, and 

2 While this period is commonly considered the span of the American eugenics movement, 
the relationship between reproductive health policy and population control goes back much 
farther. For example, laws banning abortion throughout the 1800s were motivated by “fears 
that the population would be dominated by the children of newly arriving immigrants, whose 
birth rates were higher than those of ‘native’ Anglo-Saxon women” (National Abortion 
Federation, n.d.).



42 | COLUMBIA SOCIAL WORK REVIEW, VOL. X 

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often informed consent was misleading or absent” (Simmons & McLean, 
2017, p. 36).

The lasting power of this ideology was illustrated by the myth of the 
“crack baby” during the 1980s crack cocaine epidemic (National Advocates 
for Pregnant Women, 2018). This moral panic—over the fallacy that 
fetuses exposed to crack in utero would be born with uniquely severe and 
lasting defects, including a predisposition towards violence—led to the 
implementation of mandated long-acting reversible contraceptive (LARC) 
programs, which disproportionately impacted the reproductive freedom of 
Black and/or low-income women who were the targets of the panic’s racist 
and classist rhetoric (ACLU, 1994; Sagatun-Edwards, 1998).

Throughout the 1990s, women receiving public assistance, teenage 
mothers, and women in the court system were compelled to get the LARC 
Norplant, a practice with the explicit goal of controlling the growth of 
“the underclass” (Roberts, 1999). Women convicted of drug use during 
pregnancy were frequently presented by judges a choice between jail time 
or Norplant (ACLU, 1994). Between 1991 and 1993, more than a dozen state 
legislatures introduced bills intended to coerce certain groups of women 
into LARC use, such as by conditioning receipt of public assistance upon 
Norplant implantation (ACLU, 1994). In 1996, the states of South Dakota, 
South Carolina, and Oklahoma allowed their state Medicaid programs to 
fund the implantation of Norplant, but restricted funding for the device’s 
removal—arguably an overt sterilization initiative for Medicaid recipients 
(Arnow, 1996).

Even while governments were actively pushing LARCs, a cautionary 
appraisal of Norplant published in Social Service Review in 1995 asserted:

When fertility control resides, at least in part, outside of the woman and 
her partner’s control, there is a very real risk of coercion on the part of 
health professionals and other persons in positions of authority who, 
for whatever reason, might want to limit her ability to conceive and bear 
children. (Gehlert & Lickey, 1995, p. 328) 

That “whatever reason” wondered at by Gehlert et al. seems to be the legacy 
of the American eugenics movement—the belief that some people should 
not be allowed to decide for themselves whether or when to have children 
(Dixon-Mueller, 1993).

LARCs remain popular among individuals as a powerful tool for 
controlling their own reproductive lives. What is concerning is that 
they also remain popular among policymakers and others in positions of 
power interested in engineering population controls. In 2014, a scholarly 
commentary on the growing popularity of LARCs encouraged “a moment 
for reflection and reassessment” to avoid repetition of past targeted 
abuses (Higgins, p. 238). Higgins compares contemporary LARC zeal to 
the push behind Norplant in the 1990s: “As with Norplant, policymakers 



COLUMBIA SOCIAL WORK REVIEW, VOL. X | 43 

STATE REPRODUCTIVE COERCION

have suggested incentive programs in which poor women receive cash in 
exchange for having a LARC method inserted, and such programs may be 
in practice already” (Higgins, 2014, p. 239). Despite cautions like Higgins’s, 
the coercion continues. In a 2016 qualitative study, young women reported 
believing that health care providers disproportionately recommended 
LARCs to marginalized women and that their own preferences for LARC 
selection or removal had not been honored by a provider (Higgins, Kramer, 
& Ryder, 2016). Interrogatory case studies in New York supported findings 
that physicians may exhibit racial bias both in recommending LARCs to 
their patients and in their willingness to remove such devices (Simmons 
& McLean, 2017). As late as 2017, a Tennessee judge ordered that inmates 
be granted a reduced sentence in exchange for Nexplanon implantation 
(Simmons & McLean, 2017).

While discussion of reproductive coercion often focuses on individuals 
forced into unintended pregnancies, the right to choose to get pregnant 
and safely carry out that pregnancy is an equally essential component of 
reproductive freedom—one that is infringed upon by policies as well as by 
partners.

REPRODUCTIVE HEALTH CENTERS: 
ON THE FRONT LINE

As the research involving reproductive coercion indicates (Grossman, 
White, Hopkins, & Potter, 2014; Sonfield, 2011), reproductive health care 
centers that provide abortions are on the front lines of the sociopolitical fight 
over reproductive freedom. They are uniquely positioned as intervention 
points for interpersonal reproductive coercion. If adequately trained and 
given appropriate resources, reproductive health care providers can be 
highly effective at screening for reproductive coercion (along with other 
forms of intimate partner violence) and intervening in it (American College 
of Obstetricians and Gynecologists, 2013; Miller et al., 2010; Miller et al., 
2011). This role means that they are also key sites of data collection for 
research into reproductive coercion as a form of intimate partner violence. 

Where reproductive health care centers exist in adequate supply and 
are financially accessible, there is great potential for them to act as front-
line intervention sites for reproductive coercion (ACOG, 2013; Miller et 
al., 2010; Miller et al., 2011). For example, a 2009 California pilot study 
randomized four family planning clinics to either provide their patients with 
an intervention measure or not. Among women who reported experiencing 
intimate partner violence in the preceding three months, patients who 
received the designated intervention had a 71% reduction in their odds of 
experiencing pregnancy coercion compared to the control group (Miller 
et al., 2011). The American College of Obstetricians and Gynecologists 
(ACOG) recommends that providers screen for intimate partner violence 
and reproductive coercion, as well as provide at-risk patients with education 



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on reproductive coercion, harm reduction strategies, and the option to use 
undetectable LARCs with which an abusive partner cannot tamper easily 
(2013). Miller et al.’s 2010 study of reproductive coercion among family 
planning clinic patients concluded with the same recommendations. 

Despite, and perhaps because of, their importance, reproductive 
health care centers are uniquely at risk under the rising tide of coercive 
reproductive health policies. Policies that shut down these health centers 
impact research on reproductive coercion, withhold resources for those 
experiencing intimate partner violence, and deny patients much-needed 
health services. There are numerous policies being proposed and already in 
place that limit the existence or capacity of reproductive health care centers. 

Targeted regulations of abortion providers, or TRAP laws, are one way 
that governments try to close reproductive health care centers. TRAP laws 
are mainly enacted on the state level. A common method that TRAP laws 
use to force the closure of reproductive health care centers is to regulate 
these centers like hospitals by requiring that they have more complex, high-
risk surgical capacities. For example, legislators have written TRAP bills 
(e.g. Alabama’s Women’s Health and Safety Act) designating reproductive 
health care centers as ambulatory surgical centers, meaning that the centers 
would need hallways wide enough to fit gurneys or particular sprinkler 
systems (Women’s Health and Safety Act of 2016; see also Becker, 2014). 
Underfunded community clinics that cannot meet the financial burdens 
of these licensure requirements are instead forced to close their doors. 
After the Virginia legislature passed a set of TRAP restrictions in 2013, 
the Virginia Department of Health estimated that the average cost of 
compliance would be around $1 million per clinic (Guttmacher Institute, 
n.d., “Targeted Regulations”). In the two years after Texas enacted new 
TRAP restrictions, the number of women in that state who lived 100 
miles or more from an abortion clinic tripled (Guttmacher Institute, n.d., 
“Targeted Regulations”). Fewer clinics mean that hassles associated with 
transportation, child care, or time away from work force pregnant people 
to wait longer before accessing abortion care (Ely, Rouland Polmanteer, & 
Caron, 2019). This is a significant burden for people with lower incomes; 
the median cost of an abortion more than doubles between 10 and 20 weeks 
gestation (Guttmacher Institute, n.d., “Targeted Regulations”).

Reproductive health care centers are the first line of defense for many 
women experiencing interpersonal reproductive coercion. At the policy 
level, the first line of defense against structural reproductive coercion 
must be stopping laws and regulations that force these clinics to shut down, 
putting reproductive health care out of reach for those who need it.



COLUMBIA SOCIAL WORK REVIEW, VOL. X | 45 

STATE REPRODUCTIVE COERCION

CONCLUSION
Reproductive coercion is a form of intimate partner violence in 

which an abuser attempts to exclude the victim from participation in 
decision-making about their own reproductive health and future. At its 
core, reproductive coercion is about asserting and maintaining power and 
control by denying the victim their right to reproductive self-determination. 
When state policies make contraception and abortion care inaccessible 
to some people, they are, in effect, replicating reproductive coercion on 
a structural level. Those who are likelier to experience interpersonal 
reproductive coercion at the hands of an abusive partner—mostly members 
of marginalized populations—are also more likely to face reduced access 
to contraception and abortion care by dint of being the same groups 
disproportionately affected by coercive state policies (Grace & Anderson, 
2016). Simultaneously, women who are poor, women of color, and women 
living with disabilities or addiction have long been at the receiving end of 
eugenic policies that try to deny them the right to have children at all.

 Research has shown that barriers to abortion services may cause or 
exacerbate trauma for patients seeking such care (Ely et al., 2017). Policies 
that reduce access to abortion—and to reproductive health care centers 
generally—therefore have deleterious mental health impacts in addition 
to the economic and physiological hardships they impose. The stress and 
trauma effects of coercive reproductive health policies are yet another 
parallel between the micro and macro levels of abuse and should further 
inform our understanding of the harm that these policies can cause. Pushing 
back against coercive policies that impede reproductive autonomy appears 
to be essential for effecting harm reduction for vulnerable women.

Reproductive health care centers exist at the intersection of 
interpersonal and structural reproductive coercion. These clinics can be an 
invaluable safe space where providers can screen patients for reproductive 
coercion and intervene if necessary. They prescribe contraception and 
provide abortion care. They are also important vehicles for advancing 
research on reproductive coercion. Yet anti-choice policies, such as TRAP 
laws, aim to shut down these health centers, leaving vulnerable communities 
without access to a range of health care services and without that front-line 
intervention for intimate partner violence.

The similarities between micro- and macro-level reproductive coercion 
outlined here should underscore the urgent necessity that social workers 
engage in advocacy that addresses not just interpersonal reproductive 
coercion, but structural coercion as well. As Ely and Dulmus (2010) point 
out in their call for social work policy practice around abortion rights, 
the social work profession has an unparalleled history of commitment 
to advocacy, including being “the only human service profession with a 
professional policy statement indicating the support of access to abortion 



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services as an important component of social justice” (Ely & Dulmus, 2010, 
p. 668). Ely and Dulmus’s encouragement is only more pressing today. The 
legal precedents that underpin fundamental reproductive rights in the U.S. 
are imperiled; the newly majority-conservative Supreme Court faces a 
pipeline of cases that could be used to undermine rulings such as Roe v. Wade 
(1973) and Whole Woman’s Health v. Hellerstedt (2016)3 (Haberkorn, 2018). 
Meanwhile, state legislatures are working to reduce access to contraception, 
close reproductive health care centers, and criminalize abortion. In just one 
southern state—Virginia—more than 170 such policies have been introduced 
since 2008, including a set of more than 30 TRAP regulations enacted in 
2013 (NARAL Pro-Choice Virginia, n.d.). As a macro-level incarnation 
of interpersonal reproductive coercion, restrictive reproductive health 
policies are structural violence. Structural violence should be countered 
with structural intervention. Social workers hold the professional mandate 
to engage in policy practice around this issue, including promoting proactive 
protections and opposing coercive policies wherever they appear.

3 In Roe v. Wade (1973), the Supreme Court of the United States invalidated a Texas law that 
prohibited abortion except when necessary to save the life of the pregnant person, and in do-
ing so, held that the right to privacy extended to the decision of whether to have an abortion 
and that governmental interference in that decision is subject to strict judicial scrutiny. The 
ruling in Roe did allow for states to ban abortions after fetal viability except when necessary 
to preserve the life or health of the pregnant person. In Whole Woman’s Health v. Hellerst-
edt (2016), the Court held that two provisions of a Texas TRAP law that threatened to shut 
down the state’s abortion clinics were unconstitutional as they imposed an undue burden 
(i.e. impeding access without providing medical benefit) on the right to access abortion care. 
The Court held that in future cases, the benefits of such laws must be weighed against the 
burdens they impose (NARAL Pro-Choice America Foundation, 2017).



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COLUMBIA SOCIAL WORK REVIEW, VOL. X | 53 

GIANNA DEJOY is a Master of Science in Social Work candidate in 
Accelerated Policy Practice in the field of Health, Mental Health, and 
Disabilities at Columbia University School of Social Work. She is in 
the two-year online program and is a 2018-2019 Fisher Cummings 
Washington Fellow. She is currently the Policy Fellow at NARAL Pro-
Choice Virginia where she conducts policy research and advocacy in the 
state legislature, Department of Health, and circuit court. Gianna received 
a B.A. in Sociology with departmental honors and a minor in Women, 
Gender, and Sexuality Studies, summa cum laude, Phi Beta Kappa, from 
University of Richmond in 2015. She is originally from Blue Hill, Maine, 
and now lives in Richmond, Virginia.

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