Addressing reproductive coercion in family medicine residency programs

Awarded 2014
Complex Family Planning Fellowship Research
Hilary Rosenstein, MD
Albert Einstein College of Medicine

Reproductive coercion (RC) refers to explicit attempts to impregnate a partner against her will, control outcomes of a pregnancy, coerce a partner to have unprotected sex, and/or interfere with contraceptive methods. Recent research from the CDC, family planning clinics in California, and a family medicine residency site in the Bronx, NY, report prevalence of RC from 9-24%. Given this data, family medicine physicians likely care for patients who experience reproductive coercion, but may not be aware of its impact on patients’ reproductive choices. There is no published literature about how family physicians are addressing RC with their patients and what, if anything, family medicine trainees are learning about RC. This project sought to describe the current extent of training around RC in family medicine residency programs and create and evaluate a curricular intervention to address the identified need.
(1) A needs assessment of Family Medicine training about RC, including surveys of all family medicine residency program directors and a sample of family medicine residents
(2) The development of a pilot family medicine residency curriculum about RC
(3) Evaluation of the pilot curriculum, including surveys and focus groups
Main results:
The resident survey was sent to 832 residents at 27 family medicine programs affiliated with RHEDI (Reproductive Health Education In Family Medicine) and getLARC, which receive additional support and funding for training in family planning. 60% of residents completed the survey. Less than half of respondents (48%) had ever heard of reproductive coercion. Almost all residents (97%) agreed that it is their job to ask about RC, but most (85%) had not received any training about it. Only about 1/3 (38%) of respondents had brought up the topic with a patient. Almost all respondents (98%) agreed that residents at their program would benefit from further training about RC.
The program director (PD) survey was sent to 462 family medicine residency programs. 198 (43%) PDs completed the survey. Approximately one-third (36%) of respondents stated they had ever heard of reproductive coercion. More than half (60%) of respondents stated that residents are graduating with no to few skills to assess for RC. It is encouraging to note that almost half (45%) of PD respondents stated it was very important for family medicine residents in their program to be trained to assess patients for RC.
A curriculum was developed to teach residents how to screen for and be attuned to possible cases of RC, and to be prepared to engage patients in conversation and provide appropriate guidance and referrals. The 3 sessions were piloted at the Montefiore Residency in Family and Social Medicine in February 2015. After the workshops, residents reported feeling more prepared to bring up RC with patients and more prepared to explore the issue with a patient who brings up RC. Participants reported they would consider RC more often and ask their patients about it. 
Family medicine residents do not have widespread didactic or clinical experience with reproductive coercion. However, it is feasible and acceptable to implement a curriculum about RC in a family medicine residency program. Increased comfort discussing RC with patients could increase patient-centered care around pregnancy and contraceptive decisions.