01Principles and purposeThe professional or clinical skill and the decisions it supports.
Reproductive coercion is behaviour that controls another person’s reproductive autonomy. It includes hiding or removing contraception, damaging condoms, preventing access to contraception, forcing pregnancy-capable sex, controlling fertility treatment, pressuring continuation or termination of pregnancy, and using children or pregnancy to maintain control. It can occur within a wider pattern of psychological, physical, sexual, economic or technology-facilitated abuse.
Ask when privacy is genuine. Do not use a partner, relative or child as interpreter. Explain that abuse is common and health services ask because it affects health. Use direct, non-judgemental questions about fear, control, sexual consent and interference with contraception or pregnancy choices. Accept a decision not to disclose; provide discreet routes back to care and repeat enquiry when safe.
Respond before collecting detail. Thank the person, state that the abuse is not their fault and check immediate injury, strangulation, sexual assault, suicidality, pregnancy and child risk. Avoid confronting the alleged perpetrator or insisting that the person leave. Separation can increase danger and a hurried plan may be unsafe. Specialist advocates can help assess risk and arrange refuge, legal and practical support.
Reproductive healthcare should maximise autonomy without creating new danger. Offer pregnancy testing, emergency contraception, STI testing, HIV PEP or PrEP, and contraception according to clinical need and the person’s preference. Consider whether a method, packaging, appointment reminder or billing record can be discovered. Never choose a concealed method without informed consent, and do not document speculative abuse labels in a place the perpetrator can access.
Confidentiality enables disclosure but has lawful limits. Explain likely information sharing before asking where possible. Seek consent for referral; if disclosure is required to protect a child or a person from serious harm, share relevant minimum information and record the basis. Adult domestic abuse does not automatically justify broad disclosure. Nation-specific law and organisational policy matter.
Documentation should be accurate and neutral: record the patient’s words where useful, observed injuries, examination consent, risk factors, children, referrals and communication restrictions. Do not include the alleged perpetrator in safety planning. Follow-up should use a verified safe channel and cover medical results, contraception, pregnancy, mental health, advocacy and changes in risk.
Key points
- Ask about abuse and reproductive control alone, in a private setting, using a professional interpreter and a simple empathetic explanation for the questions.
- Reproductive coercion includes contraception sabotage, forced sex, pressure about pregnancy outcome, interference with fertility care and control of appointments or medicines.
- Respond with belief and validation, assess immediate danger and medical needs, and ask what the patient wants help with today.
- Treat injury, sexual assault, pregnancy, emergency contraception, STI and HIV risks without making care conditional on leaving or reporting.
- Confidentiality is central but not absolute; explain any safeguarding or public-interest disclosure, share the minimum necessary information and document reasoning.
- Build a safety plan around transport, accommodation, children, medicines, documents, money and digital surveillance with specialist advocacy.
- Identify the UK nation because domestic-abuse definitions, child and adult safeguarding law, information sharing and local referral routes differ.
02Situations and prioritiesThe context, relevant information and actions that matter most.
Missing contraception, damaged condoms, forced sex or pressure about pregnancy outcome indicates interference with autonomous reproductive decisions.
Strangulation, threats to kill, stalking, weapon access or violence around separation requires urgent specialist risk response.
A partner speaking for the patient, monitoring messages or refusing privacy can be a sign of coercive control and unsafe communication.
Children exposed to the effects of domestic abuse require safeguarding consideration even without a disclosed physical assault.
Shared portals, location services, call logs and pharmacy notifications can reveal appointments, contraception or referrals.
Antenatal and reproductive-health contacts may offer a rare private setting for identification, medical care and advocacy referral.
03Assessment and interpretationHow to gather information, assess the situation and recognise uncertainty.
Consider the information, its meaning and its limitations before deciding what follows.
- 01
Private domestic-abuse and reproductive-control enquiry - Why
- Identify fear, coercion, sexual violence and interference with contraception, fertility or pregnancy decisions.
- Interpretation and limitations
- A disclosure guides safety and care; non-disclosure does not exclude abuse and should not trigger confrontation.
- 02
Immediate danger and strangulation assessment - Why
- Detect life-threatening injury and high-risk escalation requiring emergency or specialist action.
- Interpretation and limitations
- Absence of visible neck injury does not exclude strangulation harm; symptoms and mechanism determine urgent assessment.
- 03
Pregnancy, STI and HIV assessment - Why
- Address consequences of forced or sabotaged sexual exposure and offer time-sensitive prevention.
- Interpretation and limitations
- Select tests by site and window; pregnancy and prophylaxis choices remain the patient’s decisions whenever they have capacity.
- 04
Child and adult safeguarding assessment - Why
- Determine who may be at risk, relevant statutory duties and the least harmful information-sharing route.
- Interpretation and limitations
- Use the law and policy for the UK nation; adult disclosure alone does not mandate indiscriminate information sharing.
- 05
Communication and digital-safety check - Why
- Establish whether telephone, text, portal, letter, pharmacy or home contact could reveal care.
- Interpretation and limitations
- Record only the agreed safe route and avoid automated communication that could increase danger.
04Worked approachesCases with ordered reasoning, an action and a check of the outcome.
01Worked caseRespond without removing autonomyA patient privately discloses that a partner destroys contraception and threatens violence if pregnancy is prevented.+
- 1Validate the disclosure, assess injury, strangulation, immediate danger, sexual assault, pregnancy, suicidality and children at risk.
- 2Ask what help is wanted now and offer time-sensitive pregnancy, contraception, STI and HIV care without requiring police reporting or separation.
- 3With consent, contact a specialist domestic-abuse advocate and build a safety plan covering transport, medicines, documents, children and digital surveillance.
- 4Agree a safe communication method, document facts and disclosure decisions, and arrange named clinical and safeguarding follow-up.
02Emergency responseAct on imminent serious harmThere are threats to kill, recent strangulation, weapon access or an unsafe return home.+
- 1Treat acute injury and contact emergency services using a method that does not alert the alleged perpetrator.
- 2Use the local high-risk domestic-abuse and safeguarding route and involve specialist advocacy.
- 3Plan safe discharge or admission around children, transport, devices and the perpetrator’s likely access.
03Confidential follow-upProtect access to reproductive careThe patient wants contraception or testing but a partner monitors records and pharmacy messages.+
- 1Discuss clinically suitable options and the visibility of appointments, packaging, prescriptions and side effects.
- 2Obtain informed consent for the chosen method and do not promise absolute concealment.
- 3Set a verified safe route for results and review, involving information-governance or safeguarding advice when needed.
05Feedback, follow-up and evidenceReview outcomes, seek feedback and identify what to improve.
- Review danger and stalking risk at each contact because patterns can escalate around separation or pregnancy.
- Confirm that injury, strangulation, pregnancy, STI and HIV actions reached completion.
- Check whether contraception remains acceptable, safe to access and free from partner interference.
- Use only the documented safe communication channel and revisit it if circumstances change.
- Track advocacy, child safeguarding, housing and mental-health referrals with consent and clear ownership.
06Special situationsVariants, exceptions and circumstances that change the usual approach.
Control can target reproduction
Sabotaging contraception or coercing a pregnancy decision may be the presenting feature of a broader abusive pattern.
Leaving can raise danger
A directive to leave immediately can increase risk, so planning should be survivor led and supported by specialist assessment.
Records can disclose care
A portal notification or pharmacy message may reveal contraception or testing as surely as a paper letter.
Children experience the abuse
Witnessing or living with domestic abuse can harm children and creates assessment needs beyond visible injury.
07Common pitfallsFrequent interpretation and management errors.
- 01
Asking about abuse while a partner or informal interpreter is present.
- 02
Confronting the alleged perpetrator after a disclosure.
- 03
Making contraception, SARC or infection care conditional on police reporting.
- 04
Promising absolute confidentiality before assessing child or serious-harm duties.
- 05
Sending results to an unverified phone or shared portal.
- 06
Assuming that a patient who stays with a partner has declined all help.