Reproductive coercion: the role of clinicians in general practice
Susan Saldanha
A B # * , Khue Le A B # , Jessica R. Botfield A B , Stella May Gwini C Danielle Mazza A B
A
B
C
# Susan Saldanha and Khue Le contributed equally to this work and are considered co-first authors
Abstract
Reproductive coercion (RC) is a form of gender-based violence that directly undermines reproductive autonomy, and can result in significant sexual, reproductive and mental health harms. Clinicians in general practice are well-positioned to address RC, given the central role of general practice in sexual and reproductive health care, as well as domestic and family violence response. Yet, RC often remains poorly understood in this setting, and guidance for clinical responses is underdeveloped. In this forum article, we examine why RC should be prioritised in general practice settings, outline what an appropriate response could involve in general practice, and discuss the system-, clinician-, and patient-level challenges and considerations to identifying and responding to RC in general practice. We also draw attention to how clinical practices, particularly in sexual and reproductive health care, can unintentionally reproduce dynamics of RC, and must be consciously managed to uphold patient autonomy. We argue for a more intentional role for general practice in RC recognition and response, underpinned by context-specific evidence-based guidelines, targeted training and integrated system-level support, to safeguard reproductive autonomy among general practice patients.
Keywords: family violence, gender-based violence, general practice, healthcare response, intimate partner violence, reproductive autonomy, reproductive coercion, sexual and reproductive health.
Introduction
Across history and into the present, women’s choices about whether, when and how to have children have been shaped by forces often beyond their control: partners, families, institutions, and public policy that dictate access, restrict options and limit autonomy (Rich et al. 2021; Graham et al. 2022). Reproductive coercion (RC), a form of gender-based violence where individuals are pressured, sabotaged, or forced into pregnancy-related outcomes against their will (Grace and Anderson 2018), brings this lack of choice into sharp focus. Although not new, RC has only more recently gained recognition in research and healthcare contexts, and remains under-recognised in general practice (Wellington et al. 2021), despite its serious impacts on victim–survivor sexual, reproductive, and mental health (Miller et al. 2010; Sheeran et al. 2025).
General practice is a key setting for responding to domestic and family violence (DFV), given its accessibility, continuity of care, and the trusted relationships that often exist between patients and clinicians (Richardson and Feder 1996; Hegarty and O’Doherty 2011). It is also central to delivering a broad range of sexual and reproductive healthcare (SRH) services, including contraception, abortion, and pregnancy care (Bittleston et al. 2024; Mawson et al. 2025). However, the intersection of these two areas – violence and reproductive health – is not always well understood, and clinicians in general practice may have limited support or guidance on how to navigate these overlapping issues (Wellington et al. 2021).
This forum article argues for a stronger, more intentional role for Australian general practice in recognising and responding to RC, and outlines practical opportunities and limitations to achieving this. We use the term ‘general practice clinicians’ to include general practitioners (GPs), practice nurses, and midwives working in general practice. Furthermore, although anyone can experience RC, including men, this article focuses on women and people with the capacity to become pregnant, acknowledging the biological realities of reproduction and the gendered power dynamics in which RC occurs (Tarzia and Hegarty 2021). For clarity, we use the term ‘women’ throughout, while recognising the broader diversity of those who are victim–survivors.
What do we know about RC?
RC can take many forms, but predominantly includes behaviours aimed at either promoting or preventing a pregnancy (Sheeran et al. 2022). People who use RC may use a range of tactics to achieve these outcomes (see Table 1).
| Type of violence enacted | Intended reproductive outcome | ||
|---|---|---|---|
| To promote pregnancy Forced conception, interference with contraception, forced pregnancy continuation | To prevent pregnancy Forced contraception, forced abortion | ||
| Physical violence |
|
| |
| Sexual violence |
|
| |
| Emotional or psychological abuse |
|
| |
| Deception |
|
| |
| Financial or economic abuse |
|
| |
| Coercive control |
|
| |
| Religious, spiritual or cultural abuse |
|
| |
| Institutional or systems abuse |
|
| |
Note: The behaviours listed are examples of RC and are not intended to represent an exhaustive list.
Although RC was first studied in the context of intimate partner relationships, often involving male partners (Miller et al. 2010), it is now recognised as a broader phenomenon enacted across relationships, institutions, and structures (Graham et al. 2023). For example, parents, in-laws and other family members may coerce reproductive decisions to enforce cultural or familial expectations (Pearson et al. 2023). Carers, too, may exert control over the reproductive choices of people with disabilities and adolescents, reflecting dynamics of power and dependency (WWDA 2016). Beyond personal relationships, RC can be enacted by institutional actors, such as clinicians and social service providers, who, through gatekeeping and discretionary power, may influence reproductive autonomy (Coleman et al. 2023; Warling et al. 2023). At a structural level, social and cultural norms about childbearing, marriage, and gender, and legislation and policy that restrict SRH access, can underpin and drive RC (DeJoy 2019; Marie Stopes Australia 2020; Graham et al. 2023). Interpersonal and structural dimensions of RC are not separate, but deeply intertwined – as structural forces shape interpersonal relationships, and vice versa (Graham et al. 2023). For those at the intersections of systemic oppression, such as Aboriginal and Torres Strait Islander peoples, people with disabilities, and other marginalised groups, these layers of coercion commonly compound each other, resulting in greater vulnerability (Marie Stopes Australia 2020).
The health impacts of RC are often significant and far-reaching. RC is consistently linked to unwanted and mistimed pregnancies, sexually transmitted infections, and a wide range of mental health issues, including anxiety, depression, and trauma (Miller et al. 2010; Fay and Yee 2018; Sheeran et al. 2025). Recent evidence also highlights a significant association between RC and suicidal ideation, even in the absence of other forms of intimate partner violence (IPV; Grace et al. 2025). RC has also been linked to adverse maternal and perinatal outcomes, including delayed access to prenatal care, preterm birth, and low-birthweight neonates (Fay and Yee 2020; Price et al. 2022; Grace et al. 2025). Social and economic consequences, such as entrapment in abusive relationships, and reduced capacity for education and employment, further compound these harms (Moulton et al. 2021). However, as RC often occurs in the context of other forms of IPV (Tarzia and Hegarty 2021), and has largely been researched within this context, the health impacts listed above cannot be attributed to RC in isolation.
A 2024 media article published in The Guardian presents RC prevalence findings from a nationally representative Australian study indicating that approximately 4% of women have experienced contraceptive interference, 3% have been subjected to forced contraception or sterilisation, 5% have experienced forced abortion, and 2% have been forced into a pregnancy; however, these figures are drawn from preliminary, non-peer-reviewed data (May 2024). The prevalence of RC from peer-reviewed evidence varies by setting, 21–22% reported by community-based studies, 15.4% among those seeking pregnancy counselling for unintended pregnancy, 2–5% in family planning/sexual health services and 33% among women experiencing IPV (Cheng et al. 2021; Hegarty et al. 2022; Sheeran et al. 2022; Galrao et al. 2024; Sheeran et al. 2025). In Australian general practice, RC prevalence data are limited. Only one cross-sectional waiting room survey in Victorian general practice clinics found that almost 10% of women reported contraceptive sabotage and/or coerced pregnancy (Tarzia et al. 2017). Overall, RC prevalence has been measured inconsistently across different settings (MacDonald et al. 2023), and has focused largely on RC occurring within intimate partner relationships, with limited attention given to RC exerted by others, including family members, carers or institutional actors. Despite inconsistent prevalence data, existing evidence indicates that RC is common, often hidden, and can cause significant harm.
Why does RC matter in general practice?
RC is a recognised form of IPV and DFV, often co-occurring with other forms of physical, psychological, and sexual abuse (Tarzia and Hegarty 2021). It can also operate as a mechanism of control within broader patterns of violence (Dutton and Goodman 2005). The role of general practice clinicians in responding to IPV and DFV is well-established, as they are uniquely positioned to identify and address abuse due to the ongoing, trusted therapeutic relationships they develop with patients (Hegarty and O’Doherty 2011; Lynch et al. 2022). The Royal Australian College of General Practitioners White Book, a national clinical guideline on responding to abuse and violence in general practice, emphasises that general practice clinicians are central to early identification, safety assessment, and initial response to abuse and violence, including RC, through routine care (RACGP 2022). On average, a full-time GP may see up to five women per week who have experienced abuse in the past 12 months (Hegarty and Bush 2002), underscoring the frequency with which abuse presents in general practice.
General practice also plays a central role in the provision of SRH care in Australia. Access to most forms of contraception, including oral contraceptives, implants, and intrauterine devices requires a prescription, typically obtained through general practice or family planning clinics (Goldhammer et al. 2017). Procedural contraceptive services, such as intrauterine devices and implant insertions, are also increasingly being delivered in general practice settings (Temple-Smith and Sanci 2020). Approximately 6% of GP consultations with women aged 12–54 years involve contraceptive management (Mazza et al. 2012). Additionally, 67% of women and 46% of gender-diverse patients report discussing contraception with their GP (Bittleston et al. 2024).
Pregnancy-related care is another key domain of general practice: nearly 90% of Australian women consult a GP to confirm pregnancy and discuss maternity care options, with shared antenatal care models involving GPs accounting for 40–50% of public sector obstetric care (Prosser et al. 2013). Australian GPs are also increasingly providing early medical abortion services (Deb et al. 2020). In South Australia, for example, 12% of all abortions in 2023 were conducted by GPs (Government of South Australia 2024). Practice nurses and midwives are also taking on greater roles in providing SRH services, including for long-acting reversible contraception (LARC) and early medical abortion care (Botfield et al. 2020; Moulton et al. 2025), with legislative reforms further supporting the expansion of nurse-led SRH care (TGA 2023).
Beyond clinical service delivery, the holistic nature of general practice, which integrates both medical and social care (Tarrant et al. 2003), places general practice clinicians in a unique position to support women experiencing RC. Patients report higher levels of trust in GPs than in other healthcare providers (Hardie and Critchley 2008), and nurses in general practice, who often have longer consultations, are perceived by patients as more approachable and personable to confide in (Yeung et al. 2012). Similarly, midwives may develop close, trusting relationships with women during pregnancy (Eustace et al. 2016). These long-term, trusting relationships developed between GPs, nurses, midwives and patients can facilitate disclosure of sensitive issues, such as RC and other forms of abuse (Yeung et al. 2012). This trust may be further strengthened by clinicians’ familiarity with patients’ cultural, linguistic, religious, and social contexts (Amiel and Heath 2003). In addition, as family doctors, GPs often care for multiple members of the same family over time (Healthdirect Australia 2025), developing a longitudinal understanding of their patients’ lives, relationships and health contexts. This enables general practice clinicians to observe interpersonal tensions or conflicts that may arise around decisions about contraception, pregnancy, and abortion, areas where RC can manifest. The continuity and breadth of general practice (Jeffers and Baker 2016) mean these dynamics are often more visible in general practice than in other health settings.
Through regular SRH consultations, such as contraception provision, pregnancy care, and abortion services, general practice maintains frequent and meaningful contact with women who may be experiencing RC. Although RC experiences may come to light during any type of consultation, SRH visits are particularly important touchpoints. Every contraceptive consultation, pregnancy check, or abortion discussion is a potential moment where coercion may be disclosed or detected. Each consult provides an opportunity for general practice clinicians to identify signs of coercion and offer appropriate support. However, without a clear understanding of how RC manifests, and with some clinicians unaware of RC or lacking confidence in how to respond (Wellington et al. 2021), these opportunities can be easily missed.
What would an appropriate response to RC look like in general practice?
Currently, there is no established, evidence-based model for appropriately identifying and responding to RC in general practice. Although some research exists, significant gaps remain regarding effective inquiry methods, risk factor identification, and intervention strategies specific to RC in general practice.
Inconsistent measurement of RC prevalence has hindered comprehensive understanding of evidence-based RC risk factors (Tarzia and Hegarty 2021). Nevertheless, the most consistently documented correlate of RC is its association with IPV/DFV (Grace and Anderson 2018; Clark et al. 2014). Consequently, many risk factors for RC mirror those associated with IPV and DFV, including younger age, financial dependency, pregnancy, mental health issues, histories of repeated unintended pregnancies and abortions, and substance use dependency (Rowlands et al. 2022). Sociocultural factors also contribute: individuals living in communities with rigid gender norms, pronatalist cultural expectations, and cultural taboos around contraception and abortion face heightened risks of RC (Coleman et al. 2023; Graham et al. 2023; Warling et al. 2023). Migrant and refugee populations encounter further barriers due to language challenges and social isolation (Suha et al. 2022; Sheeran et al. 2023), while Aboriginal and Torres Strait Islander people, and individuals with disabilities, chronic illness, or HIV are disproportionately affected due to systemic discrimination and marginalisation (WWDA 2016; Anderson et al. 2017; Price et al. 2022). Importantly, individuals experiencing multiple, intersecting forms of marginalisation face cumulative and amplified risks of RC (Coleman et al. 2023; Graham et al. 2023; Warling et al. 2023). These risks are perpetuated by broader systemic inequalities, social stigma and entrenched barriers to reproductive autonomy.
Given the overlaps between RC and IPV/DFV, approaches developed for IPV/DFV screening could be considered for RC inquiry. Evidence does not strongly support universal screening for IPV/DFV (Datner et al. 2004; MacMillan et al. 2009; Klevens et al. 2012; O’Doherty et al. 2013), with some advocating for universal screening to increase disclosure rates and clinician confidence (Coker et al. 2001; Alvarez et al. 2016), whereas others caution against the potential harms of repeated questioning without adequate support or follow up (Todahl and Walters 2011; Perone et al. 2022). Reflecting this, opportunistic screening or a targeted case-finding approach is currently recommended by bodies, such as the WHO and Royal Australian College of General Practitioners for responding to IPV/DFV (World Health Organization 2013; RACGP 2022). This involves routinely asking about violence and coercion in patients presenting with clinical indicators (e.g. mental health symptoms, pregnancy) or in specific contexts, such as antenatal settings. Example questions to assist clinicians to ask about RC are available (ACOG 2013; Rowlands et al. 2022; MacDonald et al. 2023).
However, although non-specific symptoms, such as somatic pain, sleep disturbances or mood changes, are well-recognised indicators for IPV/DFV case finding (Chuang and Liebschutz 2002; Narula et al. 2012; Rathnayake et al. 2023), they may be less effective in identifying RC, which can occur in the absence of other forms of violence or present with more subtle reproductive health cues, rather than overt indicators of coercion. General practice clinicians trained in IPV/DFV screening report that existing universal IPV screening tools are not effective in identifying RC, as these tools often fail to address the nuanced dynamics of reproductive control (Wellington et al. 2021). Further research is needed to establish reliable and context-appropriate indicators for RC, distinct from those used for IPV/DFV, in clinical practice. Challenges to RC inquiry are further amplified in telehealth consultations. The remote nature of telehealth limits clinicians’ ability to assess non-verbal cues, confirm patient privacy or safely inquire about sensitive issues, such as RC and DFV (Saldanha et al. 2024). Research indicates that establishing a safe environment for disclosure is significantly more difficult via telehealth (Saldanha et al. 2024). Without visual confirmation of who is present during the consultation, clinicians may be unable to ascertain whether a partner or family member is monitoring the interaction.
The above considerations highlight the need for more nuanced, context-sensitive approaches to RC inquiry within general practice. There is a critical need for more research to inform the development of guidance on when and how to ask about RC, with tailored considerations for conducting sensitive inquiries during both in-person and telehealth consultations. Existing guidelines, largely developed in international contexts (ACOG 2013), fail to address the unique needs, resource limitations and practice structures of Australian general practice (Wellington et al. 2021). Crucially, the development of protocols or guidance to identify RC must be informed by the insights of people with lived experience of RC, ensuring that inquiry practices are not only clinically effective, but also safe, acceptable, and responsive to the realities of those most affected.
RC inquiry should be accompanied by an appropriate, evidence-informed response to ensure safe and supportive care. Best-practice models for IPV/DFV response, such as LIVES (Listen, Inquire, Validate, Enhance safety, Support) and CARE (Choice, Autonomy, Respect, Empowerment), provide structured, patient-centred approaches for responding to disclosures of violence (World Health Organization 2014; Tarzia et al. 2020). These frameworks could be adapted for RC by incorporating discussions of reproductive autonomy, informed decision-making, and harm reduction strategies.
As previously described, RC is inextricably linked to clinical reproductive health encounters, such as contraception provision, pregnancy care and sexual health services. This creates opportunities for general practice clinicians to intervene directly. Evidence supports the provision of LARCs, which are less detectable to abusive partners (e.g. intrauterine devices, subdermal implants, depot medroxyprogesterone acetate), and the discreet provision of emergency contraception (Grace and Anderson 2018; Wood et al. 2022). Moreover, counselling on safe methods of contraceptive use, strategies to prevent partner interference and safety planning tailored to reproductive health contexts are important harm reduction strategies central to RC responses (MacDonald et al. 2023). Such interventions necessitate clinician awareness of reproductive autonomy as a core component of care, distinct from general IPV responses that may not address the nuanced dynamics of reproductive control. Referral to specialist services remains a critical component of an effective RC response, with victim–survivors often requiring access to DFV support services, sexual assault counselling and legal assistance (Rowlands et al. 2022). General practice clinicians play a pivotal role in facilitating safe and appropriate referrals, ensuring that patients are connected to services that can address the broader social, psychological and legal dimensions of RC. A US-based intervention, ARCHES (Addressing Reproductive Coercion in Health Settings), which integrates universal education, harm reduction counselling, and referrals to DFV and sexual health services, has shown to effectively reduce RC among women accessing reproductive care (Miller et al. 2016).
Critically, effective RC interventions in general practice require systemic, practice-level enablers. Essential measures include practice policies mandating private consultations to prevent partner and family surveillance, and the prominent display of patient education materials, signalling the practice’s capacity to address RC (Rowlands et al. 2022; MacDonald et al. 2023). Furthermore, continuous professional development in trauma-informed care and RC-specific response strategies is necessary to build practitioner competence and confidence (MacDonald et al. 2023). RC responses must also be adaptable, acknowledging the varied manifestations of RC, from subtle contraceptive sabotage to overt reproductive control, including forced sterilisation. Clinical responses should be guided by the perpetrator’s identity (e.g. intimate partner, family member, carer, institutional actor) and the presence of co-occurring forms of violence.
Challenges and considerations for responding to RC in general practice
Time constraints are a well-documented barrier to addressing violence and abuse in general practice (Yeung et al. 2012), with clinicians likening inquiries about violence to ‘opening Pandora’s box’ (Sugg and Inui 1992). This may contribute to hesitancy among general practice clinicians to initiate conversations about the often more complex and less familiar issue of RC, underscoring the need for specific guidance on how to effectively inquire about RC within the time and structural constraints of general practice.
Structural barriers within Australia’s health system actively perpetuate RC. A persistent disconnect between primary care, DFV, and SRH services is driven by fragmented healthcare systems and poor sector integration. Referral pathways for RC are poorly developed, with GPs reporting they have ‘nowhere to refer’ patients due to the scarcity and overburdening of specialist DFV and abortion services (Wellington et al. 2021). These systemic shortcomings leave general practice under-resourced and ill-equipped to support patients experiencing RC (Wellington et al. 2021).
Access to SRH services in Australia is also frequently described as a ‘postcode lottery’ (The Senate: Community Affairs References Committee 2023), where geographic location determines the availability and quality of care. Women in rural and remote areas face long wait times and prohibitive travel distances, often exceeding 2 hours to reach abortion providers, forcing some to continue unwanted pregnancies (Wellington et al. 2021). Geographic isolation, poverty, and systemic inequities further compound these barriers, disproportionately affecting low-income, Aboriginal and Torres Strait Islander, migrant and other marginalised populations (Wood et al. 2024). This highlights the need for coordinated, equitable and integrated SRH service provision at a national scale.
General practice clinicians themselves report low awareness and confidence in identifying RC, with many feeling ‘ill-equipped’ to recognise its often subtle forms (Wellington et al. 2021). Formal training opportunities on RC are limited, leaving clinicians uncertain about what questions to ask and how to respond appropriately to disclosures. Some explicitly avoid raising RC due to concerns about responding ‘incorrectly’ and fear of causing offence (Wellington et al. 2021). Although some clinician training on RC is available in Australia (Sexual Health Quarters 2024), there is a need for broader, nationally consistent training initiatives.
Lack of comfort and confidence discussing topics, such as SRH and violence, further deters clinicians from initiating these conversations (Ramsay et al. 2012; Mawson et al. 2025). Communication barriers, particularly with migrant and refugee populations, compound these challenges (Sheeran et al. 2023). Language differences and the underuse of professional interpreter services, often due to time pressures or availability, frequently result in reliance on family members as interpreters, undermining patient confidentiality and autonomy (Cheng et al. 2023; Sheeran et al. 2023).
Victim–survivors may face significant barriers to disclosing and help-seeking for RC. Fear of partner or family retaliation, stigma, shame, and self-blame are prominent deterrents (Lévesque and Rousseau 2021), compounded by a lack of recognition of RC behaviours, such as contraception sabotage or pregnancy pressure, as forms of abuse (MacDonald et al. 2023). Social and cultural norms that normalise male control over reproductive decisions further suppress help-seeking (Graham et al. 2023; Warling et al. 2023). Distrust in the health system, shaped by prior negative experiences and perceptions of clinician judgement (Obisesan 2024), could also discourage engagement with clinicians. Many patients may also perceive disclosure as futile (Chapman and Monk 2015), particularly when support services are scarce or inaccessible. Practical concerns, including privacy limitations within general practice settings and fear of confidentiality breaches (Heron and Eisma 2021), further inhibit open discussions. Finally, emotional overwhelm and avoidance act as psychological barriers (Overstreet et al. 2016), as patients struggle to cope with the complexity of abuse. Clinicians must therefore proactively create safe, non-judgemental, and confidential environments for discussing RC, recognising that significant patient-level barriers may prevent disclosure without sensitive, trust-building approaches (Heron and Eisma 2021).
The fine line between care and coercion
Although RC is commonly framed as perpetrated by intimate partners, there is substantial evidence that clinicians, including those within general practice, can also engage in coercive reproductive practices, sometimes overtly, often subtly (Solo and Festin 2019). The most documented context of clinician-enacted RC is within contraception provision. This can manifest in two forms: upward coercion, where clinicians may pressure patients to use contraception they do not want; and downward coercion, where clinicians may discourage or deny access to desired contraception (Senderowicz 2019). Both forms are influenced by clinician biases about patient characteristics, such as age, parity, marital status, or social identity (Higgins et al. 2016; Solo and Festin 2019; Mann et al. 2022). Research highlights that these biases often align with broader social prejudices, particularly against marginalised groups, including women living with HIV, women seeking abortion, women with disabilities, and young or unmarried women (Higgins et al. 2016; Senderowicz 2019; Solo and Festin 2019; Mann et al. 2022).
Although overt coercion, such as forced sterilisation, has a documented history in Australia and continues to affect marginalised populations (Elliott 2017; Rowlands et al. 2024), more subtle forms of clinician pressure are less understood, but equally consequential. Women frequently factor in their clinician’s opinions when making family planning decisions, including choices around the initiation, continuation, and removal of LARC, as well as broader decisions about childbearing (Alspaugh et al. 2020). Even when women report selecting their preferred contraceptive method themselves, they acknowledge that their decisions were influenced by information, or lack thereof, provided by their clinician (Harper et al. 2010). This reflects the significant influence clinicians hold in reproductive decision-making, stemming from inherent power dynamics, and asymmetries in contraceptive and health knowledge between clinicians and patients (Alspaugh et al. 2020).
In Australia, studies have found that younger and nulliparous women are less likely to be offered LARC, and may be more commonly recommended other methods (Wigginton et al. 2014; Botfield et al. 2025). In another study, some women report feeling pressured to continue LARC use longer than desired, leading to dissatisfaction and damaging the patient–clinician relationship (Caddy et al. 2022). Importantly, such coercion is not always intentional, and often unconscious. Implicit biases and assumptions about what is ‘best’ for the patient can subtly shape clinician recommendations, even when well-meaning (Solo and Festin 2019). However, the impact on patient autonomy remains the same – patients feel their choices are constrained. A structured, patient-centred counselling model, emphasising shared decision-making, active listening, and transparent discussion of risks and benefits, has been proposed to address clinician bias and coercion (Bitzer et al. 2017). For clinicians, reflecting on their own potential role in enacting or enabling RC, and recognising and addressing their own biases, while ensuring that care remains genuinely patient-led, is critical to upholding reproductive autonomy and reducing the risk of providing coercive care (Solo and Festin 2019; Mann et al. 2022).
Conclusion
RC is a harmful and often hidden form of gender-based violence that remains overlooked in Australian general practice, despite its significant health impacts and direct relevance to core SRH services delivered in this setting. In this forum article, we have highlighted how general practice is a key setting for supporting women experiencing RC, through its frequent engagement in SRH care, continuity of care, and the trusted relationships clinicians build with patients. However, there is a lack of evidence-based identification and response approaches specific to RC. While existing responses to IPV and DFV offer a starting point, they are insufficient to capture the distinct and complex dynamics of RC.
We have also outlined a range of challenges at the system, clinician, and patient levels that hinder effective responses to RC in general practice. These include fragmented referral pathways, limited access to SRH services, time constraints in general practice, and limited clinician knowledge and confidence in identifying and responding to RC. These challenges are exacerbated for women from marginalised groups, who face intersecting forms of discrimination and additional barriers to disclosure. Furthermore, clinician-enacted RC, whether overt or unconscious, also remains an important consideration, underscoring the need for reflective, patient-centred care.
Echoing recommendation 28 of the Senate inquiry into universal access to reproductive health care (The Senate: Community Affairs References Committee 2023), improving responses to RC in general practice necessitates further research to develop clear, evidence-based guidelines and training on RC, specifically tailored to the realities of Australian general practice. Practical strategies for RC inquiry, harm reduction and referral must be developed with input from those with lived experience. Although general practice clinicians cannot address RC in isolation, they must be equipped and supported to play a pivotal role. A coordinated, system-level response integrating SRH, DFV, and primary care services is essential to uphold reproductive autonomy and mitigate the harms of RC.
Data availability
Data sharing is not applicable, as no new data were generated or analysed during this study.
Conflicts of interest
Dr Jessica Botfield is an Associate Editor for Australian Journal of Primary Health but was not involved in the peer review or decision-making process for this paper. The author(s) have no further conflicts of interest to declare.
Declaration of funding
This doctoral research is supported by a Monash International Tuition Scholarship and a Monash Graduate Research Scholarship.
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