Australian health and social service providers’ perspectives on interpersonal and structural forms of reproductive coercion

Abstract

This study explored how Australian health and social service providers describe both interpersonal and structural forms of reproductive coercion (RC), and how they perceive these forms to interact in practice from their experiences supporting RC victim-survivors. Guided by an adapted socio-ecological framework that helped distinguish interpersonal and structural RC, we conducted semi-structured interviews with 25 general practitioners, nurses, social workers, domestic violence workers, and obstetrician/gynaecologists. Reflexive thematic analysis identified three themes: (1) Conflict and control: being powered by fear, demonstrates how interpersonal coercion emerges when reproductive conflict is coupled with fear and power imbalances, prompting concealment or compliance; (2) The path of ‘shoulds’, captures how explicit and implicit coercion arise from layered interpersonal and structural pressures, including cultural, societal and institutional norms that dictate who should or should not bear a child, with structural conditions often enabling interpersonal control; and (3) Unspoken, unenforced, yet deeply understood pressure, describes tacit coercion, internalised pressures often rooted in cultural and societal expectations that prompt individuals to self-regulate their reproductive choices or make protective decisions within constrained circumstances. Across the three themes, RC was understood as a relational and socially embedded phenomenon, where true freedom from coercion in reproductive decision-making depends not only on the absence of direct interference but also on having the space and supportive structures to make choices freely, safely, and in alignment with one's own values. Future research must centre victim-survivor experiences to deepen this conceptualisation and explore how interpersonal and structural forms of RC intersect in lived realities.