Healthcare provider perspectives on their role in perpetrating and perpetuating reproductive coercion: a qualitative study.

Abstract

Background: Reproductive coercion (RC) refers to behaviours that interfere with an individual's autonomy over their reproductive health and decision-making. While traditionally attributed to partners or families, emerging research has highlighted the potential role healthcare providers may play in perpetrating and perpetuating RC. This study aims to explore the perspectives of Australian healthcare providers who deliver reproductive healthcare, focusing on their understanding of provider bias and coercion in the context of reproductive decision-making, both within their own practice and among their peers.

Methods: This qualitative study used semi-structured interviews to gather insights from 18 healthcare providers, including general practitioners, nurses, and obstetricians/gynaecologists who deliver reproductive healthcare services in Australia. Participants were purposively sampled to capture a range of perspectives, selecting individuals from different healthcare roles with experience in reproductive healthcare provision. Interviews were analysed using reflexive thematic analysis and themes were constructed through an inductive approach.

Results: Three key themes were identified: (1) Explicit refusals and their impact on reproductive autonomy, where participants described how refusal to provide or refer for services like abortion, sterilisation or long-acting contraception undermined patients' reproductive choices; (2) Implicit bias shaping reproductive decision-making, with participants reflecting on how unconscious biases influenced contraceptive counselling and other reproductive health decisions, often leading to coercive practices; and (3) Oversight and misinformation enabling coercion, where participants noted that a lack of awareness or incorrect assumptions about patient needs could unintentionally collude with coercive dynamics.

Conclusions: This research highlights the complex ways healthcare providers may, often unintentionally, undermine reproductive autonomy through biased guidance, non-referral, or restrictive practices. Addressing both explicit and implicit provider biases is essential for fostering person-centred, non-coercive reproductive healthcare. Our findings underscore the need for healthcare systems to prioritise bias and reflective practice training, along with corresponding clinical guidance for providers. This must be supported by institutional safeguards, such as enforceable referral mechanisms and bias-aware education to ensure reproductive decisions are respected and supported in practice. By actively dismantling coercive practices, healthcare providers can ensure that the care they provide respects and upholds patients' reproductive intentions and autonomy.