Advancing the science on measurement, determinants, and outcomes of pregnancy and abortion coercion in global settings: a scoping review

Reproductive coercion—behaviors that interfere with women's autonomous reproductive decision-making—is increasingly recognized but remains unevenly defined and measured across settings. We conducted a scoping review and searched MEDLINE, Scopus, CINAHL, Embase, and the Cochrane Library, for English-language studies from 1995 to April 2023. Of 8,515 records identified, 119 studies met inclusion criteria; 56% were quantitative, 55% were published during 2020–2023, and most were conducted in high-income settings (58% United States; 13% Australia). Conceptualizations evolved from a narrow focus on pregnancy coercion and birth control sabotage toward inclusion of abortion coercion, provider-level dynamics, and experiences during motherhood, though consensus is lacking. Measurement was dominated by the Miller reproductive control scale and adaptations; act-based items for abortion coercion were scarce. Reported prevalence spanned ∼1%–58% depending on timeframe, setting, and measure. Multi-level risk factors included unstable or non-marital partnerships, partner concurrency, co-residence with in-laws, and lower household wealth; partner education and employment were protective in several contexts. Reproductive coercion frequently co-occurred with intimate partner, sexual, and domestic violence yet showed independent associations with reduced contraceptive self-efficacy and use, increased covert contraception, unintended pregnancy, sexually transmitted infection, and adverse mental health. Evidence on interventions centers on clinic-based, trauma-informed education and counselling, with implementation barriers related to training, time, and referral pathways. Advancing the field requires a harmonized, intent-sensitive, act-based definition and improved measures, especially for abortion coercion, together with more diverse research in low- and middle-income countries and coordinated legal, health, educational, and community responses to protect women's reproductive autonomy.