The Role of Social Determinants in Reproductive Coercion: Understanding Health Information and Support Needs

PROJECT SUMMARY/ABSTRACT: In the United States, more than 10 million women have reported experiencing reproductive coercion (RC) by an intimate partner during their lifetime. This form of intimate partner violence involves deliberate actions to undermine a person’s reproductive choices, such as forcing a partner to continue or terminate a pregnancy or sabotaging contraception. Exposure to RC is increasingly recognized as a critical mechanism contributing to the acquisition of sexually transmitted infections (STIs), including HIV. Existing research demonstrates RC disproportionately impacts younger women aged 15 to 25, women in unstable intimate relationships, those with lower socioeconomic status or educational attainment, and racial and ethnic minorities. Despite these findings, a critical gap remains in examining social determinants at community and policy levels associated with RC, including neighborhood socioeconomic status, healthcare access, and state contraception policy. Furthermore, limited research exploring multiple levels of influence makes addressing women's health information and support needs challenging. Guided by a social-ecological framework, this F31 explanatory sequential mixed methods study aims to examine the role of social determinants of health in RC and to identify potential targets for future intervention development and testing. The specific aims are to (1) determine, through multilevel analyses, social determinants associated with self- reported RC among women at high risk for STI/HIV (N=1,800) and (2) explore the influence of multilevel social determinants on the health information and support needs of women reporting RC using a mixed methods approach (N=30). These aims will be achieved by leveraging pre-existing data from the sponsor’s ongoing national longitudinal epidemiological study (R01AI172469, Schnall/Johnson/Kempf, MPIs) to conduct multilevel analyses to assess associations of social determinants contributing to RC prevalence, followed by recruiting a subsample for freelisting and semi-structured interviews to explore women's experiences of RC. This study responds directly to NINR's mission, emphasizing the importance of considering the influence of social determinants to optimize women's sexual and reproductive health and advance health equity. Conducting this F31 study in coordination with proposed formal training activities will facilitate the PI’s training in (1) reproductive coercion, (2) health equity, (3) multilevel modeling and statistical analysis, (4) mixed methods design, and (5) professional development. Supported by a sponsorship team with expertise in mixed methods design (Schnall), STI/HIV prevention (Schnall), reproductive health equity (Hall), and collaborators with expertise in intimate partner violence (Glass) and multilevel modeling and statistical analysis (Liu), this proposal provides rigorous training critical to the PI’s career goal of becoming an independent, interdisciplinary nurse scientist with a research program dedicated to advancing sexual and reproductive health equity.