'He Thought a Baby Would Keep Me in His Life Forever': When Partner Abuse Isn't a Bruise But a Pregnant Belly
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Jill A. Murray, Ph.D., a leading author and expert on teen dating violence, does counseling in high school teen-mother programs. Of one recent group, she says, "every single one of the girls was in an abusive relationship, of which the pregnancy or the child was a product."
The problem is so widespread, in fact, that public-health advocates are working to cast teen pregnancy in a whole new light: not as a measure of "promiscuity," or a failure of cluefulness, but rather as a canary in the coal mine of partner violence.
"We have to treat pregnancy itself as a warning sign," says Murray. "I always tell other counselors that I'm training, 'When you see a pregnant teen girl, always, always assess for an abusive relationship, because 99 percent of the time, that will be the case.' "
Of course, not all teenage girls are 100 percent averse to getting pregnant. But that doesn't mean they're in healthy relationships.
"Teen pregnancy is likely emerging out of unhealthy relationships," says Miller. "That's not the only mechanism for teen pregnancy, but it is an important one that we've managed to miss for a very long time."
Miller, for her part, has vowed not to miss it again. Nine years ago, she was working as a volunteer physician in a teen health clinic in Boston when a 15-year-old girl asked her for a pregnancy test. It was negative. But two weeks later, the girl wound up in the ER with a severe head injury. The girl's boyfriend had pushed her down a flight of stairs.
"I assumed all she needed was to be educated about her contraceptive options," Miller recalled. "Later, I wondered what I had missed. Could I have asked a question that would have identified that she was in an abusive relationship?"
Last week, a new study revealed that while teen sex rates remain the same, teen contraceptive use is down. Fingers were pointed -- deservedly so, one imagines -- at, among other things, abstinence-only education that downright demonizes condoms.
But even as a growing body of research underscores the role male partners play in condom use and negotiation, no suggestion was made that those stats might include some girls who are forgoing condoms against their will, even those bolstered by condom-friendlier sex ed.
"The person you're 'negotiating' condom use with may not be interested in negotiation," says Miller.
"The picture out there is 'just get women birth control,' " adds Esta Soler, president of the Family Violence Prevention Fund, which has launched a public awareness campaign about reproductive abuse in relationships. "But, because of coercion or sabotage, they may not have control over whether they use it."
And it's not just about pregnancy. Dr. Anne Teitelman, Assistant Professor in the School of Nursing at the University of Pennsylvania, is an expert on partner abuse and HIV risk. In her published review on this link among adolescent girls, she found six studies identified an association between intimate partner violence and increased risk for HIV (as in condom non-use). Among adolescent girls, survivors of partner abuse are significantly more likely than others to be diagnosed with an STD.
Dr. Teitelman's research findings also indicate that verbal abuse, as well as physical abuse, is linked with increased HIV risk among adolescent girls.
Teitelman, who is also a Family Nurse Practitioner, observed this association firsthand, before studies began to confirm the link.
"We're giving teens all this information about prevention in the clinic, and yet I see them back all the time for STI testing," she says. So, she began to ask, " 'What's not working on our end? What are the obstacles in their lives that are making this difficult for them?' I was not a partner-abuse researcher before, but I became one because that was one of the major answers."