Victoria's ex-boyfriend wanted her to stop taking her birth control so that he could "prove his love" to her. She contemplated doing so, given that she suffered from some side effects of the medication, but ultimately decided against forgoing the pill.

Yet one day when the New York-based college senior was looking for her birth control, she discovered that her now ex-partner had taken it upon himself to throw it out in the trash.

"When he threw them out, I yelled at him," said Victoria, 20, who does not want her full name disclosed. "He just ended up laughing. All he said was 'chill,'" she told NBC News.

Now Victoria, who expects to graduate with her bachelor's degree next year, is also preparing to become a mother. She feels as though she has let herself and her family down for not identifying her ex's abusive and manipulative behavior, even though experts say the kind of abuse she struggled with is pervasive among young women and adolescent girls younger than Victoria —and it's not discussed nearly enough.

Approximately one-in-eight sexually active high school girls have experienced reproductive coercion, a form of relationship abuse that increases the risk for unintended pregnancy and can include contraception sabotage, condom manipulation and pressure for the partner to become pregnant when they don’t want to be, according to a recent study published in the journal “Obstetrics & Gynecology,”

“Reproductive coercion is any behavior that is used to control a partner’s reproductive anatomy,” lead author Amber Hill, M.S.P.H., an M.D. and Ph.D. student at the University of Pittsburgh School of Medicine, told NBC News. “Some common examples include throwing away a person’s birth control pills or poking holes in a condom before sex or removing a condom during sex without a partner’s permission or knowledge.”

Victoria said her boyfriend wanted to have sex every day, sometimes even twice a day, and expected that she go along. "If he didn't have sex, he'd be so angry and threaten to break up with me," she said.

In addition to unwanted pregnancies, such abuse can leave young women with sexually transmitted infections and long-term psychological damage. Reproductive coercion can also be accompanied by physical and sexual violence.

The research also suggested that Latina and black adolescent girls may be more vulnerable to reproductive coercion and sexual violence. Nearly 15 percent of Latina adolescents and 15 percent of black adolescents reported sexual coercion in the previous three months, compared to about four percent of white adolescents.

“We can’t say — because of how our sample was designed — that this [disparity] is definitely true among all populations,” Hill said. “But I think that because of what we know from the adult literature and because of the trends that we saw that this definitely warrants further investigation to see how these differences among the prevalence of reproductive coercion potentially influence the persistence disparities that we see in sexual and reproductive health among women and girls of color.”

According to the CDC, black women die of pregnancy-related causes at a rate about three times higher than that of white women. Latinas contract sexually-transmitted infections like chlamydia and syphilis at more than twice the rate than that of white women.

Though previous research has shown that older women may be more likely to request emergency contraception or tests for pregnancy and sexually transmitted infections, comprehensive literature that focused on the prevalence and effects of this abuse among female adolescents was lacking. Other studies also suggested that there were disparities in this type of abuse among women of different races, but did not look at teenage girls in particular.

Hill, Dr. Elizabeth Miller, director of adolescent and young adult medicine at the University of Pittsburgh Medical Center Children’s Hospital, and other researchers sought to fill this gap with their study “Reproductive Coercion and Relationship Abuse Among Adolescents and Young Women Seeking Care at School Health Centers.”

Using data collected from a previous project about healthy relationship counseling in eight northern California schools during the 2012-2013 school year, researchers analyzed the responses of 550 sexually active girls, ages 14 to 19.

“We thought it was important to focus on this population because the ways in which adolescents seek care and the ways in which partner violence manifests in adolescents is different than in adulthood,” Hill said. “For healthcare providers who are taking care of adolescents, this is crucial information.”

A growing focus on the issue

Hill added that reproductive coercion in and of itself is a phenomenon that’s only recently become an area of significant interest to the research community in the last decade.

While relationship abuse among adult women is often linked to them seeking out health care like emergency contraception, researchers found that there was no distinct pattern in the way teens who experience reproductive coercion use medical services.

“As clinicians, we’re always looking for clues and signs of this kind of abuse, but given that there was no obvious pattern, it shows us that we can’t just rely on these clues and that we should really be talking to all of our patients about this issue,” Hill said.

In addition to talking to their adolescent patients about sexual coercion, Miller suggest building sexual education and violence prevention programming around relationship abuse and sexual assault prevention to include “more subtle forms of control that can happen in a relationship.”

Victoria said that when she was younger, reproductive coercion was "not talked about at all" and that conversations about intimacy were framed around consent, but did not touch upon what to do when a partner you want to be intimate with is abusive.

“We need to realize that interpersonal violence doesn’t exist in a vacuum,” Miller said. “While a really razor sharp focus on identifying a phenomenon like reproductive coercion is important, we need to realize part of our work includes increasing opportunities for young people to learn prosocial behaviors, understand their emerging sexuality and develop the skills around communication, negotiation and conflict management. All of those skills need to be embedded in comprehensive sexual health education.”

Miller also calls on schools to implement strong sexual health and relationship abuse policies. A study from 2017 showed that only 35 percent of a national random sample of 750 schools addressed dating abuse in their violence prevention strategies.

“Nobody deserves to be treated like this, especially by somebody who is supposed to love them,” Hill said.

If you or someone you know needs help, contact the National Domestic Violence Hotline at 1-800-799-7233, the Rape Abuse & Incest National Network Hotline at 1-800-656-4673, or visit www.futureswithoutviolence.org.

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