He refuses to wear a condom.

He hides your contraceptive pill.

He says if you truly loved him you would terminate your pregnancy.

These are all forms of reproductive abuse, a type of domestic or family violence where someone is stopped from making their own choices about their reproductive system.

"Usually it is perpetrated against women by their male intimate partner, but other family members can also be perpetrators. This is particularly the case for women from culturally and linguistically diverse backgrounds," says Laura Tarzia, deputy lead of the Abuse and Violence Program at the University of Melbourne.

Dr Tarzia says while awareness around reproductive abuse is growing, there is a "still a long way to go to put this issue on the radar".

Because of this, women often don't realise they are victims.

In this article we help you identify if it's something that is happening to you or someone you care about, and what you can do about it.

'I could not believe he had done that to me'

Reproductive abuse, also known as reproductive coercion, is wrong and if it's happening to you, it's OK to ask for help.

There is limited research on its prevalence; some US studies estimate one in four women, and there is Australian research that estimates one in 10.

Experts agree these are likely under-reported — like most forms of violence against women — and more work needs to be done.

A 2019 study co-authored by Dr Tarzia and published in the journal Culture, Health and Sexuality says reproductive abuse manifests in three main ways: birth control sabotage (such as destroying birth control pills or removing condoms), pregnancy coercion (pressuring or promoting a pregnancy that is not wanted by the woman) and controlling the outcome of pregnancy (for example, threatening a woman if she doesn't terminate).

Selena* escaped an abusive relationship 10 years ago. Birth control sabotage was a major turning point and ultimately what pushed her to leave.

One night while staying with friends her partner woke her up demanding sex — something she says she "just had to get through" rather than argue about.

"Our method of contraception throughout the relationship was the withdrawal method which was a really successful method of contraception for us.

"He ejaculated inside me that night … I could not believe he had done that to me. I remember feeling trapped because I was in these people's house and my son was asleep in the next room.

"I was traumatised, thinking I could be pregnant and trapped even further … fearful I would have another child to deal with in this terrible violent relationship."

Selena wasn't familiar with the term reproductive abuse at the time, she only knew she had been violated.

"When I read about reproductive abuse [recently] I thought wow … that happened to me."

Dr Tarzia says a lack of awareness around reproductive abuse, and the fact other forms of violence don't have to be present for it to take place, can make it difficult for women to realise what they are experiencing is abuse.

Inez Carey is a clinical manager with domestic and family violence counselling service 1800RESPECT.

She says the service commonly hears from women whose male partner refuses to use a condom or allow their partner to use contraception.

"I was working with a young woman who had the Implanon and she started dating a guy and they were having consensual sex. Then he cut out her Implanon with a switchblade because he wanted her to get pregnant.

"This is about power and control and … a lot of people don't even recognise what is occurring to them, that they are being denied their basic human right."

As well as women from CALD backgrounds, women with disabilities are also at greater risk.

"We heard from a woman with a disability who was in a relationship and forced to take the morning after pill every time they had sexual intercourse," Ms Carey says.

How reproductive abuse impacts victims

The consequences of reproductive abuse can include poor mental health, unintended pregnancy, sexually transmitted infections and poor maternal health.

"Many women report if they have been forced to terminate or been prevented from conceiving, there is lots of guilt and shame and grief around that. It's a really complicated kind of grief for women and it's not talked about," Ms Carey says.

Safe Steps Family Violence Response Centre CEO Rita Butera explains the impacts of reproductive coercion can be lifelong.

"Pregnancy and parenthood impact women's mental and physical health and wellbeing, and can profoundly limit their ability to work, socialise, be financially independent, and escape family violence."

She says more research needs to be done looking at the experiences for trans and non-binary people.

Part of combating reproductive abuse is recognising we live in a society that expects women to become mothers, according to Ms Carey.

She says conversations around whether we do or don't want children are often private, and men will "play on" the myth that women should want a child.

"We don't often talk about human rights violations in relation to whether someone does or doesn't use contraception or whether they do or don't want to have a child."

Dr Tarzia agrees, adding anti-abortion rhetoric and ideals like "it's men's right to 'spread their seed'" impact abusive behaviour.

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What victims can do and where to seek support

If you or someone you know is experiencing reproductive abuse, you can contact 1800RESPECT on 1800 737 732 or through online chat.

"There is lots of support out there; talk to a trusted friend, jump online. Find out about your rights," Ms Carey says.

Because research shows victims of reproductive abuse are more likely to have repeated visits to a healthcare provider, Dr Tarzia says medical professionals have an important role to play in responding to reproductive abuse.

In the 2019 study mentioned earlier, it found healthcare providers should be "taking the problem seriously, reinforcing that the behaviour is wrong, asking about other forms of violence and addressing women's needs and priorities for contraception and reproductive autonomy".

Dr Tarzia adds that greater access to safe and effective forms of contraception (especially those controlled by the woman) and safe abortion access are other important steps.

"Really, we need to hear more from women who have survived this type of abuse to hear what they think would work and what their needs are."

*Name changed for privacy