The Picture of Texas

The majority of survivors interviewed reported having fair to excellent health, but there was a consistent theme that if a health issue happened they would not have adequate knowledge or financial resources to access the care they needed. Only 57% of interviewees had access to health care, with lower numbers reported by immigrant survivors who had not accessed family violence services. Survivors with children reported greater ease accessing health care for their children than for themselves. Children may be eligible for publicly subsidized programs, such as CHIP or Medicaid, but adults struggle with the high cost of health insurance and reported being uninsured and having difficulty paying past hospital bills. One survivor mentioned that, “Los niños tienen Medicaid pero yo no he sabido de un centro o algo así para mí o algo que yo pueda pagar. Porque las aseguranzas sí están muy altas.” (English translation: “The children have Medicaid but I have not been aware of any center or clinic for me where I could pay. Because the insurance is too expensive.”) This data correlates to one national study in which 37% of survivors said that they stayed longer or returned to an abusive relationship because they were worried about being able to meet their own or their children’s medical needs without their partner’s insurance or financial help ³.

The State Plan team specifically asked survivors about their experiences with reproductive coercion, an abusive tactic to control a partner’s reproductive health and/or decision-making. Participants were asked about lifetime experiences of four types of reproductive coercion, and more than 42% had experienced at least one type- with the most common type reported being a partner’s refusal to use condoms. Some reproductive coercion can look like an abuser trying to control a partner by forcing them to either get pregnant or forcing them to take birth control or to terminate a pregnancy. One survivor described her partner using this tactic, “He ruined things for me. He did things so that I would not go [to school] or not achieve it, and I think that one of those things was getting me pregnant all that time.”

¹Kazmerski, T., McCauley, H., Jones, K., Borrero, S., Silverman, J., Decker, M., Tancredi, D., & Miller, E. (2015). Use of Reproductive and Sexual Health Services Among Female Family Planning Clinic Clients Exposed to Partner Violence and Reproductive Coercion. Maternal & Child Health Journal, 19(7), 1490–1496.

²Miller, E., McCauley, H. L., Tancredi, D. J., Decker, M. R., Anderson, H., & Silverman, J. G. (2014). Recent reproductive coercion and unintended pregnancy among female family planning clients. Contraception, 89(2), 122–128.https://doi.org/10.1016/j.contraception.2013.10.011

³Adams, A. (2018, November). “We Would Have Had to Stay”: Survivors’ Economic Security and Access to Public Benefit Programs. Joint Report of National Resource Center on Domestic Violence (NRCDV), the National Latin@ Network for Healthy Families and Communities at Casa de Esperanza, and the National Domestic Violence Hotline (The Hotline). Retrieved https://vawnet.org/sites/default/files/assets/files/2018-11/NRCDV_PublicBenefits-WeWouldHaveHadToStay-Nov2018.pdf.

Research has long shown that there are serious, long-term health effects related to  both psychological and physical domestic violence resulting from abuse injuries and the chronic stress that occurs in those relationships ⁴.  In the State Plan survivor interviews, 28.8% of participants self-reported having a physical disability. Layering that increased risk of adverse health with lack of access to affordable insurance creates additional barriers for survivors. Creating multi-layered connections with integrated health care and social services could create opportunities for holistic services to survivors. Programs should also seek to promote mobile advocacy, the strategy of meeting clients out in the community or in their homes, for survivors who have disabilities or who are unable to physically access program locations. One staff member spoke about using this strategy, “We have one [client] that’s disabled that can’t even really ever leave her house. We have to go to her house.”

Targeting universal awareness interventions and education to health professionals who might see higher rates of domestic violence (OB/GYN, substance use, mental health etc.) can lead to less stigmatization and more support for survivors. Doctors can also focus on greater preventative care for survivors to lessen the physical, long-term effects of abuse. Due to the alarmingly high rates of reproductive coercion, medical professionals and advocates should become comfortable asking survivors about their reproductive health needs and how to connect them with medical services if needed.

⁴ Coker, A. L., Smith, P. H., Bethea, L., King, M. R., & McKeown, R. E. (2000). Physical health consequences of physical and psychological intimate partner violence. Archives of family medicine, 9(5), 451.