Access to contraception can be compromised for women living in abusive relationships.
For example, a partner might take a condom off during sex, restrict access to emergency contraception or feel inside a woman for evidence of an intrauterine device.
Liz Price, a project officer at counselling service Children by Choice in Queensland, told BuzzFeed News the organisation hears of numerous cases where women have had their contraception interfered with.
"We hear so many stories from women in violent relationships whose contraception was sabotaged, but also, reproductive coercion can be the beginning of patterns of violence and control," Price said.
"I dealt with a woman who very recently moved in with a man she had been dating for three months, and he pushed her pills out of the blister pack and flushed them down the toilet, and denied her car keys or emergency contraception.
"She fell pregnant in a very short amount of time."
Children by Choice, which provides information, education and advice about reproductive health, abortion, adoption and parenting, has published a resource for women and their doctors or counsellors who want to know more.
You can download the chart here.
"A third of the women we see who disclose experiences of domestic violence also disclose reproductive coercion," Price said.
"It is most common for women in their 20s, and we know that younger women are more likely to go ahead with a pregnancy as a result of the violence."
Some contraceptives are easier than others to sabotage.
"All of the long-acting reversible contraceptives [intrauterine devices and implants] offer women much greater control over their contraception, and they are not prone to user error," Price said.
"But it is important to explore each woman's situation and find what works for her."
Side effects, efficacy and price vary greatly for each method.
1. Hormonal and copper IUDs
Will someone else know I'm using it?
The strings of the IUD might be detectable but can be trimmed short by the doctor who inserts it.
"If the device is correctly fitted, the stem should not be detectable," said Price.
She said a copper IUD was one of the best forms of contraception for women in abusive relationships because there was a "great deal of concealment".
"There is no obvious change to a woman's fertility patterns because her menstrual cycle can remain normal, and if the strings are trimmed flush with the cervical wall the implant shouldn't be detected."
Menstruation can be disrupted or stop altogether with hormonal IUDs but you will still bleed with copper IUDs.
Could someone else tamper with them?
It could be forcibly removed if the strings were not cut off at the opening of the cervical canal.
2. Injection (Depot Medroxyprogesterone Acetate)
Will someone else know I'm using it?
There could be marks at the injection site on the day you receive it, but the only other sign is the cessation of regular menstruation.
"Medicare records of regular three-monthly doctor visits may be an issue for women experiencing high levels of surveillance or monitoring," Children by Choice said.
Could someone else tamper with it?
Once injected it can't be tampered with for the 12 week period.
3. Implant
Will someone else know I'm using it?
The bandaging post-insertion can make it obvious, and it is possible to feel the rod at the insertion site.
It is usually inserted in the upper arm, but may be less detectable by others if it is inserted in another place such as the leg.
Could someone else tamper with it?
"It could be forcibly removed so may not be suitable in situations of more extreme violence," Children by Choice said.
"If it is cracked whilst in place it may shorten the life of the rod, so the risk of damage due to physical violence or assault could be a consideration for some women."
4. Sterilisation (tubal ligation or occlusion)
Will someone else know I'm using it?
Depending on the method, there may be a need for incisions and anaesthesia, and a follow-up at three months, which can make it hard to have the procedure done discreetly.
Menstruation is maintained and there are no ongoing signs of use once any incision scars are healed.
Could someone else tamper with it?
No.
5. Vaginal ring
Will someone else know I'm using it?
It is easily detected.
"It can be removed for short periods of time, a maximum of three hours, without becoming less effective, so could be discreetly removed just before sex and reinserted immediately afterwards," Children by Choice said.
Could someone else tamper with it?
It is easily removed so might not be suitable for people who have little control over, if, when or how sex occurs.
6. Diaphragm
Will someone else know I'm using it?
It may be detectable during sex, particularly by fingers but less so by penile penetration.
Could someone else tamper with it?
Yes. It can be easily removed by another person before or during sex.
7. Condoms
Will someone else know I'm using it?
Condom use needs to be negotiated each time penetrative sex occurs.
Could someone else tamper with it?
"The man can easily take control of putting on a male condom or removing a female condom, so this method is very open to sabotage," the organisation said.
"Condoms can be damaged or removed, or the man may not put one on after promising to."
8. Withdrawal
Will someone else know I'm using it?
"Because this method relies almost entirely on the man’s skill and motivation, they will have full knowledge of this form of contraception," the chart states.
Could someone else tamper with it?
Yes.
"The withdrawal gives men the control and you need his 100% commitment to that for any confidence in this method," Price said.
9. Fertility awareness methods
Will someone else know I'm using it?
Fertility awareness methods, when used properly, require record keeping about cyclical changes.
These could be concealed in code in a diary or on a fertility app, but could still be risky for anyone experiencing high levels of monitoring and surveillance.
Could someone else tamper with it?
It is not suitable for women who have little or no control over if, when or how sex occurs.
10. Combined oral contraceptive pill or progesterone only pill
Will someone else know I'm using it?
Pills in their packaging can be easily recognisable.
"They could be removed from their packaging and hidden elsewhere to reduce this risk, but this could alter their effectiveness if they’re hidden in places exposed to heat, light or moisture," Children by Choice said.
Could someone else tamper with it?
Pills can be easily disposed of by anyone with access to them.
Instructions about what to do if a pill is missed are easily available online if it’s unsafe to keep that information in printed form.
Children by Choice said important factors that needed to be considered were whether the perpetrator was likely to:
- Monitor menstruation and fertility patterns and/or prescriptions
- Keep track of Medicare claims or log in to another person's MyGov account
- Engage in severe physical assaults, rape and other forms of sexual assault
- Restrict or monitor access to health care professionals
- Actively search for the contraceptive drugs or devices
If you or someone you know is experiencing violence and need help or support, there are national and state-based agencies that can assist you 24 hours a day, seven days a week. Call 1800 RESPECT (1800 737 732).