October is Domestic Violence Awareness Month. Competing for time with the cause of breast cancer awareness, and this year eclipsed by the final stretch of an extremely high profile presidential election, it may have been easy to miss the purple ribbons, awareness walks or vigils taking place in your community. But while domestic violence awareness may not be high, the toll it takes on society is. One-in-four women and one-in-seven men will experience an incidence of severe violence by an intimate partner sometime during their lives. More than 4.7 million women will experience abuse from an intimate partner each year. Three women are murdered in the U.S. every day by a former or current partner. And 40-45% of women in an abusive relationship are also raped and sexually assaulted by their abuser (references included here).

While there are a number of serious health issues that can occur during pregnancy and childbirth, homicide is still a leading cause of pregnancy-associated mortality in the United States, with the majority of those homicides committed by a former or current partner. For many women in abusive relationships, their abuse began or increased during pregnancy. Whether the partner is jealous that the attention has shifted from them, or stressed at the financial and emotional challenges caring for a child will bring, too many women experience pregnancy as a source of fear and distress rather than a time of joy.

Domestic violence takes many forms, including emotional, physical, financial and verbal abuse. Reproductive coercion is another form of abuse and control, and may be less understood by even those experiencing such abuse. It’s one thing to have a difference of opinion with one’s partner about family planning. It’s another thing for one partner to claim complete control over a couple’s reproductive lives. Because women’s bodies are central to the reproductive process in ways men’s bodies are not, women are more likely to experience this type of abuse, and in many instances have little say in how their body is used.

Refusing to use, or to allow the use of, birth control is one way reproductive coercion plays out. Sabotaging birth control – throwing away oral contraceptives, pricking holes in condoms, pulling out vaginal rings, etc. – is another, often more subtle, way this coercion occurs. Pressuring one’s partner to get pregnant when she is unsure that is what she wants is coercion. And forcing a woman to either get an abortion or carry a pregnancy to term when either of those options is against her wishes also constitutes abuse and coercion.

A societal norm of bringing public opinion to bear on the individual choices women make for their bodies coupled with the highly politicized issue of abortion means coerced pregnancy terminations are the main form of reproductive abuse many lawmakers concern themselves with. And providers need to be – and often are – on the lookout for signs of coercion in patients seeking abortions. But with roughly one quarter of abuse victims reporting being pressured or forced to become pregnant, health care providers also need to open up space for a patient who seems reluctant about a pregnancy to talk about what may be going on in their intimate relationship, and what resources may be available to help them leave the relationship if they are ready.

Forced pregnancy and childbearing may not often be thought of as a means of intimate partner abuse. During my time answering a domestic violence crisis line and working with survivors of abuse, though, I often heard victims say “if it weren’t for the children” they would have gotten out a long time ago. And even after they have left the abusive relationship, having children together kept them tied to the abuser in ways that may always leave them feeling vulnerable to more abuse. Unintended pregnancies happen in many relationships. But being four times more likely to occur in abusive relationships, it’s quite possible many abusers consciously include reproductive coercion as part of their plan of control.

We as a society spend much time debating how much autonomy women should have over their reproductive choices, and there are abusers who will extend that debate to literal control over their partners’ choices. Part of dismantling our epidemic of domestic violence will require our society to grant all persons full control over their bodies, their sexuality and their reproductive lives.

If you or someone you know is in an abusive relationship, you can always call the National Domestic Violence Hotline – 1.800.799.SAFE – 24 hours a day/365 days a year to discuss resources, connect to a local agency, or just talk about what you are experiencing.