Thesis advisor: Corrine Y. Jurgens / Background: Reproductive coercion (RC) is a form of intimate partner violence (IPV) involving a partner’s control of a woman’s reproductive health decisions regarding pregnancy and childbearing. RC is associated with numerous negative health consequences; however, the impact on a pregnancy and developing fetus and association with adverse birth outcomes is not known.Design: Secondary analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2012 – 2015, from five states. Purpose: To examine whether RC before pregnancy is associated with an increased likelihood of experiencing preterm birth (< 37 weeks gestational age), neonatal intensive care (NICU) after birth, and infant death. Method: Data on women ages 17 years and older who gave birth to a live infant (N = 18,728) were analyzed. Logistic regression procedures were used to determine the odds of preterm birth, infant death, and need for NICU care among women experiencing RC while controlling for known risk factors (age, race, ethnicity, education, marital status, depression, drinking, and smoking). The moderation effect of IPV on the relationship of RC and birth outcomes was tested by including an interaction term (product of RC and IPV) in the model. Results: No significant association between RC and preterm birth, need for NICU care, or infant death was detected. Additionally, exposure to IPV did not have a moderating effect on either the direction or magnitude of the relationship between RC and birth outcomes. Conclusions: Despite these findings, RC remains a significant concern for nurses caring for pregnant women and women of reproductive age. This study highlights a current gap in knowledge about the ways RC can affect a pregnancy and birth outcomes. Replication studies using more robust measures of RC and data collection approaches that can most accurately identify RC experiences are needed to increase understanding. / Thesis (PhD) — Boston College, 2022. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

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Literature reveals that reproductive coercion is a major contributor to unwanted pregnancy and a factor that influences the choice to terminate pregnancy in many adolescents. Adolescents represent a population vulnerable to a number of physical and psychological problems. Purpose The overall aim of this thesis was to develop a model of self-forgiveness for women who terminated pregnancy in adolescence. Objectives The study objectives are aligned according to the phases of the study as follows: Phase 1: Desk review Explore what is already known about the topic and identify gaps. Phase 2: Lived experiences of participants about TOP Explore the lived experiences of participants who terminated pregnancy in adolescence. Phase 3: Development of a model Develop a model of self-forgiveness for women who terminated pregnancy in adolescence. The social-ecological model (Bronfenbrenner 1992), through which individuals are understood to influence and be influenced by people, organisations, institutions, societal norms, rules and beliefs with whom they interact, was followed. The model offered a holistic framework for exploring interrelationships related to TOP Methodology A qualitative approach based on Heidegger (1962) interpretive phenomenological approach was used. The study was conducted at a Health Care Centre in Tshwane Municipality, Gauteng Province, South Africa. The population consisted of women, 20-35 years old, who terminated pregnancy in adolescence. A purposive and snowball sampling techniques were used to recruit 30 participants who had terminated pregnancy in adolescence. An interview guide was used to solicit information from participants. Audiotaped interviews were held at the time, date and place agreed by participants. Colaizzi’s (1978) approach of data analysis was used. Results Five major themes emerged, with 17 sub-themes as transgressing one of nature’s strongest instincts: the mother’s protection of her young; unplanned pregnancy; intra-and interpersonal relationships; experience of caring by health care professionals and a need for counselling. A model of self-forgiveness for women who did TOP in adolescence, based on the components of self-condemnation and self-blame, cultural and spiritual, as well as reproductive coercion, was developed. Conclusion Participants carried the burden of shame and guilt of having terminated pregnancy in adolescence. The influence of culture and religion were the major contributing factors to women failing to forgive themselves after termination of pregnancy. A model of self-forgiveness is needed to allow those who terminated pregnancy in adolescence to move on with their life. / Health Studies / D. Litt. et Phil. (Health Studies)