Building theory from patient narratives: A framework for understanding clinical contraceptive coercion in the U.S.

Clinical contraceptive coercion—when healthcare providers pressure patients to use or not use birth control—undermines reproductive autonomy and may have lasting consequences for health and well-being. Despite growing documentation of coercive practices, the field lacks robust frameworks to guide research and practice. This study addresses that gap, grounding theory in patient narratives. We conducted a qualitative analysis of 534 open-ended responses from a 2023 U.S. survey of reproductive-age adults who reported experiencing clinical contraceptive coercion. Using Braun and Clarke’s reflexive thematic analysis, we developed a patient-centered theoretical framework of clinical contraceptive coercion. Patients identified coercion as emerging from provider bias, inadequate provider competence, and systemic constraints. They described upward coercion (pressure to use contraception) and downward coercion (pressure not to use contraception), often occurring simultaneously, and emphasized that coercion can occur through dismissive or rushed care even without overt force. Patients highlighted consequences of coercive care, including effects on health, mental health, reproductive lives, and healthcare engagement. This study offers a patient-centered framework that conceptualizes clinical contraceptive coercion as multifaceted, relational, systemic, and deeply consequential. By centering patient voices, it advances theory and practice, underscoring the need for provider training, systemic reforms, and policies that prioritize autonomy and reproductive justice.