Sexual assault can happen in relationships, too.

April is Sexual Assault Awareness month, a nationally recognized effort to draw attention to the fact that one in five women and one in fifty-nine men will experience sexual assault in their lifetimes.

We often equate romantic relationships with consent — leading to the common misconception that sexual abuse cannot happen between individuals in dating relationships and marriages. But this is far from the truth. In fact, over the past two decades, there has been a growing body of research drawing the connection between relationship violence and poor reproductive outcomes for women — including unintended pregnancies, HIV and AIDS, and serious injury.

The symptoms and signs of this type of relationship abuse are often hidden from plain sight. To maintain power and control in the relationship, abusers may use reproductive and sexual coercion to interfere with their partner’s reproductive health, resulting in hidden and often undetected forms of victimization.

To address this widespread issue, FUTURES Without Violence is working with partners across the nation, including La Clínica del Pueblo (La Clínica) in Washington, DC, to train their providers to discuss domestic and sexual violence, promote healthy relationships, and improve health and safety outcomes for all of their clients.

La Clínica primarily serves low-income individuals and families. One of those clients is “Maria,” a 34-year-old mother of four and immigrant from El Salvador. While answering questions during a pregnancy follow-up visit, Maria disclosed to her provider that none of her pregnancies had been planned and that she was experiencing relationship problems with her partner.

Upon hearing this, a red flag went up, and her provider immediately offered to connect Maria to La Clínica’s onsite domestic violence program, Entre Amigas (Between Girlfriends). Maria revealed that her partner was physically abusive and unfaithful and frequently forced her to have sex. She endured this behavior for more than 14 years. She had tried to leave her partner more than once, but his threats to her and her children ― followed by physical and sexual abuse ― forced her to stay.

The staff at La Clínica worked with Maria to create a personal safety plan that allowed her to take control of her reproductive health and not put her or her children at risk. Over time, Maria made the bold decision to leave her husband. Today, she and her children live free from abuse thanks to the providers at La Clínica.

How do you know if you may be experiencing abuse?

Ask yourself:

• Does my partner make me have sex when I don’t want to?
• Does my partner mess with my birth control or try to get me pregnant when I don’t want to be?
• Does my partner refuse to use condoms when I ask? Am I afraid to ask my partner to use condoms?
• Does my partner tell me whom I can talk to or where I can go?
• Am I afraid my partner would hurt me if I told him I had a sexually transmitted infection and he needed to be treated, too?
• Has my partner made me afraid or physically hurt me?

If you answered YES to any of these questions, you are not alone. It’s important to seek help either from a health care provider or an advocate.

Under the Affordable Care Act, new health plans must reimburse health care providers for domestic violence screening and counseling as part of preventive health care services at no additional cost to you. Check out this brochure for tips on talking to your health care provider about your concerns. Additionally, well-trained advocates can be reached confidentially at the National Domestic Violence Hotline 24/7 by calling 1-800-799-7233 (SAFE).