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Dahl CM, Turok D, Heuser CC, Sanders J, Elliott S, Pangasa M. Strategies for obstetricians and gynecologists to advance reproductive autonomy in a post-Roe landscape. Am J Obstet Gynecol 2024; 230:226-234. [PMID: 37536485 DOI: 10.1016/j.ajog.2023.07.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023]
Abstract
The monumental reversal of Roe vs Wade dramatically impacted the landscape of reproductive healthcare access in the United States. The decision most significantly affects communities that historically have been and continue to be marginalized by systemic racism, classism, and ableism within the medical system. To minimize the harm of restrictive policies that have proliferated since the Supreme Court overturned Roe, it is incumbent on obstetrician-gynecologists to modify practice patterns to meet the pressing reproductive health needs of their patients and communities. Change will require cross-discipline advocacy focused on advancing equity and supporting the framework of reproductive justice. Now, more than ever, obstetrician-gynecologists have a critical responsibility to implement new approaches to service delivery and education that will expand access to evidence-based, respectful, and person-centered family planning and early pregnancy care regardless of their practice location or subspecialty.
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Affiliation(s)
- Carly M Dahl
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT.
| | - David Turok
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Cara C Heuser
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT; Department of Obstetrics and Gynecology, Intermountain Health, Salt Lake City UT
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Sarah Elliott
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
| | - Misha Pangasa
- Department of Obstetrics and Gynecology, University of Utah Health, Salt Lake City UT
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Nguyen BT, Jacobsohn TL. Men's willingness to use novel male contraception is linked to gender-equitable attitudes: Results from an exploratory online survey. Contraception 2023; 123:110001. [PMID: 36924819 DOI: 10.1016/j.contraception.2023.110001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/02/2023] [Accepted: 03/02/2023] [Indexed: 03/17/2023]
Abstract
OBJECTIVES To explore the association of men's willingness to use a novel male contraceptive with their attitudes toward gender equity. STUDY DESIGN We conducted an anonymous online survey examining willingness to use male contraception among reproductive-age (18-50 years) cisgender men from the United States and Canada, recruited via online forums, social media ads, and male contraceptive mailing lists from April through July of 2022. We collected sociodemographics and reproductive histories and used a 20-item Gender-Equitable Men Scale to examine men's gender role attitudes. We conducted bivariate analyses to inform a multivariable logistic regression isolating the independent influence of increasingly gender-equitable attitudes on cis-men's willingness to use novel male contraceptives. RESULTS We received 2066 surveys from primarily white (n = 1192; 58%), heterosexual (n = 1816; 88%), married cis-men (n = 1008; 49%), below age 30 (n = 1010; 49%), and who had not completed a bachelor's degree (n = 1173; 57%). The majority reported sex multiple times per week (n = 946; 46%), but had never gotten someone pregnant (n = 907; 44%); nearly half (n = 994; 48%) identified as parents. Three-quarters of respondents reported being willing to use novel male contraceptives (n = 1545; 75%); willingness was independently linked to having had an abortion (adjOR: 2.04; 95% CI: 1.37-3.02) and increasing total Gender-Equitable Men Scale scores (adjOR: 1.05; 95% CI: 1.02-1.08), even after controlling for age, race/ethnicity, and education. CONCLUSIONS Three-quarters of cis-men surveyed reported willingness to use new male contraceptives, which was correlated with increasingly gender-equitable attitudes. IMPLICATIONS As gender-equitable attitudes are linked to men's willingness to use novel male contraceptives, older population surveys may underestimate male contraceptive demand. Further, given the association of abortion experience with willingness to use novel male contraceptives, abortion-providing clinics may be considered for future dissemination of male contraceptives.
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Affiliation(s)
- Brian T Nguyen
- The Lundquist Institute at Harbor UCLA Medical Center, Torrance, CA, USA; Department of Obstetrics & Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
| | - Tamar L Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, USA
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Jacobsohn T, Nguyen BT, Brown JE, Thirumalai A, Massone M, Page ST, Wang C, Kroopnick J, Blithe DL. Male contraception is coming: Who do men want to prescribe their birth control? Contraception 2022; 115:44-48. [PMID: 35550379 PMCID: PMC9560967 DOI: 10.1016/j.contraception.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/15/2022] [Accepted: 04/29/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To assess men's preferences for healthcare provider from whom they would obtain hormonal male contraceptive (HMC) methods. STUDY DESIGN We asked participants from 3 clinical trials of investigational HMC methods-an oral pill (11β-Methyl-19-nortestosterone-17β-dodecylcarbonate, 11β-MNTDC), intramuscular or subcutaneous injection (Dimethandrolone undecanoate), and transdermal gel (Nestorone and testosterone)-to rank their top 3 preferred HMC providers from a list including: men's health doctor (urologist/andrologist), hormonal doctor (endocrinologist), reproductive health doctor (OB/GYN), family planning clinician (community health worker, midwife, nurse practitioner), regular doctor (family medicine/internal medicine), and community pharmacist. We examined preferences based on their rankings and conducted bivariate analyses. Collapsing the various specialists (men's health doctor, hormonal doctor, reproductive health doctor, and family planning clinician) into a single provider type, we examined participant demographics against provider preference (regular doctor, pharmacist, or specialist). RESULTS Participants across the 3 trials (n = 124) ranked their regular doctor (44%) and community pharmacist (18%) as their most preferred HMC provider; these preferences did not differ significantly by trial and drug formulation. Specialists in family planning (13%), men's health (12%), reproductive health (10%), and hormones (4%) were least frequently ranked as their preferred provider. Older and higher educated participants more often preferred specialists over regular doctors and pharmacists (p = 0.02 and p = 0.01). CONCLUSIONS Despite receiving contraceptive steroid hormones and care from endocrinologists and family planning specialists in a clinical trial, participants would prefer to obtain contraception from their regular doctor. IMPLICATIONS As most men expect to obtain hormonal male contraceptives from their regular doctor when commercially available, primary care physicians should become familiar with HMCs and be prepared to provide counseling and options accordingly.
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Affiliation(s)
- Tamar Jacobsohn
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Brian T Nguyen
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States; The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States.
| | - Jill E Brown
- Uniformed Services University of Health Sciences, Bethesda, MD, United States
| | - Arthi Thirumalai
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Michael Massone
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Stephanie T Page
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Christina Wang
- Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | - Jeffrey Kroopnick
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
| | - Diana L Blithe
- Contraceptive Development Program, Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States
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Nguyen BT, Streeter LH, Reddy RA, Douglas CR. Gender bias in the medical education of obstetrician-gynaecologists in the United States: A systematic review. Aust N Z J Obstet Gynaecol 2022; 62:349-357. [PMID: 35293613 PMCID: PMC9310565 DOI: 10.1111/ajo.13511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The number of men entering obstetrics and gynaecology (Ob/Gyn) residencies and general Ob/Gyn practice is decreasing. Gender biases against their participation may affect career decisions. Objective This systematic review examines: (i) female patients’ gender preferences and perceptions of men as Ob/Gyns and/or medical students; and (ii) the influence of gender on students’ education and career decisions. Search strategy We identified relevant research via PubMed using variations of three concepts in combination: Ob/Gyn care, gender bias/preference, and medical education or career. We conducted the initial review in 2018 and repeated the search in March 2021, adding additional references via citation review of included research. Selection criteria We restricted the review to original research from the United States between 2000–2021. Data collection Fifteen studies met inclusion criteria, categorised into three groups: (i) patient’s gender preference for Ob/Gyns; (ii) patient’s gender preference for medical students during the Ob/Gyn clerkship; and (iii) influence of gender bias on Ob/Gyn career decisions. Main results Patients prioritised their physician’s care attributes (eg technical skill, compassion, experience) over gender when choosing Ob/Gyns; however, provider gender was prioritised for medical students. Male medical students more commonly reported exclusion from clinical opportunities, although objective clinical exposure was like that of female counterparts. Despite perceived gender bias, male medical students reported increased Ob/Gyn interest post‐clerkship; interest did not translate into residency applications. These findings are limited by study quality and heterogeneity. Conclusions Real and perceived gender bias among female patients and male medical students in Ob/Gyn may underlie declining numbers of men entering the field.
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Affiliation(s)
- Brian T Nguyen
- University of Southern California, Los Angeles, California, USA
| | - Laer H Streeter
- Department of Obstetrics and Gynecology at Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ravali A Reddy
- Department of Obstetrics and Gynecology at the Stanford University School of Medicine, Stanford, California, USA
| | - Christopher R Douglas
- Los Angeles Medical Center, Department of Obstetrics and Gynecology at the University of California, Los Angeles, California, USA
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Jonas K, Kalichman M, Kalichman S, Morroni C, Mathews C. Factors affecting men's support for the use of the contraceptive implant by their female intimate partners. Contracept Reprod Med 2020; 5:36. [PMID: 33292739 PMCID: PMC7685537 DOI: 10.1186/s40834-020-00140-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background Family planning services have been available at no cost in the public health settings of South Africa since 1994, and now include the long-acting reversible contraceptives (LARCs) namely, the contraceptive implant and intra-uterine device (IUD). However, the uptake of LARCs has been declining in the recent years and little is known about the cause of the decline. In many relationships, men may influence their female intimate partner’s contraceptive choices. Thus, men’s involvement in reproductive health decisions and family programming may improve their support for contraceptive use, including the LARC use by their female intimate partners. This study investigated factors affecting men’s support for the use of contraceptive implant by their female intimate partners. Methods A quantitative, cross-sectional survey was conducted among adult men attending a public, primary health clinic in Cape Town, South Africa. Using a structured questionnaire, we measured men’s knowledge, awareness and support of, and attitudes towards use of the contraceptive implant by their female intimate partners. Data were analyzed using SPSS version 25. Results The sample included 65 men with a mean age of 31.2 years. Most (76.6%) believed that both men and women should be responsible for family planning. Support for general contraception use by their female intimate partners was prevalent at 80.0%, but only 33.9% reported that they would like their partners to use the implant in the future, while 35.6% were unsure and 30.5% did not support their partner’s use of the implant. Factors significantly associated with men’s support of their partner’s future use of the contraceptive implant included men’s reports that their partner wished to have another child in future, knowledge that the implant is safe for use by women who have not had children, knowledge that the implant can effectively prevent pregnancy for 3 years, and a positive attitude towards the implant’s long-lasting effectiveness. Conclusion Improving men’s knowledge of, and attitudes toward the contraceptive implant might increase their support for their partner’s use of the implant, which in turn might promote uptake of the implant among women. The findings of our study suggest the importance of actively engaging men in reproductive health and family planning programs. Supplementary Information The online version contains supplementary material available at 10.1186/s40834-020-00140-7.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Moira Kalichman
- Department of Psychology, University of Connecticut, Storrs, Mansfield, CT, USA
| | - Seth Kalichman
- Department of Psychology, University of Connecticut, Storrs, Mansfield, CT, USA
| | - Chelsea Morroni
- Liverpool School of Tropical Medicine, Liverpool, UK.,Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Jonas K, Duby Z, Maruping K, Dietrich J, Slingers N, Harries J, Kuo C, Mathews C. Perceptions of contraception services among recipients of a combination HIV-prevention interventions for adolescent girls and young women in South Africa: a qualitative study. Reprod Health 2020; 17:122. [PMID: 32795366 PMCID: PMC7427945 DOI: 10.1186/s12978-020-00970-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 08/03/2020] [Indexed: 02/05/2023] Open
Abstract
Background Adolescent girls and young women (AGYW) in low- and middle- income countries (LMICs) have high rates of unintended pregnancies and are at higher risk for HIV infection compared to older women of reproductive age. Using a socio-ecological model approach, this research investigated perceptions of contraception services among AGYW who had been recipients of a combination HIV-prevention intervention, to better understand factors affecting their access to and use of contraception services. Method Qualitative methods used in this study included focus group discussions (FGDs) and in-depth interviews (IDIs) with 185 AGYW aged 15–24 years living in five of the ten intervention districts. All interviews and FGDs were audio-recorded and data were analyzed thematically using Nvivo 12 software with manual identification of themes and labelling of raw data. Results The findings reveal that many AGYW, especially those in the younger age group 15–19 years, experience difficulties in accessing contraception services, mainly at the interpersonal and health service levels. Lack of support for the use of contraceptives from parents/caregivers as well as from sexual partners were key barriers at the interpersonal level; while providers’ negative attitude was the main barrier at the health service level. The majority of school-going AGYW felt that bringing contraception services and other sexual and reproductive health (SRH) services on to the school premises would legitimize their use in the eyes of parents and help to overcome barriers related to parental support and acceptance, as well as overcome some of the health service and structural level barriers. However, views among school-going AGYW about school-based provision of contraception services were mixed, clouded with concerns relating to confidentiality. Conclusion Interventions to improve parental/caregiver and sexual partner support for the use of contraception services by AGYW, as well as efforts to expand the provision of contraception services on the school premises are urgently needed. Future interventions should incorporate multi-level approaches to address structural and contextual barriers to access and use of contraception services to gain maximum effect.
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Affiliation(s)
- Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa. .,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Nevilene Slingers
- Office of AIDS and TB, South African Medical Research Council, Cape Town, South Africa
| | - Jane Harries
- Women's Health Research Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.,Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Nguyen BT, Schickler R. Of mosquitoes and men: mitigating Zika risk via Men's family planning and male contraception. Contracept Reprod Med 2018; 3:17. [PMID: 30338122 PMCID: PMC6174554 DOI: 10.1186/s40834-018-0069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/27/2018] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Outbreaks of mosquito-borne viral illnesses commonly occur after storms. As storms are predicted to worsen in intensity and frequency, mosquito-borne viruses, including the Zika virus are expected to spread, and with devastating consequences. While the disease is self-limited, pregnant women who contract Zika can transmit the virus to their fetuses, causing neurodevelopmental abnormalities, including microcephaly. An overlooked vector of the Zika virus, however, is men whose semen can transmit the virus at the time of sexual intercourse. Current recommendations for preventing the sexual transmission of Zika are inadequate and need to emphasize male reproductive responsibility, via expanding services for men's family planning and developing novel male contraceptives. MAIN BODY To prevent the sexual transmission of Zika, the World Health Organization recommends that couples use condoms or abstain from sexual activity for at least 6 months when traveling in Zika-infected areas. Strict adherence to these recommendations is neither practical nor adequate to address Zika's sexual transmission. As up to 13% of couples who use condoms experience unintended pregnancy, semen and consequent viral exposure is imminent. The use of contraception beyond just barrier methods is essential. However, the burden of contraception largely falls upon women and efforts to prevent vertical transmission are often aimed at educating women, when the outcome is equally undesirable among their male partners. These short-comings highlight the lack of attention to men's options for family planning. Educating men about the full range of contraceptive options, correcting misconceptions about the efficacy of withdrawal and barrier contraceptive methods, increasing access to vasectomy, and developing novel male contraceptive options would allow shared responsibility for the prevention of unintended pregnancy and Zika-related morbidity. CONCLUSION Gaps in recommendations to prevent the sexual transmission of Zika provide an opportunity to develop men's family planning initiatives and the range of accessible contraceptives to men.
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Affiliation(s)
- Brian T. Nguyen
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
| | - Robyn Schickler
- Section of Family Planning, Department of Obstetrics and Gynecology, Keck School of Medicine of the University of Southern California, Los Angeles, CA USA
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Evolutionary Concept Analysis of Reproductive Life Planning. J Obstet Gynecol Neonatal Nurs 2016; 46:78-90. [PMID: 27837650 DOI: 10.1016/j.jogn.2016.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2016] [Indexed: 10/20/2022] Open
Abstract
Reproductive life planning is recommended as an important topic of discussion at every health care interaction with women and men of reproductive age; however, this intervention has not been well studied. Therefore, the purpose of this evolutionary concept analysis was to synthesize the relevant literature, identify the essential attributes of the concept, and develop a conceptual definition to guide future research and to help implement reproductive life planning in routine health care practice.
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