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Morris JR, Kawwass JF, Hipp HS. Physical intimate partner violence among women reporting prior fertility treatment: a survey of U.S. postpartum women. Fertil Steril 2023; 119:277-288. [PMID: 36347311 DOI: 10.1016/j.fertnstert.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/01/2022] [Accepted: 11/02/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence of physical intimate partner violence (IPV) among postpartum women reporting preconception fertility treatment compared with those who conceived without the use of assisted reproduction. DESIGN Retrospective cross-sectional population-based study. SETTING Not applicable. PATIENT(S) Postpartum respondents of the Centers for Disease Control Pregnancy Risk Assessment Monitoring System survey. INTERVENTION Preconception fertility treatment utilization. MAIN OUTCOME MEASURES Physical IPV. RESULTS Of the 43,999 respondents included in this analytic sample, roughly 2% reported physical IPV. Respondents reporting preconception fertility treatment (12.6%) were less likely to endorse physical IPV than those who conceived without fertility treatment exposure (odds ratio, 0.5; 95% confidence interval, 0.4-0.7). In the multivariate regression model, the odds of physical IPV were similar among postpartum women regardless of the fertility treatment exposure (adjusted odds ratio, 1.2; 95% confidence interval, 0.8-2.0). Residing in a household with an income under the federal poverty level and increased preconception stressors were predictive of reported physical IPV. There was no difference in the type of fertility treatment and report of physical IPV. Among women exposed to fertility treatment, predictors of physical IPV included self-identification of Black or Hispanic race and ethnicity as well as report of 4 or more stressors in the 12 months before the most recent delivery. CONCLUSION The use of fertility treatment did not confer greater risk of physical IPV within this postpartum population. However, there are many individuals with infertility who never present for an assessment, proceed with treatment, or are unsuccessful, thus the extent to which infertility and fertility treatment exposure is associated with physical IPV remains to be elucidated. Women reporting a greater number of stressors may be uniquely at risk despite the access and exposure to fertility treatment. The preconception period, inclusive of encounters with infertility specialists, represents a novel opportunity to screen and counsel all women for IPV.
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Affiliation(s)
- Jerrine R Morris
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, California.
| | - Jennifer F Kawwass
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
| | - Heather S Hipp
- Division of Reproductive Endocrinology and Infertility, Emory University School of Medicine, Atlanta, Georgia
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Abota TL, Gashe FE, Deyessa N. Perinatal intimate partner violence and postpartum contraception timing among currently married women in Southern Ethiopia: A multilevel Weibull regression modeling. Front Public Health 2022; 10:913546. [PMID: 36339168 PMCID: PMC9627296 DOI: 10.3389/fpubh.2022.913546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/30/2022] [Indexed: 01/22/2023] Open
Abstract
Background Adopting contraception on time is a critical intervention for postpartum women, but violence exposure around pregnancy may interfere with postpartum contraceptive use behaviors. Hence, this study aimed to investigate the time duration of the first modern contraceptive adoption and its individual-and community-level predictors among postpartum women in the Wolaita zone, South Ethiopia. Methods A community-based prospective follow-up study was conducted among 1,292 postpartum women nested in 38 "Kebles" (clusters) using multistage-clustered sampling techniques. A multilevel Weibull regression model was employed to investigate predictors of time-to-method initiation after childbirth using STATA Version 14. Kaplan-Meier curve and Wilcoxon log-rank test were used to estimate time-to-modern contraceptive use across different variables. All variables with p-values <0.05 were considered for multivariate analysis. Adjusted time ratios (ATR) with 95 % CI were computed using Weibull accelerated failure time models. Results Of the respondents, 62% (95% CI: 59.1-64.5) had started the first modern contraception within a year after childbirth. The restricted mean survival time-to-postpartum modern contraceptive use was 6.28 months. Being a rural dweller (aTR: 1.44; 95% CI: 1.06-1.99) and living in the middle household wealth quintiles (aTR: 1.10; 95% CI: 1.02-1.19) predicted longer time duration to adopt first modern contraception by 44 and 10%, respectively. The women from the community with a high early marriage (aTR: 1.14; 95% CI: 1.01-1.28) took longer time to initiate modern postpartum methods. Furthermore, women who had no history of perinatal abuse took less time than those who had a history of abuse to start postpartum contraception (aTR: 0.71; 95% CI: 0.66-0.78). Conclusion Rural residence, poor household wealth status, history of perinatal abuse, and a high rate of early marriage in the community are predicted to lengthen the time duration to start modern postpartum contraception. Thus, community-level women's empowerment, particularly among rural women and integration of intimate partner violence screening into family planning counseling throughout the continuum of care will likely to improve postpartum contraception timing.
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Affiliation(s)
- Tafesse Lamaro Abota
- College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fikre Enqueselassie Gashe
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Negussie Deyessa
- Department of Epidemiology and Biostatistics, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Grace KT, Holliday CN, Bevilacqua K, Kaur A, Miller J, Decker MR. Sexual and Reproductive Health and Reproductive Coercion in Women Victim/Survivors Receiving Housing Support. JOURNAL OF FAMILY VIOLENCE 2022; 38:713-722. [PMID: 35283554 PMCID: PMC8901387 DOI: 10.1007/s10896-022-00362-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 06/14/2023]
Abstract
Housing instability and intimate partner violence (IPV) compromise women's sexual and reproductive health (SRH) through reduced contraceptive access and increased risk of unintended pregnancy. This study describes the reproductive health status and needs of IPV survivors receiving housing support and explores factors influencing their experience of reproductive coercion (RC), specifically. Cross-sectional baseline data from a quasi-experimental study of 70 IPV survivors enrolled in housing programs in the Baltimore, MD, metropolitan area from June 2019 through December 2020 were analyzed. Of the 70 women enrolled in the study, 70.3 percent (n = 45) desired to avoid pregnancy, but 57.4 percent were either using no contraceptive method (31.2%) or methods with low effectiveness (26.2%). Approximately, 1 in 6 women (16.4%, n = 11) experienced RC in the past 3 months, which was associated with frequency and severity of IPV (p = 0.001 to 0.005) and PTSD (p = 0.001), as well as not sharing children with the abusive partner (p = 0.002). This study highlights reproductive health risks in an important and under-studied population of women seeking housing due to IPV. Leaving an abusive relationship is a uniquely vulnerable time, and also a time of opportunity, as women are accessing services that can be tailored to their SRH needs. Significant results highlight vulnerability to and consequences of RC in this population. This study has implications for IPV support programs and housing programs that serve women.
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Affiliation(s)
- Karen Trister Grace
- School of Nursing, College of Health and Human Services, George Mason University, 4400 University Drive, MSN 3C4, Fairfax, VA 22030 USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | | | | | - Arshdeep Kaur
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
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Drexler KA, Quist-Nelson J, Weil AB. Intimate Partner Violence and Trauma-Informed Care in Pregnancy. Am J Obstet Gynecol MFM 2021; 4:100542. [PMID: 34864269 DOI: 10.1016/j.ajogmf.2021.100542] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022]
Abstract
Intimate partner violence is defined as any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship. Globally, women are disproportionately victims of intimate partner violence. The risk increases during pregnancy, with rates estimated as high as 20% among pregnant persons. Intimate partner violence is associated with adverse perinatal outcomes, including perinatal and maternal death. As pregnancy is a period of frequent interaction with the healthcare system, it is an opportune time to screen and intervene for intimate partner violence. Universal screening at the first prenatal visit and subsequently every trimester is recommended, with either written or verbal validated tools. Pregnant persons experiencing intimate partner violence need nonjudgmental, compassionate, confidential and trauma-informed care. The goal of this review is to outline pregnancy-specific care considerations.
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Affiliation(s)
- Kathleen A Drexler
- Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine.
| | - Johanna Quist-Nelson
- Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine
| | - Amy B Weil
- Chapel Hill, North Carolina; University of North Carolina at Chapel Hill, Department of Medicine, Division of General Medicine and Clinical Epidemiology
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Carlyle KE, Guidry JPD, Burton C. Recipes for Prevention: An Analysis of Intimate Partner Violence Messages on Pinterest. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP6106-NP6123. [PMID: 30461346 DOI: 10.1177/0886260518812073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Social media platforms such as Pinterest are often used as venues for discussing relationships, making them ideal channels for promoting healthy relationships and preventing intimate partner violence (IPV). This is particularly relevant for IPV, which has been historically understood as a personal issue and lacked support as a significant public health issue. To explore its potential as a platform for prevention, this study examines the ways in which IPV messages on Pinterest reflect public health understandings of, and approaches to, prevention, and how Pinterest users engage with these posts. We analyzed 750 Pinterest posts about IPV using the Social Ecological Model as a theoretical framework for conceptualizing framing devices. The majority of pins (82.9%) used contextually focused thematic framing, while only 8.0% used individually focused episodic framing, and 4.4% used both. The predominance of thematic framing is contrary to findings in examinations of traditional media portrayals of IPV and is likely to facilitate sharing information and education about IPV. However, posts that mention individual causal attribution and individual solution responsibility elicit more engagement than pins that do not. Overall, the Pinterest sample was more reflective of the range of IPV experiences than previous, older analyses of traditional media content, possibly indicating that the public health approach to this issue is gaining momentum. Encouragingly, the study showed increased engagement with posts that discuss psychological abuse, indicating a potentially promising transition from an emphasis on physical abuse to the neglect of psychological abuse. Although Pinterest does still show some stereotypical portrayals of IPV similar to traditional media stories, it also shows much promise for shifting the narrative around IPV in line with the current public health approach and public health professionals should be encouraged to enter the dialogue on IPV on Pinterest.
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Kalyesubula R, Pardo JM, Yeh S, Munana R, Weswa I, Adducci J, Nassali F, Tefferi M, Mundaka J, Burrowes S. Youths' perceptions of community health workers' delivery of family planning services: a cross-sectional, mixed-methods study in Nakaseke District, Uganda. BMC Public Health 2021; 21:666. [PMID: 33827502 PMCID: PMC8028711 DOI: 10.1186/s12889-021-10695-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND High rates of unintended adolescent pregnancy are a significant health problem in Uganda. To improve access to family planning (FP) services, community-based Village Health Teams (VHTs) are widely employed in Uganda to deliver education and services. However, evaluations of FP programs suggest that mainly older, married women use VHT FP services. METHODS To better understand youth reluctance to use VHTs, we collected quantitative FP and contraceptive-seeking behavior data from a survey of 250 youths aged 15-25 in randomly selected households in Nakaseke District, which we triangulated with data from 3 focus group discussions (FGDs) (n = 15). RESULTS Most respondents received FP services from the formal health sector, not VHTs. Only half had talked to a VHT, but 65% knew that VHTs provide free FP services, and most (82%) felt comfortable talking to VHTs about FP. The main reasons for discomfort were fear that VHTs would violate privacy (mentioned by 60% of those not comfortable), that VHTs would talk to parents (33%), shyness (mentioned by 42% of those ≤18), and fear of being judged (14%). Concern about side effects was the most common reason for not using FP methods. Survey respondents said having VHTs of the same sex was important, particularly those in the youngest age group (OR = 4.45; 95%CI: 1.24, 16.00) and those who were unmarried (OR = 5.02; 95%CI: 2.42, 10.39). However, FGD participants (who were older than survey respondents on average) often preferred older VHTs of the opposite sex, whom they viewed as more professional and trustworthy. Respondents said the primary deciding factors for using VHTs were whether privacy would be respected, the proximity of care, and the respectfulness of care. CONCLUSIONS VHTs are a known source of FP services but not widely used by youth due to privacy and quality of care concerns. VHT messaging and training should increase focus on ensuring privacy, protecting confidentiality, providing respectful care, and addressing concerns about contraceptive side effects. Preferences for VHTs of similar age and sex may be more important for younger adolescents than older youths for whom quality concerns predominate.
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Affiliation(s)
- Robert Kalyesubula
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Richard Munana
- African Community Center for Social Sustainability, Nakaseke, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Ivan Weswa
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - Faith Nassali
- African Community Center for Social Sustainability, Nakaseke, Uganda
| | | | - John Mundaka
- African Community Center for Social Sustainability, Nakaseke, Uganda
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Skracic I, Lewin AB, Steinberg JR. Types of Lifetime Reproductive Coercion and Current Contraceptive Use. J Womens Health (Larchmt) 2021; 30:1078-1085. [PMID: 33404346 DOI: 10.1089/jwh.2020.8784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Intimate partner violence and differential power dynamics are associated with contraceptive behaviors. This study examines the role of reproductive coercion (RC) by an intimate partner in women's decisions about contraceptive use. Materials and Methods: A self-report survey was administered to a probability sample of a diverse group of women of reproductive age in Delaware's Title X health care facilities. Currently used contraceptive methods were categorized into three effectiveness levels based on typical use failure rates: no method or low effectiveness (>10% failure), moderate effectiveness (>1% and <10% failure), and high effectiveness (<1% failure). The short-form RC scale was used to categorize RC experiences: no RC, verbal only, or behavioral. We conducted multinomial logistic regression to examine the association between types of RC and effectiveness level of current contraceptive method, taking our sampling design into account and adjusting for covariates. Results: Among 240 women (weighted n = 6529) included in the sample, 13.9% reported experiencing only verbal RC, and 16.1% reported behavioral RC. Women who reported behavioral RC were more likely to currently be using highly versus moderately (adjusted relative risk ratio [aRRR]: 26.71, 95% confidence interval [CI]: 4.59-156.0) and low effective methods (aRRR: 3.08, 95% CI: 0.97-9.82), but less likely to be using moderately (aRRR: 0.12, 95% CI: 0.02-0.77) than low effective methods. Conclusions: Using highly and low effective methods may indicate two opposing ways of managing behavioral RC experiences: controlling fertility by choosing less detectable but highly effective methods or feeling disempowered and using no or low effective partner-dependent methods.
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Affiliation(s)
- Izidora Skracic
- School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Amy B Lewin
- School of Public Health, University of Maryland, College Park, Maryland, USA
| | - Julia R Steinberg
- School of Public Health, University of Maryland, College Park, Maryland, USA
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Silverman JG, Challa S, Boyce SC, Averbach S, Raj A. Associations of reproductive coercion and intimate partner violence with overt and covert family planning use among married adolescent girls in Niger. EClinicalMedicine 2020; 22:100359. [PMID: 32382722 PMCID: PMC7198910 DOI: 10.1016/j.eclinm.2020.100359] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In Niger the prevalence of girl child marriage and low female control over family planning (FP) has resulted in the world's highest adolescent fertility. Male control of FP is associated with intimate partner violence (IPV) and reproductive coercion (RC). We assessed associations of IPV and RC with FP use among married adolescent girls (ages 13-19 years) in Dosso, Niger (N = 1072). METHODS Multivariable, cross-sectional regression models assessed associations between physical IPV, sexual IPV, and RC and any FP use, FP use with husband knowledge (overt use), and FP use without husband knowledge (covert use). FINDINGS One in four married adolescent girls using FP reported doing so without husband's knowledge. Unadjusted and adjusted models indicated that physical IPV and RC were associated with covert FP use (vs. no use and vs. overt use), but not with overt use vs. no use. Only physical IPV remained significantly associated with covert use in models including all three forms of violence (AOR: 1.94 vs. any use; AOR: 3.63 vs. overt use). INTERPRETATION Married adolescents experiencing physical IPV or RC were more likely that others to use FP without their husbands' knowledge. No form of GBV affected odds of FP use with husbands' knowledge. Current results suggest caution regarding promoting engagement of men in decisions to use FP in this context, as this may undermine the reproductive autonomy of girls and women who will choose to use FP without the knowledge of their male partners.
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Affiliation(s)
- Jay G Silverman
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sneha Challa
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sabrina C Boyce
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
| | - Anita Raj
- Center on Gender Equity and Health, University of California San Diego School of Medicine, 9500 Gilman Dr. La Jolla, San Diego, CA 92093, USA
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Stevenson AA, Bauman BL, Zapata LB, Ahluwalia IB, Tepper NK. Intimate Partner Violence around the Time of Pregnancy and Postpartum Contraceptive Use. Womens Health Issues 2020; 30:98-105. [PMID: 31911042 PMCID: PMC10983028 DOI: 10.1016/j.whi.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/14/2019] [Accepted: 11/26/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We sought to examine postpartum contraceptive use among women who reported physical intimate partner violence (IPV) during or within 12 months before pregnancy compared with women who did not report physical IPV and to identify factors associated with nonuse of contraception among women who reported physical IPV. METHODS Data were obtained from women with a recent live birth from 2012 to 2015 who participated in the Pregnancy Risk Assessment and Monitoring System. We described characteristics of women and postpartum contraceptive use by method effectiveness (most effective [female sterilization, male sterilization, intrauterine device, implant], moderately effective [injectable, pill, patch, ring], less effective [condoms, natural family planning, withdrawal, other]) or no method, stratified by reported physical IPV. Multivariable logistic regression was used to examine characteristics associated with nonuse of contraception among women who reported physical IPV. RESULTS The proportion of women using most or moderately effective contraception was similar for women reporting and not reporting physical IPV. Less effective contraceptive use was lower among women who reported physical IPV (13.9%) than those who did not report physical IPV (25.1%) (p < .001). Nonuse was higher among women who reported physical IPV (33%) than those who did not report physical IPV (21%) (p < .001). Having no health insurance at the time of survey and experiencing traumatic stress within 12 months before delivery were associated with nonuse of contraception among women who reported physical IPV. CONCLUSIONS The higher proportion of contraception nonuse among women who reported physical IPV indicates a potential unmet need for contraception among this vulnerable population. Recommended screening for IPV and counseling about the full range of contraceptive methods should begin during pregnancy and continue through the postpartum period.
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Affiliation(s)
| | - Brenda L Bauman
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren B Zapata
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Indu B Ahluwalia
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Naomi K Tepper
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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Reyes-Lacalle A, Montero-Pons L, Manresa-Domínguez JM, Cabedo-Ferreiro R, Seguranyes G, Falguera-Puig G. Perinatal contraceptive counselling: Effectiveness of a reinforcement intervention on top of standard clinical practice. Midwifery 2020; 83:102631. [PMID: 32036192 DOI: 10.1016/j.midw.2020.102631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 11/05/2019] [Accepted: 01/14/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. DESIGN Community-randomized trial. SETTING "Reproductive and Sexual Health Care" units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain). PARTICIPANTS 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. INTERVENTIONS At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. MEASUREMENTS AND FINDINGS 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. KEY CONCLUSIONS Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. IMPLICATIONS FOR PRACTICE Despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.
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Affiliation(s)
- Azahara Reyes-Lacalle
- Grup Emergent Consolidat en Atenció a la Salut sexual i Reproductiva (GRASSIR), Institut Catala de la Salut (ICS), Sabadell, Barcelona, Spain.
| | - Laura Montero-Pons
- Grup Emergent Consolidat en Atenció a la Salut sexual i Reproductiva (GRASSIR), Institut Catala de la Salut (ICS), Santa Coloma de Gramanet, Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Unitat de Suport a la Recerca Metropolitana Nord del IDIAP Jordi Gol, Cerdanyola del Valles, Barcelona, Spain; Departament d'Infermeria, Universitat Autonoma de Barcelona, Cerdanyola del Valles, Barcelona, Spain
| | - Rosa Cabedo-Ferreiro
- Grup Emergent Consolidat en Atenció a la Salut sexual i Reproductiva (GRASSIR), Institut Catala de la Salut (ICS), Granollers, Barcelona, Spain
| | - Glòria Seguranyes
- Nursing School, Universitat de Barcelona, Grup Emergent Consolidat en Atenció a la Salut sexual i Reproductiva (GRASSIR), Barcelona, Spain
| | - Gemma Falguera-Puig
- Coordinadora Grup Emergent Consolidat en Atenció a la Salut Sexual i Reproductiva (GRASSIR), Direccio d'Atenció Primaria Metropolitana Nord, Institut Catala de la Salut (ICS), Barcelona, Spain
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Contraceptive Counseling in Clinical Settings: An Updated Systematic Review. Am J Prev Med 2018; 55:677-690. [PMID: 30342631 PMCID: PMC6613590 DOI: 10.1016/j.amepre.2018.07.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/16/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022]
Abstract
CONTEXT The objective of this systematic review was to update a prior review and summarize the evidence (newly identified and cumulative) on the impact of contraceptive counseling provided in clinical settings. EVIDENCE ACQUISITION Multiple databases, including PubMed, were searched during 2016-2017 for articles published from March 1, 2011, to November 30, 2016. EVIDENCE SYNTHESIS The search strategy identified 24,953 articles; ten studies met inclusion criteria. Two of three new studies that examined contraceptive counseling interventions (i.e., enhanced models to standard of care) among adolescents and young adults found a statistically significant positive impact on at least one outcome of interest. Five of seven new studies that examined contraceptive counseling, in general, or specific counseling interventions or aspects of counseling (e.g., personalization) among adults or mixed populations (adults and adolescents) found a statistically significant positive impact on at least one outcome of interest. In combination with the initial review, six of nine studies among adolescents and young adults and 16 of 23 studies among adults or mixed populations found a statistically significant positive impact of counseling on at least one outcome of interest. CONCLUSIONS Overall, evidence supports the utility of contraceptive counseling, in general, and specific interventions or aspects of counseling. Promising components of contraceptive counseling were identified. The following would strengthen the evidence base: improved documentation of counseling content and processes, increased attention to the relationships between client experiences and behavioral outcomes, and examining the comparative effectiveness of different counseling approaches to identify those that are most effective. THEME INFORMATION This article is part of a theme issue entitled Updating the Systematic Reviews Used to Develop the U.S. Recommendations for Providing Quality Family Planning Services, which is sponsored by the Office of Population Affairs, U.S. Department of Health and Human Services.
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Morgan IA, Robbins CL, Basile KC. Addressing Intimate Partner Violence to Improve Women's Preconception Health. J Womens Health (Larchmt) 2018; 27:1189-1194. [PMID: 30325291 PMCID: PMC10985540 DOI: 10.1089/jwh.2018.7366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Exposure to violence can harm women's overall health and well-being. Data suggest that one in three women in the United States experience some form of violence by an intimate partner in their lifetime. In this commentary, we describe the implications of intimate partner violence (IPV) on women's health, specifically for women of reproductive age. We use a life-course perspective to describe the compounded impact of IPV on preconception health. Preconception health generally refers to the overall health and well-being of women (and men) before pregnancy. This report also discusses primary prevention of IPV and healthcare recommendations, and highlights surveillance systems that capture IPV indicators among women of reproductive age. Ongoing collection of state-level surveillance data may inform the implementation of intervention programs tailored to reproductive age women at risk for IPV.
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Affiliation(s)
- Isabel A Morgan
- 1 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
- 2 Oak Ridge Institute for Science and Education (ORISE) , Oak Ridge, Tennessee
| | - Cheryl L Robbins
- 1 Division of Reproductive Health, Centers for Disease Control and Prevention , Atlanta, Georgia
| | - Kathleen C Basile
- 3 Division of Violence Prevention, Centers for Disease Control and Prevention , Atlanta, Georgia
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Masho SW, Rozario S, Walker D, Cha S. Racial Differences and the Role of Marital Status in the Association Between Intimate Partner Violence and Unintended Pregnancy. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:3162-3185. [PMID: 26940349 DOI: 10.1177/0886260516635317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
More than half of all pregnancies in the U.S. are unintended which may lead to poor health outcomes. Racial and ethnic differences underlying the association between IPV and unintended pregnancy are inconsistent. This study examines the association between IPV and unintended pregnancy across racial/ethnic and marital strata among U.S. women. Data from the national 2009/11 Pregnancy Risk Assessment Monitoring System consisting of women who recently delivered a live birth baby were analyzed (n=108,220). A dichotomous variable was created to indicate whether women experienced IPV in the 12 months leading to their most recent pregnancy (yes; no). The outcome, pregnancy intention, was dichotomized as intended or unintended. Subpopulation analysis was conducted stratified by race/ethnicity and marital status. Adjusted odds ratios and 95% confidence intervals were generated using multiple logistic regression models. The odds of unintended pregnancy were increased for married non-Hispanic White women who reported IPV compared to their non-abused counterparts even after controlling for sociodemographic factors, health care access, and reproductive history. Among unmarried non-Hispanic other women, abused women were significantly less likely to report unintended pregnancy than the non-abused. No significant differences were observed for Hispanic or non-Hispanic Black women. There are significant racial and ethnic differences in the association between IPV and unintended pregnancy. Additionally, the association differed by marital status. Public health professionals and health care providers should be aware of these differences.
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Affiliation(s)
- Saba W Masho
- 1 Virginia Commonwealth University, Richmond, USA
| | | | - D'Won Walker
- 1 Virginia Commonwealth University, Richmond, USA
| | - Susan Cha
- 1 Virginia Commonwealth University, Richmond, USA
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Nelson DB, Zhao H, Corrado R, Mastrogiannnis DM, Lepore SJ. Preventing Unintended Pregnancy Among Young Sexually Active Women: Recognizing the Role of Violence, Self-Esteem, and Depressive Symptoms on Use of Contraception. J Womens Health (Larchmt) 2017; 26:352-360. [PMID: 28045570 DOI: 10.1089/jwh.2016.5753] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Ineffective contraceptive use among young sexually active women is extremely prevalent and poses a significant risk for unintended pregnancy (UP). Ineffective contraception involves the use of the withdrawal method or the inconsistent use of other types of contraception (i.e., condoms and birth control pills). This investigation examined violence exposure and psychological factors related to ineffective contraceptive use among young sexually active women. MATERIALS AND METHODS Young, nonpregnant sexually active women (n = 315) were recruited from an urban family planning clinic in 2013 to participate in a longitudinal study. Tablet-based surveys measured childhood violence, community-level violence, intimate partner violence, depressive symptoms, and self-esteem. Follow-up surveys measured type and consistency of contraception used 9 months later. Multivariate logistic regression models assessed violence and psychological risk factors as main effects and moderators related to ineffective compared with effective use of contraception. RESULTS The multivariate logistic regression model showed that childhood sexual violence and low self-esteem were significantly related to ineffective use of contraception (adjusted odds ratio [aOR] = 2.69, confidence interval [95% CI]: 1.18-6.17, and aOR = 0.51, 95% CI: 0.28-0.93; respectively), although self-esteem did not moderate the relationship between childhood sexual violence and ineffective use of contraception (aOR = 0.38, 95% CI: 0.08-1.84). Depressive symptoms were not related to ineffective use of contraception in the multivariate model. CONCLUSIONS Interventions to reduce UP should recognize the long-term effects of childhood sexual violence and address the role of low self-esteem on the ability of young sexually active women to effectively and consistently use contraception to prevent UP.
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Affiliation(s)
- Deborah B Nelson
- 1 Department of Epidemiology, Biostatistics, and Ob/Gyn, Temple University , Philadelphia, Pennsylvania
| | - Huaqing Zhao
- 2 Department of of Biostatistics and Epidemiology, Temple University School of Medicine , Philadelphia, Pennsylvania
| | - Rachel Corrado
- 3 Applied Public Health Informatics Fellow, Division of Informatics, Information Technology and Telecommunication Centers for Disease Control , New York, New York
| | | | - Stephen J Lepore
- 5 Department of Social and Behavioral Sciences, Temple University , Philadelphia, Pennsylvania
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Cha S, Masho SW, Heh V. Partner violence victimization and unintended pregnancy in Latina and Asian American women: Analysis using structural equation modeling. Women Health 2016; 57:430-445. [DOI: 10.1080/03630242.2016.1170094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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